Policy on the prevention and management of obesity focuses on environmental causes. As understanding of the genetic basis for obesity improves, is it time for a rethink?

Obesity is a significant and increasing problem worldwide. It is causally linked to a number of the leading causes of mortality and morbidity in the UK, including type 2 diabetes, cardiovascular disease and some cancers. It also has a significant economic impact, with high costs to the health service and to the wider economy.

In England today, more than two-thirds of men and more than half of women are overweight or obese. Prevalence has risen rapidly over recent years, a trend which is predicted to continue. Obesity is also occurring earlier in life and more than one-third of children in England are overweight or obese by the time they start secondary school.

UK guidelines and policies for the prevention and management of obesity focus on the environmental causes, and current care guidelines make little mention of the role of genetics, other than in particularly severe or complicated cases. The PHG Foundation report, “The genomics of obesity”, identifies a typical four-tier system of obesity services and care pathways in the NHS and proposes where and under what circumstances genetic testing for obesity could benefit patient care.