Gastrointestinal traits: individualizing therapy for obesity with drugs and devices

Abstract

Objectives The objectives were to review the discrepancy between numbers of people requiring weight loss treatment and results, and to assess the potential effects of pharmacological treatments (recently approved for obesity) and endoscopically deployed devices on quantitative gastrointestinal traits in development for obesity treatment. Methods We conducted a review of relevant literature to achieve our objectives. Results The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9% (116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss ~5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These gastrointestinal and behavioral traits identify sub-phenotypes of obesity based on recent research. Conclusions The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative gastrointestinal and behavioral traits measured in obese patients.

Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events

“…2 Ultimately, given the differences in safety, efficacy, and response to therapy, the ideal approach to weight loss should be highly individualized, identifying appropriate candidates for pharmacotherapy, behavioral interventions, and surgical interventions. 53 Historically, concerns regarding the long-term safety profile of pharmacotherapy for weight loss have limited their clinical use, particularly among medications with significant adrenergic actions (eg, sibutramine) or central appetite-suppressing actions (eg, rimonabant). 54 Short-term clinical trials may not provide comprehensive information on the long-term safety of these agents, and prospective postmarketing surveillance studies are warranted.…”

Amylin receptor activation in the ventral tegmental area reduces motivated ingestive behavior

“…However, the results of the free-choice diet experiments demonstrate an intriguing effect of baseline food preferences on the ability of amylin to suppress intake of particular foods. With the growing interest in individualized medicine for obesity and related comorbidities (Camilleri and Acosta, 2016; Kaul and Ali, 2016; Reddon et al, 2016), these results also underscore the importance of recognizing preexisting individual differences when identifying novel treatment strategies for obesity.…”

A working paradigm for the treatment of obesity in gastrointestinal practice

“…by urinalysis or finger stick blood glucose) and obstructive sleep apnea [using validated sleep apnea questionnaires or the sleep apnea clinical score (29)]. With the assessment completed, the multidisciplinary team can suggest the appropriate intervention based on the health needs, expected weight loss, the patient’s wishes and expectations according to the patient’s BMI (Table 1 or NIH recommendations) or individualized to the patient’s phenotype, such as behavioral or psychological issues associated with documentation of accelerated gastric emptying of solids (30). ).…”