PAST MEDICAL HISTORY:, He has difficulty climbing stairs, difficulty with airline seats, tying shoes, used to public seating, and lifting objects off the floor.  He exercises three times a week at home and does cardio.  He has difficulty walking two blocks or five flights of stairs.  Difficulty with snoring.  He has muscle and joint pains including knee pain, back pain, foot and ankle pain, and swelling.  He has gastroesophageal reflux disease.,PAST SURGICAL HISTORY:, Includes reconstructive surgery on his right hand 13 years ago.  ,SOCIAL HISTORY:, He is currently single.  He has about ten drinks a year.  He had smoked significantly up until several months ago.  He now smokes less than three cigarettes a day.,FAMILY HISTORY:, Heart disease in both grandfathers, grandmother with stroke, and a grandmother with diabetes.  Denies obesity and hypertension in other family members.,CURRENT MEDICATIONS:, None.,ALLERGIES:,  He is allergic to Penicillin.,MISCELLANEOUS/EATING HISTORY:, He has been going to support groups for seven months with Lynn Holmberg in Greenwich and he is from Eastchester, New York and he feels that we are the appropriate program.  He had a poor experience with the Greenwich program.  Eating history, he is not an emotional eater.  Does not like sweets.  He likes big portions and carbohydrates.  He likes chicken and not steak.  He currently weighs 312 pounds.  Ideal body weight would be 170 pounds.  He is 142 pounds overweight.  If ,he lost 60% of his excess body weight that would be 84 pounds and he should weigh about 228.,REVIEW OF SYSTEMS: ,Negative for head, neck, heart, lungs, GI, GU, orthopedic, and skin.  Specifically denies chest pain, heart attack, coronary artery disease, congestive heart failure, arrhythmia, atrial fibrillation, pacemaker, high cholesterol, pulmonary embolism, high blood pressure, CVA, venous insufficiency, thrombophlebitis, asthma, shortness of breath, COPD, emphysema, sleep apnea, diabetes, leg and foot swelling, osteoarthritis, rheumatoid arthritis, hiatal hernia, peptic ulcer disease, gallstones, infected gallbladder, pancreatitis, fatty liver, hepatitis, hemorrhoids, rectal bleeding, polyps, incontinence of stool, urinary stress incontinence, or cancer.  Denies cellulitis, pseudotumor cerebri, meningitis, or encephalitis.,PHYSICAL EXAMINATION:, He is alert and oriented x 3.  Cranial nerves II-XII are intact.  Afebrile.  Vital Signs are stable.bariatrics, laparoscopic gastric bypass, weight loss programs, gastric bypass, atkin's diet, weight watcher's, body weight, laparoscopic gastric, weight loss, pounds, months, weight, laparoscopic, band, loss, diets, overweight, lost