Weight management

A 34-year-old Hispanic woman comes to clinic to discuss weight management. She is currently 5-ft 2-in tall and weighs 120 kg. She says she always had a hard time managing her weight as a child, but let things get out of control when she was living on her own in college. She has had two children in the past 5 years. She gained 22 kg with the first child and lost 13 kg. With the second child she gained 15 kg and lost 4.5 kg. She has tried many fad diets where she initially loses weight but eventually gains it back. She exercises some but is limited by osteoarthritis of the knees. She has thought about gastric bypass but is fearful of undergoing a surgical procedure.