Q: I am 15 years old and currently weigh 312 pounds. I have tried eating nothing but vegetables and fruit and working out all day. I have a low metabolism and don’t know how to get my weight under control. It is very discouraging when I work out every day and don’t get any positive results. I have been having back problems and I suspect that it is because of my weight. I don’t know who else to contact and you help so many other people so please help me.

A: Well, you may have a weight problem but I’m impressed with you already because you appear genuine, articulate, and want to turn your life around.

As with so many medical conditions including diabetes, hypertension, thyroid abnormalities and cardiac issues having a genetic component, my first thought is whether your parents or grandparents may have also struggled with obesity. There are countless articles available to indicate that genes can play a role in obesity because genes may influence everything from rates of food absorption to the sensitive nature of our metabolism.

One study in Czechoslovakia was conducted for just this purpose. A registry of twins separated from each other at birth and given to different foster parents found, many years later, that both children were equally likely to be obese and have the same resting metabolic rate, which is a measure of how many calories each will burn while doing absolutely nothing. It didn’t matter whether the foster parents were heavy or thin, what each family ate, or how much they exercised. Ghrelin is one of the hormones that controls hunger, yet it isn’t clear if the problem is simply the production of ghrelin which is produced primarily in the stomach and duodenum, but also how the ghrelin affects receptors in the brain. .

A study at Boston Children’s Hospital involved mice and found a rare genetic mutation that prevented the animals from burning off fat calories. The mutation in the Mrap2 gene led the mice to consume fewer calories, while gaining twice as much weight as they should have, causing the mice to hold on to the fat rather than breaking it down for energy. The researchers found that within a group of obese individuals, the same gene was mutated.

Now, on to other possible causes for obesity that include leading a sedentary lifestyle, consuming more calories than are burned off, and some medical conditions. In order to lose weight, an individual must take in fewer calories a day than he or she burns. Let me give an example of losing one pound per week. Many individuals must reduce their caloric intake by 3,500 calories in that time period. This is easy enough to do simply by eliminating that candy bar after work each day or a treat that contains 500 calories. Keep in mind, however, that if a person is already at his or her maximum efficiency for weight, it will differ from someone who is weight-deficient and someone else who is overweight. The body will react differently to different situations.

I recommend you make an appointment with your physician for an examination, lab work and possibly other testing if appropriate. Should you have undiagnosed hypothyroidism, Cushing’s disease, or depression, there may be a correlation with your increased weight. If you are currently taking seizure medication, steroids, some antidepressants or even a drug for high blood pressure, they, too, could cause your weight gain. Ask if a referral to your local hospital’s dietitian is appropriate. Exercise regularly and by all means, maintain a positive attitude. Help is out there for you.