Differences in individual response to the wide range of available obesity interventions can be better understood--and predicted--when the disease of obesity is itself understood as comprised of phenotypes, according to Andres Acosta, MD, PhD, a gastroenterologist and obesity expert at the Mayo Clinic in Rochester, MN.
Acosta led a research team that has proposed 4 distinct biological/behavioral obesity phenotypes based on validated measures of body composition, resting energy expenditure, satiety, satiation, eating behavior, affect, and physical activity. The phenotypes are characterized by:
Acosta and Mayo Clinic colleagues recently conducted a year-long pragmatic clinical trial that assigned participants with obesity to treatment with antiobesity medication that was either phenotype-guided or non-phenotype guided. They found the former associated with a 1.75-fold greater weight loss than the latter and with more participants losing >10% of baseline bodyweight.
Most recently the research team announced findings at ObesityWeek® 2022 that demonstrate similar outcomes for phenotype-guided treatment with lifestyle interventions.
Researchers enrolled adults with a baseline body mass index (BMI) >30 kg/m2 who were assigned to either a standard lifestyle intervention--a low-calorie diet (500 kcal/day), moderate physical activity, and weekly wellness coaching sessions—or a lifestyle intervention tailored to one of the 4 obesity phenotypes:
The investigators measured satiation by calories to fullness (CTF), postprandial satiety by gastric emptying (GE), emotional eating behavior by questionnaires, and resting energy expenditure (REE) by calorimetry at baseline and after 12 weeks of participation in the phenotyped or non-phenotyped multidisciplinary interventions. The primary endpoint of interest was total weight loss percentage at 12 weeks.
There were a total of 84 participants in the standard lifestyle intervention group (mean age 42.9 years, 79% women, mean BMI 37.9 kg/m2) and 81 participants in the phenotype-tailored lifestyle intervention group (mean age 44.7 years, 83% women, mean BMI 38.6. kg/m2).
At the 12-week follow-up, 62% of patients in the phenotype-tailored intervention group had a total weight loss of >5% from baseline vs 31% in the standard lifestyle group (p<.01), according to the study abstract.
When investigators evaluated the change from baseline to 12 weeks in metrics for the 4 obesity phenotypes in the targeted treatment group, they found significant improvements in calories to fullness in participants with abnormal satiation, gastric emptying in participants with abnormal postprandial satiety, anxiety levels in in participants with emotional eating, and an increase in body lean mass in participants with low resting energy expenditure.
Acosta et al concluded that “a multidisciplinary lifestyle intervention based on obesity phenotypes that targeted the individual’s physiological and behavioral factors led to greater weight loss compared to a standard weight loss intervention.”
Abstract reference: Cifuentes L, Ghusn W, Feris F, et al. A phenotype tailored lifestyle intervention for weight loss: results from a 12-week clinical trial. Abstract presented at ObesityWeek®2022; November 1-4, 2022; San Diego, CA.