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The Pediatric Forum
February 2013

Genetic Risk in Childhood Obesity: Implications for Clinical Practice

Author Affiliations

Author Affiliations: Schools of Biological Sciences and Health Sciences, University of Auckland, Auckland, New Zealand.

JAMA Pediatr. 2013;167(2):196-198. doi:10.1001/2013.jamapediatrics.252

We wish to comment on the recently published editorial by Fernandez1 in relation to an article by Belsky et al2 that validates a gene-based risk tool for obesity in a birth cohort followed up prospectively.

First, given the steeply rising rates of obesity over the last few decades, it is clear that changes in lifestyle (ie, the environment) are “pivotal” to the development of obesity.1 While the genes underlying obesity have been present for centuries, it is their effect that has recently emerged in societies where “lifestyle” has dramatically changed. This means regardless of genetic predisposition, there need be no concern about “genetic determinism” in the public health community. Instead there should be enthusiasm for the potential to identify those at greatest risk for targeted and cost-effective interventions. This must be preferable to (over)generalized health messages that are inconsequential for the wider population. The best example of the success of the targeted approach comes from the enormous drop in death rates from coronary artery disease following several decades of cholesterol-lowering treatment (see later).

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