ABOM Exam Prep: Obesity Medicine Certification (ABOM) Study Guide + 600+ Practice Questions

A 58-year-old male with obesity (BMI 38 kg/m²), hypertension, and hyperlipidemia has been on a medically supervised ketogenic diet for 8 weeks. He reports good adherence and has lost 6% of his initial body weight. Pre-diet labs showed LDL-C 110 mg/dL and uric acid 6.0 mg/dL. Current labs reveal LDL-C 160 mg/dL and uric acid 8.2 mg/dL. He also mentions mild constipation but no gout symptoms. He is motivated to continue the diet. What is the most appropriate next step in nutritional management?

A 32-year-old patient with severe obesity (BMI 48 kg/m²) since early childhood presents for genetic counseling following obesity gene panel testing ordered due to hyperphagia and developmental delay. The report identifies a heterozygous variant in the *MC4R* gene. One database classifies it as “Pathogenic,” citing functional studies showing impaired signaling, while another classifies it as “Variant of Uncertain Significance (VUS)” due to its presence in a population database at low frequency. The patient expresses significant anxiety about passing this to their future children. Which is the most appropriate initial counseling approach regarding this genetic finding?

A 58-year-old woman with a BMI of 42 kg/m² presents with a 9-month history of progressive, bilateral knee pain worsening with weight-bearing activity and prolonged standing. She reports 15-20 minutes of morning stiffness that improves with movement. Examination reveals bilateral knee crepitus, mild effusions, and slight limitation in terminal extension. No erythema, warmth, or joint instability is noted. Recent labs show an elevated CRP (1.2 mg/dL) and ESR (35 mm/hr), but she is afebrile and has no history of acute attacks or other joint involvement. Based on this presentation, which weight-related musculoskeletal condition is the most likely primary diagnosis?

A 42-year-old female presents for a 15-minute follow-up visit 18 months after Roux-en-Y gastric bypass. She reports a 12-pound weight regain over the past 6 months despite adhering to recommended protein intake and vitamin supplementation. She states she avoids liquid calories and sugary foods. During the nutrition history, she mentions increased work stress leading to frequent “grazing” on nuts and cheese in the evenings while watching TV, often not feeling physically hungry. She denies dumping syndrome or vomiting. Her food log shows consistent protein goals but frequent small, high-fat snacks outside planned meals. What is the MOST critical dietary behavior to address FIRST to support weight management in this patient?

A 45-year-old male with Class III obesity (BMI 43 kg/m²) requires significant weight loss within 3 months for elective knee replacement surgery. He has well-controlled hypertension (on hydrochlorothiazide 25mg daily) and a history of gout, with his last flare 8 months ago. His current eGFR is 58 mL/min/1.73m². During nutritional counseling focused on achieving rapid, supervised weight loss, which dietary strategy is specifically contraindicated for this patient?

A 42-year-old male patient of South Asian descent presents for a routine health evaluation. He reports no significant medical history but admits to a sedentary lifestyle. Physical exam reveals a weight of 82 kg and height of 1.72 meters (BMI 27.7 kg/m²). His blood pressure is 142/88 mmHg. When characterizing the severity of his weight status using appropriate classifications, what is his obesity category?

A 42-year-old woman with Class II obesity (BMI 37 kg/m²) presents for obesity management. She reports worsening depressive symptoms over the past 6 months, including low mood, anhedonia, and low energy, significantly impacting her daily function. Her primary care physician started paroxetine 20 mg daily 8 months ago for anxiety, coinciding with a 15 kg weight gain. She expresses significant distress about this weight gain and fears trying another antidepressant that might cause further gain. She also mentions she “doesn’t like stimulating medications.” What is the MOST appropriate next step regarding her antidepressant medication during this initial obesity medicine evaluation?

A 58-year-old patient with class III obesity (BMI 44 kg/m²) and severe osteoarthritis limiting ambulation presents for initial obesity management. During the social history, they report living alone in a rural town 25 miles from the nearest city. Their sole local food source is a small convenience store with limited fresh produce. While they qualify for SNAP benefits and have a neighbor who occasionally provides vegetables from a community garden, they struggle to afford regular transportation to supermarkets in the city. Which environmental/geographic characteristic represents the *most significant* barrier to accessing healthy food for this patient, requiring prioritization in the care plan?

A 52-year-old woman with obesity (BMI 34 kg/m²) and well-controlled type 2 diabetes (HbA1c 6.8% on stable metformin dose) presents for initial weight management evaluation. She reports diligently following a reduced-calorie diet and increasing physical activity for 3 months but has gained 2 kg. During the medication and supplement history, she lists: daily multivitamin, calcium 600 mg, vitamin D 2000 IU, chromium picolinate 200 mcg, ginseng 400 mg, and fish oil capsules (takes 4 capsules daily providing 1200 mg EPA/DHA each). Her diet recall is consistent with her prescribed plan. Which supplement is most likely contributing to her unexpected weight gain?

A 52-year-old male with obesity (BMI 38 kg/m², stable for 6 months), moderate obstructive sleep apnea (OSA) diagnosed 3 months prior, and hypertension presents for follow-up. He reports poor adherence to CPAP (<2 hours/night 4x/week) due to discomfort and difficulty falling asleep. He works rotating shifts (days/nights alternating weekly) and experiences daytime fatigue and increased evening snacking. During counseling on behavioral modifications to support weight management and OSA management, which sleep hygiene recommendation should be prioritized *first* to address his specific barriers?

A 32-year-old woman with obesity (BMI 38 kg/m²) presents for evaluation of irregular menstrual cycles (every 45-90 days) for 18 months and worsening acne. She reports mild hirsutism (Ferriman-Gallwey score 9). Laboratory evaluation shows elevated free testosterone (45 pg/mL) and Anti-Müllerian Hormone (AMH 8.2 ng/mL). Thyroid-stimulating hormone (TSH) is 0.35 mIU/L (low-normal range), free T4 is normal, and prolactin is mildly elevated at 28 ng/mL (normal <25 ng/mL). Pelvic ultrasound reveals 20 follicles per ovary (2-9 mm diameter). Based on current diagnostic criteria, which diagnosis is most appropriate?

A 45-year-old woman with obesity (BMI 38 kg/m²) presents for follow-up after regaining 5 kg over 3 months. She expresses frustration, stating she prepares healthy meals but struggles when her husband brings home high-calorie treats “to cheer her up” and her teenage son keeps sugary snacks visible in their shared pantry. She feels unsupported and says, “It’s impossible when everyone else isn’t trying.” She is motivated but tearful. What is the *most appropriate* initial advice regarding changes to the home environment?

During a 15-minute follow-up visit for a patient with Class II obesity (BMI 38 kg/m²) and newly diagnosed hypertension, the physician needs to efficiently obtain a comprehensive baseline physical activity history before initiating an exercise prescription. The patient reports generally being sedentary but occasionally walks short distances. Which assessment tool is *most* appropriate to quantify current activity levels across key domains (type, frequency, duration, intensity) in this time-limited setting?

A 45-year-old patient with Class II obesity (BMI 37 kg/m²) presents for evaluation of progressive dyspnea over 6 months. They report symptoms occurring primarily at night, waking them from sleep 3-4 times weekly with cough and a sensation of chest tightness. They use CPAP nightly for diagnosed severe obstructive sleep apnea (OSA) with good adherence and report no heartburn or regurgitation. Physical exam reveals clear lung fields without wheezes or crackles, and oxygen saturation is 97% on room air. Which symptom complex is most indicative of comorbid asthma requiring specific diagnostic evaluation beyond their known OSA?

A 45-year-old woman with obesity (BMI 37 kg/m²) presents for weight management. During the neuropsychiatric history, she reports 6 months of low mood, anhedonia, and insomnia. She also mentions increased fatigue impacting her job performance and variable concentration difficulties. Her TSH is normal. She recently finalized a divorce. The physician has 20 minutes for the initial consultation. Which action is the *most* appropriate next step regarding neuropsychiatric diagnosis?

A 45-year-old woman with class II obesity (BMI 38 kg/m²) and symptomatic knee osteoarthritis presents for initial obesity management. During the physical activity history, she reports joining a gym 3 months ago intending to exercise 5 days/week but only attends 1-2 times weekly due to a demanding desk job requiring 10 hours/day of sitting. She states she “tries to walk” but stops after 10 minutes due to knee pain. She denies other structured exercise. Her job involves no physical labor, and she drives door-to-door. Based on current physical activity guidelines, which component of her history represents the *most significant barrier* to achieving recommended moderate-intensity physical activity levels?

A 58-year-old patient with class III obesity (BMI 42 kg/m²), hypertension, and type 2 diabetes presents for a routine follow-up. During the neuropsychiatric history, their spouse reports the patient has recently begun forgetting to take metformin doses, struggles to manage household bills (previously handled easily), and gets confused following new recipes. The patient denies feeling sad or anhedonic but admits to fatigue. A Montreal Cognitive Assessment (MoCA) performed 3 months ago during a research study was normal (26/30). Which clinical finding is *most* suggestive of underlying cognitive impairment requiring further evaluation?

A 48-year-old woman with Class II obesity (BMI 38 kg/m²), hypertension managed with lisinopril, type 2 diabetes managed with metformin, obstructive sleep apnea (OSA) using CPAP, and a history of unprovoked deep vein thrombosis (DVT) 3 years ago (currently stable on therapeutic apixaban) is scheduled for endoscopic sleeve gastroplasty (ESG) in 72 hours. Her pre-procedure evaluation is otherwise unremarkable. According to current consensus guidelines for periprocedural management of anticoagulation in patients undergoing endoscopic bariatric procedures like ESG, what is the most appropriate management of her apixaban prior to the procedure?

A 52-year-old male with class II obesity (BMI 38 kg/m²) and recently diagnosed hypertension presents for a 3-month follow-up. His home BP logs show persistent readings averaging 148/92 mmHg despite starting lisinopril 4 weeks ago. He reports adhering to his medication. During the nutrition history, he states he “eats pretty healthy” but feels overwhelmed tracking his food due to a demanding job. His recent basic metabolic panel shows a serum sodium of 144 mEq/L. The physician has 10 minutes left in the visit to assess dietary factors impacting his hypertension control. Which dietary assessment method is MOST appropriate to implement at this specific visit to gain actionable insight relevant to his blood pressure management?

A 52-year-old woman with Class III obesity (BMI 42 kg/m²), hypertension managed with lisinopril, and prediabetes presents for her annual weight management visit. She feels well. Her last Pap smear was 4 years ago and was normal. Her last mammogram was 13 months ago (BI-RADS 1). She has never had a colonoscopy. She expresses concern about cancer risk due to her weight. Her vital signs are stable. Based on current USPSTF guidelines and her clinical profile, which cancer screening recommendation is the most appropriate at this visit?

A 45-year-old patient with obesity (BMI 38 kg/m²) presents for evaluation of fatigue. They report unintentional weight gain of 15 kg over the past year despite no significant dietary changes. Fasting plasma glucose is 128 mg/dL. Hemoglobin A1c (HbA1c) is 6.3%. Past medical history includes hypertension managed with hydrochlorothiazide 25 mg daily. Review of systems is positive for mild polyuria. Laboratory results also show a hemoglobin level of 11.8 g/dL (reference range 12.0-16.0 g/dL for women) with normocytic indices. Considering the patient’s presentation and lab results, what is the most appropriate interpretation regarding glycemic status?

A 42-year-old woman with class II obesity (BMI 38 kg/m²), hypertension, and prediabetes presents for a follow-up visit. During social history, she mentions recent job instability and “stretching groceries” due to rising costs. She denies skipping meals but reports relying more on inexpensive processed foods. Her two school-aged children receive free breakfast and lunch. With only 10 minutes remaining in the visit, which action by the physician is the most appropriate next step to specifically evaluate for nutritional insecurity in this patient?

A 52-year-old man with obesity (BMI 34 kg/m²), newly diagnosed prediabetes (HbA1c 6.2%), and hypertension (BP 142/88 mmHg on two readings) presents for initial obesity management. His 24-hour dietary recall reveals consistent patterns: skipping breakfast, consuming large portions of processed red meat (e.g., sausages, bacon) at lunch and dinner, drinking 3-4 cans of sugar-sweetened soda daily, and minimal intake of fruits, vegetables, or whole grains. He reports low motivation for structured exercise. Given his limited availability for frequent follow-up, which single dietary modification, based on current USDA Dietary Guidelines and ACSM recommendations for cardiometabolic risk reduction, should be prioritized *first* to address his weight and metabolic health most effectively?

A 52-year-old Black woman with hypertension and Class II obesity (BMI 37 kg/m²) presents for follow-up. She expresses frustration that previous weight loss attempts failed despite “eating healthy.” Social history reveals she works overnight shifts, relies on public transportation limiting grocery access, experiences intermittent food insecurity, and culturally prefers soul food. Her neighborhood lacks affordable fresh produce markets. During counseling, which action is the *most critical initial step* to address potential barriers to effective obesity treatment?

A 38-year-old woman with obesity (BMI 36 kg/m²) presents for initial weight management evaluation. She desires pregnancy within the next year. Physical exam reveals moderate acanthosis nigricans in the axillae. Review of recent labs ordered by her PCP shows fasting triglycerides 210 mg/dL and HDL cholesterol 38 mg/dL. Her mother has type 2 diabetes. Her HbA1c result is 5.8%. Based on current guidelines, what is the most appropriate diagnostic action regarding her glucose status at this visit?

A 45-year-old woman with class III obesity (BMI 42 kg/m²), poorly controlled hypertension despite three medications, and new violaceous striae presents for evaluation of possible Cushing’s syndrome. An initial 1-mg overnight dexamethasone suppression test (DST) shows a cortisol level of 6.2 µg/dL (reference: <1.8 µg/dL). However, two separate late-night salivary cortisol measurements are within normal limits. She takes no medications known to affect the DST or cortisol assays. Which is the most appropriate next diagnostic step?

A 10-year-old boy presents for a well-child visit. His weight is at the 50th percentile, but his height has declined from the 75th percentile at age 8 to the 25th percentile currently. His parents both have obesity (BMI >35). Physical exam is unremarkable, and developmental milestones are age-appropriate. Reviewing his growth chart, which action is most urgently indicated based on this growth pattern?

A 34-year-old woman with obesity (BMI 38 kg/m²) presents for weight management. She reports lifelong irregular menses (every 45-90 days since menarche) and recent worsening hirsutism. Lab results show elevated total testosterone (85 ng/dL) and normal TSH (2.1 mIU/L) and prolactin (15 ng/mL). She has attempted lifestyle changes for 12 months with minimal weight loss. The patient expresses concern about “too many doctors.” Based on guideline-directed evaluation for weight-related complications, which specialist referral is most appropriate for definitive diagnosis of the underlying condition contributing to her obesity and symptoms?

A 58-year-old patient with class 2 obesity (BMI 38 kg/m²), type 2 diabetes (HbA1c 8.2%), and moderate knee osteoarthritis presents for medication adjustment. They report significant fatigue limiting daily activities and express frustration with previous unsuccessful weight loss attempts, citing pain and breathlessness as barriers to exercise. During a time-constrained 15-minute follow-up visit focused on optimizing diabetes control and initiating obesity management, the physician needs to objectively assess functional capacity to guide safe exercise prescription. Which ambulatory test is *most* appropriate to conduct or interpret *first* in this specific clinical context?

A 45-year-old female presents for a routine health evaluation. She reports no significant symptoms but expresses concern about her family history of type 2 diabetes and cardiovascular disease. Her BMI is 23.5 kg/m². Physical exam is unremarkable. Fasting labs reveal: Triglycerides 190 mg/dL, HDL-C 38 mg/dL, blood pressure 128/84 mmHg (measured twice), fasting glucose 108 mg/dL, and HbA1c 5.8%. She also mentions her mother has autoimmune thyroiditis. Based on standard diagnostic criteria for metabolic health status, what is the most accurate characterization of this patient?