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The BMJ Today: Is “Madonna” the answer and do these genes make me look fat?

19 Mar, 14 | by BMJ

Is “Madonna” the answer? Definitely “No” although the woman nominated one of Time Magazine’s 25 most powerful women of the past century would certainly have something to say about (Dr) Tracey Koehlmoos’ experiences as the only woman on a panel of experts. Each time she is introduced as plain “Tracey” at yet another high powered meeting where her male counterparts are introduced as “Dr X, Professor Y, Captain Z, etc,” she tells herself it’s the same as being known simply as “Madonna” or “Adele.” But, she says, “when I am honest with myself, I know this is not actually the case.”

The same thing happened at the launch of her own book. Bear in mind that she is not only a doctor, but special assistant to the assistant commandant of the Marine Corps, and author of “something like” 80 publications.

So how does she now respond to these situations? She acknowledges that many others have valued her contributions to the extent of giving her equal billing when they introduce her. But “I do know that things will not improve until I take a stand at least in a small way. It might mean saying, “It is Dr Koehlmoos, but please call me Tracey,” after an errant introduction or even bringing my “Tracey Koehlmoos” name plate to the conference organizer during the first break in the meeting and pointing out, “It is Dr Koehlmoos.”

We now have more female prime ministers, CEOs, and editors-in chief. But as this doctor and even a recent Australian PM have found, we’re not there yet. If you’ve had similar experiences, how have you handled them?

Now from the deflating effects of an “errant introduction” to the inflationary pressures of the wrong genes and the wrong diet. The novel finding of a large prospective cohort study is that, if you’re at the highest genetic risk of obesity, you may be more susceptible to the adverse effects of eating fried food. Harvard researchers used data from three cohort studies (and over 37,000 participants) to calculate genetic risk scores for each participant based on common genetic variants, 32 single nucleotide polymorphisms. They also used food frequency questionnaires and measured height and weight, at the start and at followup. One of their key findings was that eating fried food more than four times per week had twice as big an effect on BMI as for those at lowest genetic risk.

The authors of a linked editorial nominate this as “formal proof of interaction between a combined genetic risk score and environment in obesity.” So how does this affect my next weight loss consultation? It doesn’t yet, say the editorialists—such genetic risk scores predict individual phenotype poorly. And most of us should eat less fried food anyway, regardless of genotype. It would be unwise to ignore genetics entirely though. While these common single nucleotide polymorphisms have “relatively subtle effects on BMI,” rarer single gene forms of obesity do have more dramatic effects. So understanding these may help us tailor management better—lifestyle interventions work better in people who aren’t far off the desired BMI, while weight loss surgery is the preferred option in those with more severe obesity (though we don’t yet know what’s the best operation, as a recent Uncertainties page explains). One size definitely doesn’t fit all.

Mabel Chew is practice editor, BMJ.

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