Hello and Welcome to Ask A Doctor I understand that you would like to lose weight and admit to a high carbohydrate, low protein diet with little activity or planned exercise and a genetic history of weight issues. My advice to you, in light of the fact that you are seemingly ready to make some changes and your weight is in the high risk range of a BMI of 40.5 necessitating intervention to prevent medical complications, is the following: 1) Set up an appointment with a qualified Dietitian/Nutritionist for a complete assessment and a high protein, low carbohydrate, possibly even a ketogenic diet plan with therapy for managing genetic problems. Of course, your medications and labs would have to be considered before a diet prescription is made, but the carbohydrates need to be lowered and the lean proteins increased to make a more favorable weight friendly diet. 2) The diet should also be high in fiber increasing gradually to the public health recommendation of 25 grams per day from choosing fresh fruits/vegetables rather than canned or juice and whole grains avoiding white bread, noodles, pasta, sweets, added sugars. 3) Discuss with your doctor how much exercise you can do but I suggest starting with a walking program building up to walking briskly at 60% of your maximum heart rate or 90 beats per minute. Exercising at 60% of your Maximum Heart Rate will burn more fat. 4) Decrease your sodium intake to less than 1500 mg per day by reading labels and avoiding the salt shaker. This will not only help you release stored body fluids, but help with blood pressure management as well. This is a general public health recommendation for those over the age of 50. The healthier your heart, the better you will feel. 5)Have your vitamin D checked. Vitamin D tends to run low in those who are at high BMIs and can affect how you feel, your heart and even the inflammatory condition of obesity in the long run. If repletion is necessary you will need to supplement per your dietitian or physician.I hope this gives you some ideas of what needs to be done to be successful at reaching and maintaining your weight loss goal. Be patient as it can be a slow, but hopefully, steady, process. Warmly,Kathy Shattler, MS, RDN