Personalizing Obesity Treatment

When it comes to obesity, research has already identified several common characteristics that go beyond the higher risk for hypertension and diabetes. For example, one study published in Drug and Alcohol Dependence found that a quarter of the obese patients surveyed met criteria for a food disorder and were also more likely to exhibit psychiatric comorbidities. Another study, this one in Surgery for Obesity and Related Diseases, found that anxiety and depression were not only prevalent among obese people in general, but also among obese patients at Bariatric Surgical Weight Loss clinics.

Now, researchers have identified at least four distinct classes of obese patients who underwent bariatric weight-loss surgery, which could help tailor treatments. For “Association of Obesity Subtypes in the Longitudinal Assessment of Bariatric Surgery Study and 3‐Year Postoperative Weight Change,” published in the Nov. 13, 2018 issue of Obesity, researchers analyzed data from more than 2,400 obese patients who underwent bariatric weight-loss surgery, examining rate of diabetes, weight loss in three years after surgery, and a range of biological variables such as hormone levels, as well as psychological variables including smoking, drug and alcohol use, eating patterns, and weight history. From this, they identified four classes of obesity:

  1. Diabetes with low rates of high‐density lipoprotein
  2. Disordered eating
  3. Mixed
  4. Extreme obesity with early onset

Approximately 98 percent of participants in Class 1 had diabetes compared with less than 40 percent in the other classes. Other findings included Class 2 having high rates of binge eating and eating when not hungry, the latter of which was reported by more than 92 percent of patients. Class 4 had a higher BMI at baseline and saw male adults lose an average of 25 percent of their baseline weight and females lose just over 30 percent. Those in Class 2 and Class 3 had a significantly larger weight loss over three years than those in Class 4. Class 1 had elevated glucose and triglyceride levels but the lowest HDL levels of the four groups, while the median BMI in Class 4 was much higher than the others.

The study marked the first time that psychological variables were evaluated to help identify different types of obesity. This allowed for identification of multiple subgroups that would otherwise have been missed.

“Our results highlight the merits of including both behavioral and biological constructs in classification systems. Had we only included indicators of eating behavior, we would not have identified the sharp contrast in metabolic health of Class 1 compared with Classes 2 through 4 and may have only identified the group that may be at particularly high risk for poor outcomes because of the high rates of aberrant eating behaviors,” researchers wrote.

Researchers plan to look next at whether longer‐term postoperative weight loss trajectories or change in comorbidity response varies across these obesity subtypes. Noting that “the current study demonstrates that, using preoperative information, one can discern obesity subtypes that have different weight change trajectories after surgery,” they concluded that further research may also “help to identify those who would most benefit from bariatric surgery, as well as identify those in need of additional modalities to achieve an optimal postoperative weight change.”

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