Is the term “insulin resistant” being used clinically as a way to avoid telling patients directly that they are overweight or obese?
The thought occurred to me at a session held during at a joint meeting of the Lawson Wilkins Pediatric Endocrine Society and the European Society for Pediatric Endocrinology. To a jam-packed room, 5 members of an international committee presented a new consensus statement on the assessment, management, and prevention of insulin resistance in children.
The document, to be submitted for publication in October, will strongly advise against testing overweight and obese children for insulin resistance. Assuming the patient has already been tested for specific disorders such as diabetes and polycystic ovarian syndrome (PCOS), measuring fasting insulin levels—the most common clinical method for assessing insulin resistance—is inexact and does not provide useful information, the panel concluded.
The practice is currently widespread. “We get a lot of referrals saying ‘high insulin level’ and meanwhile the child is obese and the parent was never told that the child is obese,” panel member Dr. Silva Arslanian said in an interview following the panel’s presentation.
Healthcare providers who measure insulin levels, she said, “are making healthcare costs more expensive…when there’s totally no use for it. Your eyes can tell you or the [body mass index] can tell you. If you’re obese the insulin will be higher. You treat the obesity and then the insulin comes down. You don’t treat the insulin.”
It can’t be easy for a physician to tell a patient that he or she is obese and needs to adopt a new lifestyle. Telling a parent the same about a child might be even tougher. A medical term—albeit not a diagnosis—may lesson the discomfort of the conversation, and also serve to alert the patient that the problem isn’t just cosmetic.
But a medical problem suggests a medical—not behavioral—solution. Thus, the committee also advised against using the glucose-lowering drug metformin for treating insulin resistance in the absence of an actual diagnosis like diabetes or PCOS. And although there is evidence that weight-loss drugs may help obese adolescents, the panel emphasized that lifestyle modification should remain the key to management.
Once published, will the new consensus document result in greater efforts in that direction? ###
–Miriam E. Tucker (@MiriamETucker on Twitter)