A personalized obesity treatment plan based on phenotypes resulted in greater weight loss than that of standard care, according to a speaker from ObesityWeek Interactive.
“We have classified obesity based on pathophysiology and behavioral phenotypes on abnormal satiation (hungry brain), abnormal postprandial satiation (hungry gut), emotional hunger (hedonic eating) and abnormal energy expenditure at rest (slow burn),” Healio Andres Acosta noted. He is an MD, PhD, ABOM, and medicine assistant professor at the Mayo Clinic. “Selecting drugs to fight obesity based on each patient’s abnormal phenotype increases weight loss 1.75 times compared to selecting standard care drugs. Moreover, a phenotype-guided use of obesity drugs resulted in 79% of patients losing more than 10% of total body weight compared to only 35% of patients in the non-phenotypical obesity drug group”.
Obesity phenotypes
Acosta and his colleagues used various methods to classify 450 study participants (average age, 39 years; 72% female; 93% white) into four phenotypes. The “hungry brain” was measured using kilocalories consumed at an ad libitum buffet meal and a visual analog scale that measures satisfaction 30 minutes after a meal. The “hungry gut” was calculated using a visual analog scale that measures satiety 2 hours after a meal and gastric discharging time after a meal. The “emotional hunger” combined the score of a questionnaire of eating factors focused on emotional restriction and anxiety level through the hospital anxiety and depression scale. “Low burn” was measured with the predicted residual energy expenditure, the number of self-reported steps taken, and self-reported physical activity. All the data was collected during a “phenotype day” at the Mayo Clinic.
Participants were classified into a phenotype when they were placed at the 75th percentile or higher of the median value of the study cohort. Different mean values ??were used for each phenotype for men and women. In the study cohort, 18% fell into the hungry gut phenotype, 16% were classified as hungry brain, and 12% were placed into each of the slow burn and emotional hunger phenotypes. Roughly 27% of participants were classified into multiple phenotypes and 15% had an unknown phenotype.
Personalization of obesity treatment
Acosta and his colleagues also conducted a pragmatic trial in which participants were randomly assigned to phenotype-guided treatment (n = 68; 68% females; average age 42 years) or standard care (n = 200; 75% women; average age, 49 years).
Those assigned to phenotype-guided practice were prescribed a treatment plan that included a lifestyle intervention with a diet adapted to each phenotype, medication, devices, and surgery. The hungry brain strategy included extended-release phentermine/topiramate (Qsymia, Vivus), a block of the vagus nerve, an endoscopic sleeve gastroplasty, and a laparoscopic sleeve gastrectomy. Those in the hungry gut phenotype were administered liraglutide (Saxenda, Novo Nordisk) and intragastric balloons and gels and underwent a Roux-en-Y gastric bypass. The emotional hunger strategy employed an intervention diet, behavioral therapy, and naltrexone/bupropion (Contrave, Currax). The slow burn phenotype participated in an intensive exercise plan in addition to a diet and the prescription of phentermine.
“Our goal was to characterize obesity phenotypes and assess the effectiveness of phenotype-guided obesity medication, in comparison to non-phenotypical drug therapy,” Acosta affirmed during the presentation. “Our long-term goal is to develop a personalized approach to obesity management.” After 12 months, 79% of the phenotype group had lost 10% or more weight versus 35% in the non-phenotypical group (p <0.001). The average weight loss at 12 months was 16.1% in the phenotype cohort and 9.2% in the non-phenotypical group (p <0.001).
The next nutritional advise
Acosta said the findings have several clinical implications that could alter the way care providers prescribe drugs to people with obesity. “Firstly, obese patients will lose almost twice as much weight [with phenotype-guided therapy] in 1 year,” Acosta told Healio. “Secondly, care providers will improve the response rate of patients who lose more than 10%, to 80%, which will improve patient outcomes and adherence as well as satisfaction, and overall obesity, also improving comorbidities. Thirdly, we will stop the current standard of care, which is based on trial and error, and move towards a precision approach to medicine in order to select drugs based on abnormal pathophysiological and behavioral phenotypes.”
Reference: ObesityWeek Interactive. 2 – 6 November, 2020
Link:https://www.sochob.cl/web1/la-terapia-basada-en-fenotipos-conduce-a-una-mayor-perdida-de-peso-en-la-obesidad/
Date: November 11th, 2020
Source: https://www.healio.com
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