How can genetics help in the management of obesity?

Obesity usually results from unwanted variations in metabolism. Inadequate neurotransmission, thermogenesis, or acylation underlie about 90% of cases. These are complex, weakly heritable, polygenic traits. Mutations in major gene loci cause another 5% of cases, and still another 5% of cases are due to gluttony. Careful observation can help define the type of obesity. All forms are associated with excess mortality and require lifelong episodic or continuous management. Management centers around diet, exercise, behavior therapy, and life-style counseling. Serotonin agonists and serotonin uptake inhibitors, as well as alternative therapies like phototherapy and 5-hydroxytryptophan are worthwhile for neurotransmitter inadequacy, except in children and pregnant women. When thermogenesis is inadequate, intake may be normal and weight reduction may require subnormal intake. Some degree of obesity may be required for optimal health in patients with inadequate acylation. In some Mendelian syndromes, obesity may balance a metabolic error, and weight reduction may restore metabolic imbalance.