Top Takeaway from the Spring Obesity Medicine Association Conference

n April, I went to the national conference of the Obesity Medicine Association that they held right here in Seattle. Here was my #1 takeaway.

Test your kid's fasting insulin.

Test it if your child carries extra weight, but also test it if your child, or anybody in your family, experiences an unexplained weight gain.

The hard part here is identifying an unexplained weight gain. We’re so used to taking the blame for a gain in weight that it may be hard to recognize that you or your child has put on 5-10 lbs even though your life is about the same as it has always been.

At the conference, Dr. Nicholas Pennings explained that in adults, those extra pounds are an early indication of insulin resistance years before it shows up lab tests.

In kids, insulin resistance and diabetes seem to progress faster than in adults. I first heard about this during a presentation by Dr. Suzanne Cudas at the same conference in October 2015.  This fast progression is unusual and the opposite of many other medical conditions where kids fare better because they’re younger, healthier and stronger.

Many pediatricians do order an A1C test for kids, and that's great, especially because you don’t need to do that test fasting. But by the time A1C is elevated, you’ll be catching your child’s insulin resistance late.

Here’s why. That A1C test measures your child’s blood glucose level over the last 2-3 months. So if glucose has been high, it should show up in the test.

The problem is, in kids, by the time the glucose is high, the kid is already insulin resistant. You’re not catching it early. The reason? A kid's pancreas is strong. It's fresh. It's strong enough to pump out extremely high levels of insulin to keep the glucose levels low. Dr. Pennings mentioned that some of the highest insulin readings doctors see are in kids, not adults. Readings ten and fifteen times normal.

I, unfortunately, have seen that in my own child.

To understand this better, just picture an old scale. Insulin on one side, glucose on the other. When there’s too much glucose in the blood, say after a big meal of white rice, the pancreas pumps out insulin to take care of the glucose. Since a kid has a strong, fresh, new pancreas, it's able to pump out crazy high levels of insulin to keep that scale in balance. But not forever. Just like an adult pancreas, the child’s will tire out. Glucose levels will get high and the problem will show up in an A1C test. But that’s late. Some of the cells in the pancreas that make insulin may have already stopped working by then. They were overtaxed.

Here's a quick overview of the different lab tests to talk about with your provider.


  • A1C
  • Fasting insulin and fasting glucose or, better, a 4-specimen glucose tolerance test (Ask to use a regular balanced meal, like an egg sandwich, rather than the glucose drink.)
  • Cholesterol panel (mostly looking at triglycerides)