I have a nine-year-old son who currently weighs 180 pounds at a height of 5 feet. He was 10 1/2 lbs at birth and accelerated from there. He has been gaining weight at about 20 to 30 pounds a year. I have taken him to two different endocrinologists who have diagnosed him with insulin resistance and with a male version of PCOS.

Family history, PCOS in great-grandmother, grandmother, and myself (mother). No gestational diabetes during pregnancy. He was an IVF baby. I went on to have quadruplets through IVF after beginning Glucophage (I am not overweight). My other four children (six years old) are all at the 50% for weight or below. Their diets are all the same. The kids don’t drink soda or fruit juice, nor do we keep any chocolate, chips in the home.

Despite our efforts to help him lose weight, he seems to gain without even trying. I am super concerned for his health. He was tested for diabetes, but none found. His insulin levels were high along with his trigylcerides. Considering his issues, are metformin or Glucophage a form of treatment for children with this situation? I seem to get nothing from these doctors except for lectures on feeding him too much junk. Nobody seems to have anything else to offer and I am fearful.

Thank you for any insight that you can offer for me. I am interested in him seeing someone for another check; it has been over nine months. He was 157 pounds at that visit.

He likely has some “set point” error and makes it easier for him to gain weight. However, the doctors are correct that excess calories and/or insufficient activity to burn them off still remains the mainstay. You may want to see a nutritionist or get a personal trainer since you seem stuck in identifying these imbalances. If his sugar levels are okay but the insulin levels are high, then clearly this is insulin resistance and with the high lipids, part of the metabolic syndrome. Acanthosis nigricans is a thickening and darkening of the skin of the neck, armpits, groin areas that sometimes also shows up with such insulin resistance but can be subtle – and none of these things are always present. I assume that they also checked his liver enzymes since fatty liver is part of this syndrome. Early androgens also are part of this syndrome, which is called officially precocious adrenarche or precocious pubarche, early types of adolescent development. Metformin in clinical trials has been helpful in some cases, but none of this means much if you cannot cut back caloric intake somewhere and increase caloric expenditure, even if it is difficult. Daily, sweaty, vigorous physical activity at home or at the gym that lasts for more than an hour (bicycle riding, weight lifting, treadmill or exercycle, soccer, basketball) are all key to make this happen. No school lunches. And, you must cut obvious carbohydrates and fats to get the total calories decreased.

You are right to be concerned and this is an extremely difficult problem.

SB