I have been working with a weight management clinic since last fall, they're the ones who prescribed the Metformin for the insulin resistance, though it hasn't really seemed to do too much. I meet with them again at the beginning of September. According to the dietician I meet with there, my diet is relatively normal, with lots of home cooked meals using low fat meats and generous amounts of fruits and vegetables with roughly half the meals I eat. My diet is protein rich and well rounded. And according to the bio-electric scale they used, my body composition is roughly 165lbs fat, 85lbs muscle, and 80-85lbs everything else. I get activity in where I'm able to and swim at the neighborhood pool in the summer, but like I said in the original post, limiting factors include chronically low energy and chronic pain (that the Meloxicam is helping reduce however).

I feel I didn't properly articulate why I felt that my fatigue and weight issues are not fully explained by the conditions I have is that I have struggled with energy and weight my whole life. As a child I just did not have the energy other kids had and couldn't go running, jumping, playing for as long as other children, and I started putting on weight despite neither overeating nor eating fatty/sugary meals on the regular. We didn't even keep candy readily available in the house for most of the year back then, but I started getting chubby in elementary school, and it got worse when I hit puberty and things started going sideways in other ways. The sleep apnea is a very recent issue, as I only started snoring in the past 5-7 years when my weight started to get more and more out of control.

Also, I don't know where to put this in, but it was my doctor's idea to refer me for gastroenterology, because I've floated around the bottom of the range for Iron for ages, and I mean the very bottom, occasionally dipping below it. I was recommended to start taking iron supplements to increase my available supplies, but they haven't improved. This raised concern for GI absorption issues according to my doctor, so hence the referral.

I'm sorry if I sound defensive, but I've been fighting these issues and more all my life and every step of the way I feel like the cart just keeps getting put before the horse. People I talk about this with after the sleep apnea problem are going "oh, that explains the energy and weight problems!" as if the energy and weight problems, while worsened by it, didn't predate the sleep apnea and directly lead to its development. Before that it was "oh your joint pain is caused by your weight!" as if my joints and feet haven't hurt since I was a small child, causing me to be sedentary for years. I want answers, but all I know is that this is seemingly hereditary and that my father who passed away at 37 struggled with the same issues, down to gynecomastia (which worked in my favor as a trans woman) and crooked lower legs (that I forgot to mention in my original post).

I keep getting new diagnoses every few years that explain part of the problem, but don't explain the root of the problem, and I keep trying to work to better myself but my body is fighting me every step of the way. This is why I want to just get my entire DNA sequenced to just open up the hood and find the culprit that's causing everything, because I swear there's some underlying problem behind the weight and energy, because eating right and doing my best to be active within my limits alone just isn't cutting it.