Background: A 15-year-old boy who had been overweight since the age of 6 months was referred to an adolescent obesity clinic for further assessment of his comorbidities and management of his obesity. The patient had no history of developmental delay or abnormal growth velocity. He had previously tested negative for Prader-Willi syndrome and the melanocortin-4 receptor gene mutation. The patient had made numerous attempts at weight loss in the past, but any weight loss he achieved had been temporary. At presentation, the patient had a BMI of 52.3 kg/m(2), a waist circumference of 156 cm, blood pressure of 130/85 mmHg and severe acanthosis nigricans in the cervical and axillary skin folds.
Investigations: Measurement of height, weight, waist circumference and blood pressure; screening tests, including a fasting glucose test, 2 h glucose-tolerance test, measurements of blood lipids and liver function tests.
Diagnosis: Morbid obesity, metabolic syndrome, nonalcoholic fatty liver disease, impaired glucose tolerance and dyslipidemia.
Management: The patient was assigned to an extensive lifestyle-modification and behavior-modification program, with clinic-based follow-up every 4 weeks.