Hi, Thanks for your question. After going through your question, I can understand your concern. Considering your Height & weight your BMI is more than 39 which denote Level 2 obesity. Also you fulfill the criteria of Metabolic syndrome. That increases possibility of insulin resistance in you. Insulin resistance increases the chances of - - Diabetes or Pre- Diabetes. - NASH (Non Alcohol Stato- Hepatitis) which is associated with enlarged fatty liver with increased liver enzymes. Changes of cystitis on ultrasound denote urinary infection which is further supported by presence of pus cells on urine examination. You should do following investigations - - OGTT (Oral Glucose Tolerance Test) & HbA1c. - T3, T4, TSH. - Liver function test. - Renal function test. - Calcium, phosphorus, uric acid. - ECG, 2DEcho. There is a need for Weight reduction in you for which there is a need of - - Calories and fat restricted planned diet after consulting nutrition specialist. - Regular exercise to be started gradually according to your level of effort tolerance. - Bariatric surgery surgery may be considered if above measures failed. Also there is a need for antibiotic treatment for urinary infection and statin therapy for cholesterol control. You should consult Endocrinologist for better evaluation. Hope this helps you.