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Does obesity really protect against psychological distress? Examining the ‘fat‐jolly’ versus ‘fat‐sad’ hypotheses using Mendelian randomization

In this issue of the Journal of Internal Medicine, Lawlor et al. [1] present interesting results to address this puzzle by utilizing two genetic variants that are robustly associated with adiposity: FTO rs9939609 andMC4R rs17782313.This is aMendelian randomization (MR) study with the aim of improving causal inference from observational data which are often confounded by third variables, some of which are measured, others not. The MR approach is predicated upon the random assortment of alleles at the time of gamete formation, which leads to population distributions of genetic variants that are, generally, independent of the environmental exposures commonly confounding risk factor–disorder associations [2]. These unconfounded genetic differences in risk factor levels (in this case adiposity) should translate into genuine differences in disorder occurrence (i.e., psychological distress) if the exposure is truly a causal risk factor.