PATIENT STORY: Cathy is a 12-year-old schoolgirl who was referred to the paediatric department at Tallaght Hospital by her GP, who was concerned about her obesity. She lives locally with her parents and 10-year-old brother, who is an active footballer and does not have a weight problem.
Cathy's mother has always struggled with her weight. Significantly, there is a family history of Type II diabetes mellitus.
A clinical examination confirmed that Cathy was clinically obese. Her blood pressure was raised. Blood tests showed that she had elevated amounts of insulin in her bloodstream. A glucose tolerance test, in which blood sugar is tested two hours after taking a sugary drink, was high, confirming that Cathy was in a pre-diabetic state. Her body was developing a resistance to insulin, which the pancreas was pumping out to combat the resistance. Without intervention, Cathy would almost certainly develop Type II diabetes.
Cathy and her mother shared a fondness for sweet things and a dislike of exercise. They are both avid TV viewers.
Prof Hilary Hoey, professor of paediatrics at TCD and a consultant paediatrician at Tallaght Hospital, explained the diagnosis and emphasised that there was no "magic pill" to reverse Cathy's weight problem. Management would consist of diet, exercise, psychological support and lifestyle changes.
Her mother was told to clear out all sugary foods, such as fizzy drinks, biscuits, jam and sugar-based cereals. She was also advised to get rid of the frying pan. Dietary advice included increasing the family's intake of fruit, vegetables, bran, plain cereals and slimline milk.
Cathy was encouraged to participate in games and her parents were urged to take her on cycling trips and swimming. The TV in Cathy's bedroom was moved out and set times for watching TV were agreed. The family was also referred to a psychologist for ongoing support.
A year later, Cathy has managed to halt her weight gain, but she has not been able to maintain a sustained weight loss.
Prof Hoey and her team continue to push home the message that Cathy has an opportunity to avoid chronic ill-health simply by changing her lifestyle.