On physician examination he appeared obese and in no acute distress. His weight was 388 lbs ( 176.4 kg) and height 69 inches ( 1.75 m). The resulting BMI was 49 kg/m². His laboratory studies revealed the following data: fasting glucose: 233 mg/dl, Total cholesterol 154 mg/dl, Triglycerides 271 mg/dl, HDL cholesterol 31 mg/dl, LDL cholesterol 69 mg/dl.

The skin findings reveal acanthosis nigricans. The latter is a sign of insulin resistance syndrome. The patient has overt metabolic syndrome also. He was diagnosed with diabetes mellitus, type 2 and dyslipidemia.