My 13 year old daughter has had a rapid weight gain of almost 100 pounds over the past 4 years. She seems to be hungry constantly. There is a strong family history of type 2 diabetes with the majority of the females on the paternal side of the family being extremely obese. I have heard of earlier onset of type 2 diabetes and “syndrome X.” Her pediatrician has done insulin levels that were normal. Should I have her evaluated by an endocrinologist?

Most important would be to have your daughter see her pediatricians or primary care providers and get a sense of physical activity or inactivity and calorie intake. This is an enormous weight gain and usually indicates huge excess in calories or major decrease in activity. Looking for other treatable causes of such weight gain would also be important (for example, hypothyroidism, adrenal excess, physical or sexual abuse, and depression). The risks for Type 2 diabetes are clearly associated with obesity as you have mentioned but also with high blood lipids, hypertension, acanthosis nigricans, and hirsutism with menstrual irregularities. Your pediatrician can evaluate for these associated problems and also consider referral to a pediatric endocrinologist interested in such problems.

SB
Additional comments from Dr. Robertson:

And a dietitian! It is unlikely that your daughter’s problems are endocrine. However, it may help you to concentrate on the importance of diet and exercise if you have your fears of a medical problem addressed. It is vitally important to tackle the problem now because, once puberty is over and your daughter stops getting taller, she will find it very hard to lose weight.

KJR