Congenital deficiency of proopiomelanocortin (POMC) results in a syndrome of hypoadrenalism, severe obesity, and altered skin and hair pigmentation. The concept that subtle variation in POMC expression and/or function might contribute to common obesity is suggested by studies reporting linkage of obesity-related traits to a locus on chromosome 2p22 encompassing the POMC gene. We identified a novel homozygous frameshift (C6906del) mutation in POMC in a child of Turkish origin with severe obesity and hypoadrenalism. This mutation would be predicted to lead to the loss of all POMC-derived peptides. The availability of a large extended pedigree provided the opportunity to address whether loss of one copy of the POMC gene was sufficient to alter obesity risk. Twelve relatives were heterozygous for the mutation and 7 were wild type. Of the heterozygotes, 11 of 12 heterozygotes were obese or overweight compared with only 1 of 7 of the wild-type relatives. The mean BMI SD score was 1.7 ؎ 0.5 in heterozygotes and 0.4 ؎ 0.4 in the wild-type relatives. Parametric linkage analysis of the trait "overweight" provided statistically significant evidence of linkage with this locus, with a maximum "location score" (comparable with multipoint logarithm of odds scores) of 3.191. We conclude that loss of one copy of the POMC gene predisposes to obesity in humans. Thus, genetic variants having relatively subtle effects on POMC expression and function could influence susceptibility to obesity. Diabetes 55:2549 -2553, 2006 P roopiomelanocortin (POMC) is a complex propeptide encoding a range of melanocortin peptides that are released by tissue-specific proteolytic processing (1). These peptides have important roles in a range of functions such as skin pigmentation and the control of adrenal growth and function (2). In the central nervous system, POMC is most highly expressed in the arcuate nucleus of the hypothalamus, and POMC-expressing neurons are critically involved in the control of appetite and energy balance (3). Mice and humans lacking all POMC-derived peptides are severely hyperphagic and obese (4). A role for genetic variation in or near the POMC locus in determination of obesity or obesity-related quantitative traits in the general population has been suggested by a number of independent studies (5,6). If the POMC gene itself is the causative gene, this would imply that relatively subtle variation in POMC structure or function is sufficient to significantly alter energy balance. This notion is supported by the association of a number of point mutations in POMC with obesity (7,8), although some of these appear to have the capacity for dominant-negative interference with wild-type melanocortins (9). Limited data on existing human POMC-null heterozygotes show a trend toward increased adiposity (10).In the present study, we report a patient homozygous for a novel frameshift mutation in POMC (C6906del) associated with severe obesity and ACTH deficiency. This mutation results in the complete loss of all POMC-derived peptides. A larg...