A 34-year old woman requests medication to help her lose weight. She has tried multiple diets and is eating only 1200 calories a day without success. She walks daily. She is taking hydrochlorothiazide for her hypertension and managing her diabetes mellitus type 2 with glyburide. She admits to depression but feels this is secondary to her inability to become pregnant. Her menses are irregular, and she finds that her wounds heal slowly. She also complains of thinning hair. Which of the following is most appropriate for the management of this patient?