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According to the report, despite the initiation of lifestyle modifications and metformin therapy at 9 years of age, the patient showed a poor response after 1 year of treatment: his BMI increased from 46.7 to 51.2 kg/m 2 , body fat percentage worsened from 53.1% to 65%, and he continued to experience difficulty achieving satiety with nocturnal awakening due to hunger and subsequent eating