부산대학교 도서관

Introduction: In the last decades, the incidence of overweight and obesity has reached epidemic proportions. Both genetic and environmental factors are involved. When a disease clusters in a family our first instinct is to search for a genetic cause, but where obesity is concerned, careful evaluation is required. Purpose: to discuss the possible factors related the early and severe weight gain of three morbidly obese siblings. Methods: Mădălina, Denisa and Cătălin were referred to our Medical Genetic department for evaluation. We performed a complete assessment. Results: The siblings were born to obese parents. The family had chaotic eating habits and lived a profoundly sedentary life and did not attend kindergarten or school. Mădălina, the oldest, had multiple admissions to the hospital for obstructive sleep apnea (OSA). Anthropometric measurements confirmed the severe obesity. Their facial features resembled each other's' and their mother's. Only Mădălina presented with acanthosis nigricans, while all 3 children had skeletal complications of obesity. Metabolic markers were in normal range, Mădălina's leptin and Denisa's adiponectin levels were low. In all 3 children the abdominal ultrasound was suggestive for nonalcoholic fatty liver disease. All children proved to be under stimulated and below average intellects were found. Lifestyle modifications recommendations were made and after 2 months all children lost weight. They also underwent psychological counseling. Mădălina's OSA improved. Conclusions: Nurture is the major determinant of the siblings' severe obesity. While on the short term prognosis is fair, on the long run, the multiple comorbidities associated with obesity make it reserved. [ABSTRACT FROM AUTHOR]