What are the current treatment recommendations for obese children younger than age 8 years with elevated insulin levels and normal fasting blood sugar/hemoglobin A1c?—ELIZABETH WETMORE, ARNP, Dodge City, Kan.

A child younger than age 8 years who is obese and has elevated insulin levels despite normal blood glucose testing can still be considered at high risk for metabolic cardiovascular syndrome (Metabolism. 2002;51:423-428). The American Academy of Pediatrics has published recommendations for the treatment of child and adolescent overweight and obesity (Pediatrics. 2007;120:S254-S288) and provides a Web site with a number resources for health-care providers, patients, families, and communities on this challenging topic. It is encouraging to note that increased physical activity may reduce insulin resistance even if body weight or BMI does not improve (J Clin Endocrinol Metab. 2007;92:4230-4235).—Julee B. Waldrop, MS, PNP (137-8)

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