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A 15-year-old boy of Turkish origin presented with his mother and father, who were worried about his dramatic weight loss over the past six months. He was a quiet boy who spent his lunch hours at school in the library and most of his weekend at home playing computer games. He was previously obese but otherwise well. The parents spoke little English and their son functioned as their interpreter for all business and health transactions. Father was unemployed and pursuing compensation for a "bad back"; mother had chronic irritable-bowel syndrome. The boy spent at least half a day per week out of school taking his parents to various medical or legal appointments. He related as a serious "pseudomature" young man but was not clinically depressed. Examination revealed that he was 20% underweight, with delayed puberty. He was concerned about his personal fitness and stated that he was engaging in strenuous exercise for about three hours per day.

He was referred to a dietitian, whom he saw regularly. Turkish interpreters were provided for the parents, allowing the boy to resume fulltime schooling. On a subsequent visit to the general practitioner, the young man confided his concern about his parents and his relief that they were no longer his sole responsibility. He became more engaged in school and extracurricular activities and slowly gained weight. Participation in soccer and weightlifting obviated his need for the covert exercise program.

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