Relationship with ingestive behavior and choice of pharmacological treatment

Abstract

The variability in weight loss in people living with obesity undergoing different treatments such as diets, drugs, devices and/or surgery expresses the heterogeneity in the response to the treatment of this disease. To identify predictors that improve outcomes through precision medicine, it is possible to characterize the ingestive behavior phenotype and improve the selection of pharmacological treatment with a personalized approach, and the choice of the drug with this method demonstrated better results.

Four obesity-related phenotypes were identified: hungry brain (abnormal satiety, prevalence 32%), emotional hunger (hedonic eating, prevalence 21%), hungry gut (abnormal satiety, prevalence 32%), and slow burner (decreased metabolic rate, prevalence 21%), and a group of patients without a determined phenotype (15%). Two or more phenotypes were documented in 27% of patients (mixed group) that somehow express the multifactorial complexity of obesity. The responses observed in relation to phenotype-guided weight loss support its usefulness by allowing selection between different molecules approved by the Food and Drug Administration (FDA) based not only on the mechanism of action of the drug but also on ingestive behavior, thus choosing sustained-release phenterminetopiramate for the hungry brain, sustained-release bupropionnaltrexone for emotional hunger, liraglutide or another GLP1RA for the hungry gut, and dosed phentermine lows plus resistance training for the slow burner phenotype.

In the case of mixed phenotypes, the best drug appropriate to these phenotypes is chosen and the clinical evaluation on which predominates. Precision medicine-guided pharmacotherapy increases total weight loss by an average of 75% compared to standard care with the use of drugs without regard to phenotype, however, studies are needed additional data to identify the best responders in multicenter randomized clinical trials that allow us to have this valuable tool with greater accuracy.