Paediatricsmiddle twist
A 12-year-old boy attends with his mother. His body mass index for age is above the 99.7th percentile on his growth chart, having been on the 92nd percentile at 8 years of age. There is velvety thickened darkening of the skin in both axillae and around the neck. His mother says he snores every night and she has watched him stop breathing and then gasp. His blood pressure is 134/86 mmHg, above the 95th percentile for his age, sex and height, on two occasions. Fasting glucose is 4.9 mmol/L (3.0 to 5.4). Which one of the following is the most appropriate management?