Because it is not a question of giving overweight or obese people a single size because there is no ideal "format" adapted to everyone. There is no miracle cure either. Obesity must be treated, also in a personalized way. This study, which characterizes several major types of obesity, "familial", "metabolic", "behavioural" or even "addictive", presented in the journal Obesity, thus claims precision medicine for overweight patients as well. Just as it is not possible to aim for a single size, it is not desirable to adopt the same treatment or the same management for all patients.
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It was the analysis of data from more than 2,400 obese patients who underwent bariatric surgery that allowed researchers from Brown University (Providence) to identify these 4 main subgroups of patients with weight loss after surgery. , eating behaviors and a very different rate of diabetes.
There is no silver bullet to obesity , writes lead author Dr. Alison Field, chair of Brown University's Department of Epidemiology, and " if there is one, it is bound to be different for different groups of patients. There is a clear clinical difference between a child who becomes very obese at age 5 and a patient who has gradually gained weight. The patient's story can help us provide a more personalized approach to treating obesity ”.
4 groups of patients, 4 subtypes of obesity: examining psychological factors, such as eating habits, weight history and biological variables, including hormone levels, allowed researchers to identify, using an algorithm, different types of obesity:
- group 1 is characterized by low levels of high-density lipoproteins, called "good" cholesterol, and very high levels of glucose in the blood before bariatric surgery. 98% of patients in this group were diabetic (vs 30% in the other groups);
- group 2 is characterized by severe eating disorders (ED). Specifically, 37% of participants in this group suffered from binge eating, 61% from loss of food control, and 92% reported eating regularly without feeling hungry.
- group 3, “metabolically average”, has very low levels of TCA disorders (7% say they eat when they are not hungry). No other factor distinguishes this group from the others.
- group 4 includes obese patients since childhood. Their BMI peaks at age 18, and averages 32. It is therefore a case of severe obesity. This group had the highest preoperative BMI, with an average of 58 compared to around 45 for the other three groups.
Different surgical results according to patient groups: If, overall, during the 3 years following the bariatric procedure, men lose an average of 25% of their weight and women an average of 30%, patients in the groups 2 and 3 are clearly those who benefit the most from the intervention. Thus, patients with TCA are those who lost the most weight, on average 28.5% and 33.3%, respectively, for men and women.
The need for “targeted” treatment: identifying the “type” of the patient and understanding the characteristics of their obesity can help to better orient the treatment. This is particularly the case of the bariatric surgery option which benefits most patients with ED. Finally, these data are important for research as well: one of the reasons why the results remain mixed on new obesity treatments lies in the fact of treating all patients in the same way, and globally by diet or weight loss intervention.
"There are probably incredibly effective strategies to prevent or treat obesity, but the single treatment only has a 'diluted' effect."
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