Elsevier

Progress in Cardiovascular Diseases

Volume 62, Issue 1, January–February 2019, Pages 15-20
Progress in Cardiovascular Diseases

Precision Medicine in Weight Loss and Healthy Living

https://doi.org/10.1016/j.pcad.2018.12.012Get rights and content

Abstract

Obesity affects 600 million people globally and over one third of the American population. Along with associated comorbidities, including cardiovascular disease, stroke, diabetes, and cancer; the direct and indirect costs of managing obesity are 21% of the total medical costs. These factors shed light on why developing effective and pragmatic strategies to reduce body weight in obese individuals is a major public health concern. An estimated 60–70% of obese Americans attempt to lose weight each year, with only a small minority able to achieve and maintain long term weight loss. To address this issue a precision medicine approach for weight loss has been considered, which places an emphasis on sustainability and real-world application to individualized therapy. In this article we review weight loss interventions in the context of precision medicine and discuss the role of genetic and epigenetic factors, pharmacological interventions, lifestyle interventions, and bariatric surgery on weight loss.

Section snippets

Genetic and epigenetic factors

The framework for a genetic predisposition to obesity has been well established in the literature.18,21,22 Previous studies have indicated that the contribution of genetic heritability to the development of obesity may be as high as 70%18,21,22 and several genes have been identified as key contributors.23 These genes may regulate food intake, nutrient preferences, energy expenditure, leptin sensitivity, and other biological aspects that might contribute to the risk of obesity.24 The genome-wide

Therapeutic approaches for weight loss

There are many potential therapeutic interventions for weight loss. In obese individuals, the primary interventions for weight loss include lifestyle interventions, pharmacotherapy, and bariatric surgery.9,44 However, there is some controversy regarding which interventions are the most successful for reducing weight and maintaining weight loss for each individual patient. Individual responses to weight loss interventions demonstrate heterogeneity, which is likely due to a multitude of factors.

Lifestyle intervention programs

Lifestyle intervention programs are a popular choice for weight loss for obese individuals. The core elements of such programs typically involve exercise training, dietary interventions, and patient education. The literature demonstrates that these programs can be successfully implemented using a variety of methods (supervised or limited supervision),45., 46., 47. settings (hospital based, outpatient, community based, occupational or commercial) and with different providers (physicians,

Pharmacological interventions for weight loss

Although lifestyle interventions have been shown to result in clinically significant weight loss in obese individuals, many populations face difficulties both achieving and maintaining long term weight loss.14,47,75 Obese individuals participating in such programs may lose up to 10% of body weight over a 4–6-month period before experiencing a plateau in weight loss.47,76 This plateau in weight loss following such programs is often followed by weight regain within one year in many patients, and

Bariatric surgery

For obese patients with a BMI > 40 kg/m2 or a BMI > 35 kg/m2 with obesity related comorbidities who fail to lose weight from lifestyle interventions and pharmacological therapies,83 bariatric surgery (BS) is an increasingly popular treatment choice.84 Bariatric surgery has consistently been shown to result in rapid weight loss and a reduction of obesity-related comorbidities such as hypertension, dyslipidemia, and diabetes.85 The two most common procedures performed are the Roux-en-Y Gastric

Conclusions

While the connotation of “Precision Medicine” is often clinical interventions that are optimized for a patient's unique genetics, environmental and lifestyle factors are also included in the definition by the NIH. These other factors are as important as genetics, and potentially to greater degree in obese patients. Most obese patients demonstrate a polygenic manifestation with obesogenic genes which may be switched on or off by epigenetic regulators that are influenced by both lifestyle and

Conflict of interest/disclosures

None of the authors have any conflicts of interests with regard to this publication.

Acknowledgments

This review was supported in part by NIH training grant T32-HL-139439 (AS). Funding received from NIH grants 1K99HL140049 (AMM) and HL130513A1 (SAP).

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