Individualized Approach to Obesity Epidemic?

The future of treatment of severe obesity is in personalized medicine, which will take into consideration the individual’s DNA, combined with a personalized, in-depth understanding of physical fitness and clinical well-being, according to an article published this month in Translating Science. This type of personalized treatment is a radical shift from today’s treatment, which is more of a one-size-fits-all approach.  Dr. Sunil Bhoyrul, author of the article and expert bariatric surgeon practicing in San Diego, explains that obesity is a disease in which a person’s “weight thermostat” is reset.  While diets and exercise lead to weight loss, for severely obese people, the weight loss is temporary. These individuals “realize that, despite their best efforts, their weight will creep back up in time and then they are back to where they started”, he said.  This is because the hypothalamus part of the brain is responsible for maintaining physiological parameters within narrow ranges, including body weight regulation. It is an essential survival mechanism as we have evolved through millions of years of food shortages. Dr. Bhoyrul explained that “the maladaptive response to food excess is the likely cause of persistent sustained lifelong obesity.”

The prospect of creating a tailored method of treating the severely obese is exciting for Dr. Bhoyrul. With this type of medicine, food choices could be tailored to one’s DNA, and physical fitness plans could be designed using scientifically validated methods. These changes would improve the quality of life for many obese people and would allow physicians to treat patients according to their unique genetic make up and environmental factors.

Dr. Bhoyrul concluded that “We hope to also be able to make recommendations about the type of surgery our patients need based on their genotype as well as their phenotype. Obesity, like every health care epidemic that mankind has faced so far, can be eradicated – however, it will take a revolution.”

There have been several scientific presentations this year about the role of genetics in severe obesity and how genotypes can be used to create more individualized treatment for bariatric patients.  Dr. Mona Misra, a leading bariatric surgeon in Los Angeles agrees with the idea of individualizing obesity treatment, saying:

One of the most fascinating and important areas of research being done in our battle against obesity is in the concept of individualism and personalized medicine. Throughout the past several decades, obesity has been a disease that we have been trying to conquer through increasingly creative, innovative and comprehensive options. However, even with all of the advances in medicine and surgery—including laparoscopy and hormonal research–we have still been unable to find the perfect solution for each patient to reach 100% success in the long-term. It has been difficult to understand why every person does not respond in the same manner with each specific surgical treatment option, with 10-15% failure rates seen in all surgeries available to date. Genetics and thermogenetics have been suggested as part of the reasons why patients can respond differently, but finding the characteristics that will predict success for our patients will be an invaluable step forward in conquering this disease.

Dr. Misra concluded that she “commends those pursuing research on how to better individualize obesity treatment, and is optimistic that we will gain more insight into this area that will inevitably lead to our patients’ success.”

The theme of individualism and personalized medicine has been coming up repeatedly with medical innovators and researchers. Another example was in an article last month about Obesity in the Modern Environment by Dr. Emma Patterson.

You can read Dr. Bhoyrul’s full article here.

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