Visceral adiposity drives gallstone formation through three synergistic pathways, Metabolic: Leptin upregulates hepatic HMG-CoA reductase (3.2-fold increase in murine models) [23], Inflammatory: IL-6 suppresses bile acid synthesis (40% reduction in ABCG5/8 expression) [24], Mechanical: Visceral fat volume correlates with gallbladder hypomotility (r=-0.51, p < 0.001) [25]. This evidence concerns the gene LEP and gallstones.