The long and difficult quest to personalize obesity medicine

A group of doctors at Mayo Clinic are delivering weight loss treatments tailored to each patient — but the work is controversial.

Reading a lot about obesity over the years, one thing has become remarkably evident: it’s not one thing, it’s many.

First, there are a multitude of causes. In rare cases, obesity is brought on by a single-gene disorder, or even a head injury. More commonly, it’s thought to be “polygenic” — caused by many gene variants and their interactions with our environment. The impact of excess weight also varies widely. Some people struggle with metabolic disorders, such as diabetes, even at lower BMIs. Others are spared the metabolic complications, but have obesity-related knee pain or even cancer. This is part of the reason why the question of whether obesity constitutes a disease is so fraught. As the authors of a recent Lancet Commission about defining obesity point out, “Logic and evidence suggest that obesity can be both a risk factor and, sometimes, a disease in and of itself.”

Yet, doctors typically use one-size-fits-all solutions to care for patients with obesity. Until the recent approval of GLP-1 drugs, such as Ozempic and Wegovy, people were typically given “eat less, move more” prescriptions, which in most cases failed. Even with the GLP-1s, considered true medical breakthroughs, responses can vary widely. As one doctor, Andres Acosta, told me, we are still approaching obesity the way doctors did cancer decades ago, treating every manifestation bluntly, as if it were the same thing.

So I wondered if there were any health providers who were trying to reflect obesity’s diversity in the clinic, taking an individualized approach to care. As it turns out, there’s a team at the Mayo Clinic in Rochester, Minn., led by Acosta, and since 2016, they have been experimenting with personalized obesity medicine. The work is controversial, as I wrote in Stat today — part of a long, mostly fruitless effort, to subtype obesity and deliver tailored treatments. But it represents what many consider to be a holy grail in obesity medicine — treatment to reflect obesity’s diverse causes and manifestations.

You can read the whole story here.

Thanks, as usual, for checking in — and please reach out with comments, questions, or tips any time.

Julia

Correction: An earlier version of this post misstated the location of the Mayo Clinic featured in the story. As a Torontonian, I reflexively wrote Rochester *New York* but as stated in the story, it’s the Minnesota Rochester. I updated the post to correct that.