Severe obesity

Case presented by Dr Dominique Cellier

The clinical context

Marie-Christine, a 40-year-old night-shift nurse, has severe obesity with a BMI of 39 (160 cm, 101 kg). Since moving to night shifts, her weight gain has accelerated, making daily life increasingly difficult. She seeks advice after recently developing high blood pressure. This warning sign prompts her to look for a lasting solution.

Brought up in a highly controlling family, Marie-Christine has been dieting since adolescence without ever managing to stabilise her weight. Despite repeated efforts, she has experienced a succession of setbacks that have deeply affected her self-esteem. She describes considerable emotional distress. She says she "gives in" when restrictions become too difficult and feels guilty and powerless, convinced that "nothing works".

Although her healthcare professionals recommend more exercise, Marie-Christine feels anxious and discouraged. Her weight, unsuccessful diets and night-shift schedule create a vicious circle in which tiredness, hunger and frustration build up. Single and isolated in her attempts to lose weight, she arrives at the consultation exhausted and with low self-esteem, but still determined to understand why nothing has ever worked for her.

The role of the FTO gene

After stopping the restrictive diets that had intensified her guilt and sense of failure, a comprehensive laboratory assessment is carried out to rule out any endocrine cause. Given her history of persistent hunger, difficulty feeling full and repeated failure of low-calorie diets, genetic testing is proposed to investigate, in particular, the FTO gene (fat mass and obesity associated).

Three weeks later, the results confirm the presence of a polymorphism, explaining her constant hunger and inability to sustain calorie restriction. This finding brings her real relief and an objective explanation for her difficulties. Psychological support is then introduced to help her move away from family blame and regain confidence.

The nutritional approach focuses on more frequent meals that are higher in protein and fibre, to stabilise hunger without frustration. She also begins appropriate, gradual physical activity that does not cause anxiety.

Gradually, Marie-Christine regains energy, feels calmer and begins to lose weight steadily, reaching a loss of almost 9 kilos. Returning to day shifts consolidates her progress by restoring an eating pattern more in keeping with her natural rhythms. Her newly developed high blood pressure returns to normal, and she achieves a lasting balance.

Genetics and epigenetics applied to nutrition

Today, understanding genetics and epigenetics has become essential to developing truly personalised, more pragmatic and genuinely preventive medicine. Understanding how genetic and epigenetic variations influence individual responses enables us to fine-tune our recommendations and support each patient more appropriately and effectively.

ADNAcademy’s Genetics and Nutrition course supports you in this development. It provides the tools to integrate this knowledge into everyday practice, anticipate individual responses to nutritional advice and refine your approach for greater clinical relevance and impact.