How personalized medicine may be used to treat obesity and sustain weight loss successfully

Personalized or targeted medicine is transforming how we treat conditions like obesity. Our Board-Certified gastroenterologist at Atlantic Gastroenterology, Dr. Alexander Shapsis, stays on top of the latest research to benefit patients with persistent weight loss challenges in Brooklyn and greater New York City. Notably, research partly supported by the Mayo Clinic and featured in the April 2021 issue of the journal Obesity suggests strides in: 

• How nuances among patients with obesity are identified 
• How those nuances are accounted for in the selection of antiobesity medication 

Eighty-five percent of the initial 450 study participants were classified into “subgroups” and subject to phenotype-based treatment. Individuals were classified into these subtypes or phenotypes based on available tests to assess and measure functions like gastric emptying and metabolism, as well as questionnaires completed by participants. From there, the year-long study categorized participants into one of the four following phenotypes:

• The “hungry brain,” whereby satiation is “abnormal” and excess calories are consumed before these individuals “feel full” 
• “Emotionally hungry,” or the hedonic or pleasure eater, characterized by negative moods, emotion-driven cravings, and reward-seeking behaviors
• The “hungry gut,” whereby rapid gastric emptying is present (that feeling of “fullness” is abbreviated)
• “Slow-burners,” defined by a sluggish metabolic rate, low muscle mass, and diminished physical activity

From here, medications were prescribed to each participant based on the identified phenotype. The optimal medication for each phenotype was derived from the primary mechanism of action and previous studies exploring how subgroups responded to these drugs. The medications that were selected to treat each phenotype in this study are as follows:

• Hungry brain/abnormal satiation = Lorcaserin (brand name: Belviq)
• Emotional hunger/hedonic eating = Naltrexone/bupropion (brand name: Contrave)
• Hungry gut = Liraglutide (brand name: Saxenda)
• Slow burn = Phentermine + increased resistance training 

Researchers found that 79% of those subjects within the phenotype-based treatment group lost at least 10% of their weight at the 12-month mark. For comparison, 34% of those treated with a “non-phenotype-based” approach lost 10-plus% of their weight after one year. The mean weight loss for the former, phenotype-based group was nearly 16% (versus 9% for the latter, non-phenotype group). In all, such a subtype-based approach to treatment was associated with 1.75-fold greater weight loss than those medications and treatments that were not driven by these individuals’ identified phenotypes.

What all of this means

Historically, weight loss interventions have been limited. They did not account for nuances and dissimilarities among obese individuals. Based on their findings, researchers have concluded that phenotype groups are “clinically meaningful.” Validated by biological and behavioral analyses, this research reportedly supports an enhanced understanding of pathophysiology within each subgroup. In turn, tailored, phenotype-based pharmacotherapy demonstrated greater weight loss. These findings may be used to advance precision medicine approaches designed to successfully treat obesity. 

Benefit from tomorrow’s therapies and interventions today. Contact our state-of-the-art specialty team at Atlantic Gastroenterology. Our offices in Brooklyn, NY, may be reached at 718 521-2840. 

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