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Null mutations in Mc4r cause pronounced, dominantly inherited, monogenic obesity in rodents and humans, and are associated with increased food intake, decreased energy expenditure, and increased lean body and fat mass [56,57]

Common signs include: Persistent fatigue and low energy unrelated to sleep Brain fog, poor concentration, and short-term memory lapses Mood changes, irritability, or low motivation Tingling or numbness in the hands and feet Cold extremities and pale skin Hair thinning or weakened nails Shortness of breath or dizziness on exertion A smooth or sore tongue (glossitis) If several of these resonate, a clinical assessment is the right next step

The belief that B12 injections provide a long-term store that renders a day or twos difference insignificant is a significant and persistent misconception