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May 23, 2023 – Seems like a simple solution to a complicated problem – find out what gentle of obesity you have based on a unique genetic saliva test. Then you and your doctor can get a better idea of whether anti-obesity drugs or other treatments are more likely to work for you.
The goal of creating the obesity types and test is to increase the chances that you will lose weight and improve your health and well-being, rather than a one-size-fits-all approach. It’s what Mayo Clinic researchers had in mind when they created four obesity phenotypes.
Obesity experts not affiliated with the research have some concerns, saying independent studies are needed to verify the potential of this strategy.
This research could help predict who will respond best to popular obesity drugs, said Andrés Acosta, MD, PhD, co-founder of Phenomix Sciences, the company behind the trials. These drugs include the class of drugs called glucagon-like peptide (GLP-1) receptor agonists, such as liraglutide (Saxenda, Victoza) and semaglutide (Ozempic, Wegovy).
“We know that not all users of a GLP-1 will respond. Actually, about a third of patients don’t do well on GLP-1s,” said Acosta, an assistant professor of medicine and researcher in the Division of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, MN.
The most advanced in development is the “My Phenome Hungry Gut” test to predict the GLP-1 response. People in this hungry gut group tend to empty their stomachs faster after a meal and are more likely to feel hungry again soon after, as explained in the company website.
A pilot study to test how well it works began in April in three primary care practices. Plans are to scale up real-world testing for this and other types of obesity later this year.
The other categories of obesity are:
- “Hungry brain,” where the brain doesn’t recognize signals that the stomach is full
- “Emotional hunger,” where cravings to eat are driven by emotions, anxiety, and negative feelings.
- “Slow Burn”, where people have a slow metabolism and low energy level
People in these categories are more likely to benefit from other obesity control strategies, such as changes to their diet or placement of a intragastric balloon.
Some things to consider
While they applaud their efforts to be more accurate in treating people with obesity, not all experts are convinced that this saliva test is the answer. The company’s research may seem promising, but verification of the results is warranted.
“Can we get better results with things like this? Well, that’s the hope,” said Jaime Almandoz, MD, medical director of Weight Wellness at the University of Texas Southwestern Medical Center in Dallas.
“We don’t yet have randomized trials looking at the obesity phenotype,” said Almandoz, who is also a spokesperson for The Obesity Society, a professional group of physicians, researchers, educators and others who focus on obesity science. treatment and prevention.
There is always concern when a diagnostic test is developed for commercial use, said Daniel Bessesen, MD, professor of medicine, endocrinology, metabolism and diabetes at the University of Colorado School of Medicine in Denver. “What they are talking about doing is super important. But this is a company. This is a company that, I think, is selling a product.”
In an online search, Bessesen didn’t find any external studies showing how well the saliva test worked. But referring to the work of Acosta and Michael Camilleri, MD, the other co-founder of Phenomix, he said, “I found some articles that they did that I hadn’t read before that are good.”
“These guys are smart guys. And they have worked a lot on [the movement of food through the gut] and how that correlates with obesity and response to some therapies,” said Bessesen, who is also a spokesperson for The Obesity Society. “So his scientific work aligns with this area.”
Validation of any research is important because the obesity industry has been known for many rapid weight loss strategies, some with little or no science behind them, he said.
It’s also essential, he said, because “anytime you do anything commercial in the obesity arena, you have to recognize that people with obesity are a vulnerable population. These people face stigma and prejudice all the time.”
Eliminating the stigma
If knowing your type of obesity ends up making a difference, it could change the conversation people have with their medical provider, Acosta said. It could also help remove some of the stigma around obesity.
“We’re going to change the conversation because now we can say, ‘Hey, you have obesity because you have the ‘Hungry Gut’ phenotype. And for that, you are going to respond to this medication,” Acosta said. Phenotyping suggests a strong genetic tendency, a biological basis for obesity.
“So it’s not just a way to take the blame off, but also a way to explain that there’s a reason why you’re obese,” Acosta said. He tells people: “You are not a failure.”
Most profitable treatment?
Focusing on obesity treatment could also save on overall health care costs, Almandoz said. She estimated a cost of $1,400 per month for “forever and ever semaglutide” or at least $1,400 per month for a 3-month trial to see if this drug works in a particular obese person.
“That’s a lot of money when you extrapolate over the number of people likely to meet the criteria for treatment,” he said. A total of 42% of Americans meet the CDC definition for obesity.
“You can imagine the potential cost if we were to provide anti-obesity therapies to everyone and use the most effective class of drugs, which is over a thousand dollars a month, indefinitely,” Almandoz said. “It’s not that we shouldn’t treat everyone. That is not the message I am saying. But if we’re looking at performance or value in terms of treating obesity in a resource-constrained setting, it may be best to start with who is most likely to benefit.”
How they created four types of obesity
Starting in 2015, Acosta and his colleagues began comparing tests in normal-weight versus obese people. At first, they used artificial intelligence and machine learning to classify obesity into 11 types. They realized that many types of obesity were impractical for clinicians and people with obesity, so they combined them into four phenotypes.
“AI machine learning was followed by, as I like to call it, HI, or human intelligence,” he said.
The saliva test checks about 6,000 genetic SNPs. SNPs are “single nucleotide polymorphisms” or changes in genes. Six thousand gene changes may sound like a large number to check until you learn that people walk around with 5 to 6 million SNPs in their DNA.
The results are translated into a score that shows a low or high risk of Hungry Gut or other types of obesity. “You can have all six thousand gene mutations, or you can have zero,” Acosta said.
Going forward
After the preliminary launch of the Hungry Gut test in April, Phenomix plans to continue studying its saliva test in other types of obesity.
Acosta is not aware of any direct competitors to Phenomix, although that could change. “I think we are the only diagnostic company in the space right now. But if it’s really a $14.8 billion market, we’re going to see a lot of diagnostic companies trying to do what we’re doing, if we’re successful,” he said.
A October 2022 report from Polaris Market Research estimates that the global market for obesity treatment (drugs, surgery, and everyone else) was approximately $14 billion in 2021. The same report predicts that the market will grow to $32 billion by 2030.
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