There are several possible mechanisms by which high BMI increases the risk of gallbladder stones and polyps: (1) high BMI is associated with a larger gallbladder and increased cholesterol synthase activity that promotes bile cholesterol supersaturation and the formation of gallstones and polyps (17), (2) high BMI causes slower metabolism of lipids and endogenous hormones, reducing gallbladder movement and increase risk of gallbladder stones and polyps (18), and (3) high BMI can lead to insulin insensitivity and resistance, additional risk factors for gallstone formation (19). The gene discussed is INS; the disease is gallstones.