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What's the role of genetics in early-onset severe obesity?

I am 32 years old, male, obese since early childhood and currently have a BMI of 45. Although I consider myself living a healthy lifestyle (excercising on a regular basis, versatile diet etc) I never managed to lose weight. Since I'm experiencing problems in coping with this condition emotionally it would mean a lot to me, to know whether this is "my fault" or maybe partly due to genetics. Usually friends and family naturally only tell me what I want to hear (that this is not my fault at all), therefore I'm seeking an unbiased professional opinion.

Interesting question. In answer to your query, here are a few facts about childhood obesity:

1. Early onset obesity is defined as occurring before the age of 10 - ie you were severely obese in childhood before turning 10.

2. Your BMI has to be 3 standard deviations above the norm.

If there were 100 people that fell within this group, approximately 7 of them would have a genetic mutation in the form of a single point genetic mutation - in other words, 7% of childhood obesity can be directly attributable to your "bad genes".

What about the other 93%? Well, the majority of obesity is still due to a combination of:

1. Too much food intake

2. Lack of physical activity

How do we know that genetics has a role to play in obesity?

We know this as not everyone who grew up in urban or rural environments become obese, which suggests that genetics play a role as well.

Genetics in obesity

Recognized forms of obesity attributable to genes include:

  • A deficiency of the leptin and melanocortin-4 receptors
  • Mutations in the melanocortin-4 receptor gene
  • People with 2 copies of the FTO gene (fat mass and obesity associated gene) have been found to weigh 3–4 kg more and have a 1.67-fold greater risk of obesity compared with those without the risk allele.

Finally, obesity is also a feature in a few rare and inherited syndromes such as:

  1. Prader–Willi syndrome
  2. Bardet–Biedl syndrome
  3. Cohen syndrome, and
  4. MOMO syndrome
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