Precision Medicine in Weight Loss and Healthy Living
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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Cited by (28)
Circadian misalignment in obesity: The role for time-restricted feeding
2023, Clinical Nutrition ESPENParticipation effects of workplace promoting activities on healthy eating behavior
2022, Public Health in PracticeCitation Excerpt :A number of studies included healthy and young adults as their participants [28,29]. These interventions generally showed improvement in healthy eating among the participants, but maintaining these acquired habits is often a challenge afterwards [29,30]. This phenomenon motivated us to find effective intervention strategies in maintaining behavior changes.
Interplay between cognition and weight reduction in individuals following a Mediterranean Diet: Three-year follow-up of the PREDIMED-Plus trial
2021, Clinical NutritionCitation Excerpt :We also found evidence for correlated changes between cognition and some intervention outcomes; specifically, the associations of higher improvements in cognition with greater reductions in BMI, and higher improvements in PA and QoL. Our results are in agreement with previous studies proposing that the executive functions profile predicts weight loss outcome, as limiting the calorie intake requires strong planning and inhibitory control skills [61,62]. Moreover, higher verbal memory skills may help consolidating the knowledge about the benefits of MedDiet and exercise, which may facilitate adherence to the proposed intervention, and consequently the achievement of the weight reduction goal [63].
Obesity, Cancer, and Risk Reduction with Bariatric Surgery
2021, Surgical Clinics of North AmericaCitation Excerpt :Future research in this area will likely focus on identifying the prognostic factors that can be used to deliver precise care to those patients that would most benefit from bariatric surgery. In fact, preliminary work in this area has already begun in an effort to better serve patients desiring weight loss99; however, research into optimizing the use of bariatric surgery in the context of cancer prevention and treatment is still lacking. Based on the systematic literature search used to inform this article, several future research areas have been identified, including research to determine the types of cancer that are most affected by weight-loss surgery, and the effect of different bariatric procedures on cancer mitigation and proliferation.
Comparing remission and recurrence of hypertension after bariatric surgery: vertical sleeve gastrectomy versus Roux-en-Y gastric bypass
2021, Surgery for Obesity and Related DiseasesControl of 24-hour blood pressure with SGLT2 inhibitors to prevent cardiovascular disease
2020, Progress in Cardiovascular DiseasesCitation Excerpt :In turn, middle-aged subjects with pre-HTN are particularly predisposed to developing CVD later in life.206 However, achieving lasting reductions in body weight using standard pharmacological and non-pharmacological interventions is difficult.207–209 Therefore, the decrease in body weight that occurs during treatment with SGLT2i might contribute to the prevention of CVD, although this needs to be evaluated in future randomized controlled trials.
Statement of conflict of interest: See page 19.