5 Systematic reviews suggest lifestyle modification interventions improve quality of life23 and may have small effects on lipids and insulin.5 In contrast, we found no impact on BMI, lipids or quality of life. There were small non-significant increases in self-esteem. Other studies have shown a benefit in self-esteem measures often in the face of little change in obesity measures.24 The gene discussed is INS; the disease is obesity due to melanocortin 4 receptor deficiency.