A phenotype-based approach to the treatment of obesity holds promise

In a pilot study of 165 people, Mayo Clinic researchers looked at the effectiveness of two different approaches to weight loss: a standard lifestyle intervention and individualized therapy. Standard lifestyle intervention includes reduced diet, exercise, and behavioral therapy. An individualized approach is based on phenotypes and includes different interventions depending on the predominant underlying cause of the person’s obesity. A phenotype-based diet takes into account an individual’s genetic and phenotypic characteristics to create a personalized meal plan designed to optimize health and well-being.

Researchers compared whether dietary and lifestyle interventions tailored to obesity phenotypes would work better than standard lifestyle interventions for weight loss, cardiometabolic risk factors, and physical variables contributing to obesity. Cardiometabolic health describes the relationship between the heart and blood vessels and the energy and chemical processes in the body. It covers a wide range of diseases and risk factors that contribute to heart disease and metabolic syndrome.

In obese adults, phenotype-tailored lifestyle interventions resulted in more weight loss than standard lifestyle interventions of reduced-calorie diet, exercise, and behavioral therapy.

Findings after 12 weeks include:

• Patients who used phenotype-tailored lifestyle interventions did better in managing their obesity than those who used standard lifestyle interventions.
• The phenotype-focused group of patients had greater weight loss, reduced waist circumference, reduced triglycerides, reduced daily caloric intake, and less anxiety.
• They had a significant increase in lean mass percentage.
• They also have a smaller reduction in the number of calories the body needs at rest.

The results highlight the relevance of identifying the root cause of obesity as a complex multifactorial disease.”

Andre Acosta, MD, Ph.D., an obesity researcher at the Mayo Clinic and the study’s final author

What is phenotype-tailored intervention?

Obesity phenotypes are based on the cause of the disease and behavioral components and include three main areas:

• Homeostatic nutrition -; feeding in response to the brain’s perceived energy demand.
• Hedonic eating behavior -; consuming foods for pleasure rather than for physical hunger or energy needs.
• Abnormal energy expenditure -; the number of calories burned in 24 hours compared to an average person.

Four applicable phenotypes of these areas include abnormal fullness as measured by calories ingested to experience unpleasant fullness; unusual duration of fullness; emotional eating behavior; and abnormal energy expenditure at rest.

The researchers reported that people who used the phenotype-tailored lifestyle interventions showed significant improvement in some target areas, such as abnormal fullness and emotional eating.

“The results of this study support the need for a workable phenotype-based classification [of patients in obesity treatment] instead of just relying on the number on the scale, body measurements or [if they have] obesity-related diseases such as heart disease, high blood pressure and certain cancers,” says Dr. Acosta.

Opportunities for further research

Dr. Acosta says more research is needed to assess the long-term effect of the phenotype-based approach. In particular, further studies may need to look at other physical and metabolic variables to understand individuals without an identified phenotype.

Dr. Acosta also notes that the effects of therapy on both approaches should be studied independently. People with an emotional eating component received a more intensive intervention with 24 behavior change sessions to address this underlying trait that may have a leading role in the development of obesity.

“More research will improve the personalized approach suggested by the data,” says Dr. Acosta. “We will continue to work on individualized obesity therapy targeting specific traits to identify the right therapy for the right patient.”