Child and Adolescent Psychiatric Clinics of North America
Environmental and Genetic Risk Factors in Obesity
Section snippets
Formal genetic aspects
There is a general consensus that parental obesity is by far the strongest risk factor for childhood and adolescent obesity. The degree of parental obesity influences this risk, which is further elevated if both parents are obese.17, 18 According to several studies, offspring BMI is somewhat more strongly correlated with maternal than paternal BMI,19 suggesting intrauterine influences, imprinting effects, an influence of mitochondrial genes, or a rearing effect. Formal genetic studies have led
Syndromal Obesity
The Prader–Willi syndrome (PWS) is caused by the deficiency of one or more paternally expressed imprinted transcripts within chromosome 15q11-q13, including SNURF-SNRPN and multiple small nucleolar RNAs (snoRNAs). Recently, a microdeletion of the HBII-85 snoRNAs in a child with the typical features of the PWS provided conclusive evidence that deficiency of HBII-85 snoRNAs causes the key characteristics of the PWS phenotype.34 The pleiotropic Bardet–Biedel syndrome, of which obesity is a
Environmental factors
Secular changes in energy intake and expenditure are assumed to underlie the obesity epidemic.30 However, attempts to unequivocally pinpoint the relevant mechanisms, even within a single country or society, have been largely futile. Controversy exists as to the proportional contribution of an elevated energy intake in comparison to a reduced energy expenditure due to the modern-day sedentary lifestyle. In England, energy intake counterintuitively seemingly declined between 1970 and 1990;61
Summary
Disentangling the diverse mechanisms underlying variation of BMI and, in particular, overweight and obesity is proving exceedingly difficult. The advent of GWA will continue to enable the detection of polygenes. DNA of tens of thousands individuals is required to validate an initial finding, thus illustrating the small effect sizes. Complex interactions between genes and environmental factors can be assumed to occur.
Treatment of obesity is difficult in both children and adults. Whereas weight
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