Included prevention assessment

Weight care with a wider clinical view.

We assess the cardiovascular, kidney, metabolic, liver, sleep, and screening issues connected to weight—then give you a written plan to take to your primary care physician.

The model

Heart, kidney, and metabolism are one system.

Cardiovascular–kidney–metabolic health — CKM — is the framing the American Heart Association now uses, and it matches what actually happens in a body. Excess visceral fat drives insulin resistance. Insulin resistance drives blood pressure, triglycerides, and fatty liver. Those damage the kidney. Kidney damage accelerates cardiovascular disease, which feeds back into all of it.

That is why weight treatment should not happen in isolation. We stage the system and show how weight, labs, and risk fit together.

We treat weight here. When the assessment identifies hypertension, dyslipidemia, diabetes, kidney disease, or another condition, we explain the finding and direct you back to the PCP or specialist responsible for ongoing treatment.

What we assess

The scores we use, and why.

PREVENT

10- and 30-year risk of heart attack, stroke, and heart failure

The AHA's current equations. They include kidney function and metabolic factors, which the older calculators ignored — and the 30-year view is what actually matters at 40.

Metabolic syndrome criteria

Waist, triglycerides, HDL, blood pressure, glucose

Five simple thresholds that predict diabetes and cardiovascular disease better than weight alone.

FIB-4

Liver fibrosis risk in metabolic liver disease

Fatty liver is common in metabolic disease, and staging it changes what we do. FIB-4 is calculated from labs you already have and tells us who needs elastography.

UACR & eGFR

Kidney damage and filtration

Albumin in the urine is one of the earliest and strongest signals of cardiovascular risk, and it isn't part of a standard panel.

STOP-BANG

Obstructive sleep apnea screening questionnaire

Untreated apnea drives blood pressure, arrhythmia, and weight-loss resistance. Eight questions that flag who should be evaluated — we do not order or interpret sleep studies, so a positive screen is pointed out for your PCP.

Scores are calculated when the required inputs are available and updated when a repeat assessment is clinically useful. They inform a conversation; they do not replace your PCP's diagnosis or treatment plan.

What we measure

The inputs that can clarify the larger picture.

System	Usually ordered	Consider when useful
Cardiovascular	Total cholesterol LDL-C HDL-C Triglycerides	ApoB Lp(a) — once in a lifetime hs-CRP Coronary artery calcium score discussion when it would change the decision — pointed out for your PCP
Metabolic	Fasting glucose HbA1c	Waist circumference Metabolic syndrome criteria Repeat A1c on a defined interval once you're in the prediabetes range
Kidney	Creatinine / eGFR	Urine albumin-to-creatinine ratio Cystatin C when eGFR is borderline
Liver	ALT, AST	FIB-4 score Elastography referral pointed out for your PCP when FIB-4 is indeterminate or high
Other drivers	CBC TSH	25-OH vitamin D Uric acid Ferritin Hepatitis C and HIV once, per USPSTF

Why ApoB and Lp(a)

ApoB counts the actual number of atherogenic particles, which predicts events better than LDL-C — especially in metabolic disease, where LDL-C reads falsely reassuring. Lp(a) is largely genetic, needs measuring exactly once in a lifetime, and changes how aggressively we treat everything else. Roughly one in five people has an elevated level and almost none of them know it.

We order lab work only

Not every member needs every marker. Blood and urine testing is the only thing we order. Imaging, elastography, coronary calcium scoring, sleep studies, and screening procedures are pointed out for your PCP to order and act on. Treatment outside weight care stays with primary care or the appropriate specialist.

Prevention care gaps

Important items to bring back to primary care.

Colorectal cancer

Colonoscopy or stool-based testing, from age 45

Breast cancer

Mammography, timing individualized by risk

Cervical cancer

Cytology and HPV co-testing on schedule

Lung cancer

Low-dose CT for adults with a qualifying smoking history

Prostate cancer

A real shared-decision conversation about PSA, not a reflex order

Osteoporosis

DEXA timing by risk — including bone loss during rapid weight loss

Hepatitis C & HIV

One-time screening for adults, per USPSTF

Adult immunizations

A running ledger so nothing lapses

We review and organize these care gaps; we do not take over routine screening or immunization care. Your written plan identifies what appears due so you can confirm and complete it with your PCP, gynecologist, or local screening provider.

Where the plan comes from

Published guidance, cited — not house protocol.

AHA / ACC: Cardiovascular risk equations, cholesterol, blood pressure, heart failure
ADA Standards of Care: Prediabetes, type 2 diabetes, and obesity pharmacotherapy
KDIGO: Kidney disease staging, albuminuria, and treatment targets
AASLD: Metabolic dysfunction–associated steatotic liver disease and fibrosis
USPSTF & ACIP: Cancer screening, one-time screening tests, adult immunization
AACE & Obesity Medicine Association: Obesity treatment and long-term maintenance

Every plan names the target, the measurement behind it, and the guideline it comes from. It is meant to be read by your primary care physician, cardiologist, nephrologist, or endocrinologist and either used or argued with — not taken on faith.

You receive the plan to share with the physicians you already see. It organizes findings and questions for discussion; it does not replace their diagnosis or treatment plan.

Every plan here is written by one internal medicine physician. Who that is, and what we intend to add.

Cadence

Built into your weight-care year.

Visit 1 — week 1
60-minute weight evaluation, treatment decision, baseline testing, and goals
Visit 2 — week 6–12
Early treatment review, relevant labs, and your written prevention plan
Visit 3 — month 12
Annual review, maintenance strategy, updated assessment, and PCP handoff
Between visits
Structured check-ins and secure messaging for weight-treatment doses, side effects, results, and questions

Treat weight without losing sight of the rest.

Your weight plan includes a clinician-reviewed prevention assessment and a written handoff for your PCP.

Become a patient