Six Different Kinds of Obesity (For Starters)

Different kinds of obesity may well require different kinds of treatment. The medical establishment is just barely coming to terms with the realization that obesity is a disease. But the scientists who devote their careers to obesity have moved on to trying to understand the different subtypes of obesity that will likely require different kinds of treatment. Alison Field and colleagues have published a thoughtful perspective on these efforts in the latest issue of the Journal of the American Medical Association (JAMA).

The task of identifying and understanding the important subtypes of obesity is at a very early stage, but here are a few candidates identified by Field et al:

  1. High Insulin Secretion. Insulin secretion has been found to be highly predictive of one’s response to a low-fat diet for the treatment of obesity. People with high insulin secretion may be resistant to weight loss on a low-fat diet.
  2. Low Response to Fullness. Children with the lowest-risk form of the obesity-associated FTO gene have been shown to respond better to signals of fullness than children with higher-risk forms of the gene. In this way, the low-risk form of the gene provides protection against overeating. For people who lack this protection, treatments that compensate for its absence may be especially useful.
  3. High Response to Food Cues. The sight and smell of food elicits a greater response — desire to eat and salivation — in some people with excess weight than in people who are more resistant to obesity.
  4. Learned Preferences for Junk Food. Learned preferences for food high in calories, fat, sugar, and salt — junk food — are developed early in life. Tailored behavioral interventions may be useful in addressing this risk factor.
  5. Binge Eating or Food Addiction. Binge eating and food addiction are two distinct, possibly related conditions associated with obesity that may require treatment tailored to the needs of the individuals affected.
  6. Activity Avoidance or Rest Seeking. The relative reinforcing value of physical activity and sedentary activities have been shown to have significant impact on an individual’s engagement in physical activity and risk of obesity. Individuals vary greatly in the reinforcement they naturally receive from physical activity.

More than forty years ago, at the beginning of the “War on Cancer,” oncologists already had an understanding of the different types and stages of cancer. The understanding of cancer subtypes has exploded since then and continues to grow with the emergence of genomic or personalized medicine. Similar approaches have led to much more effective treatment in other chronic diseases, but not so much in obesity yet.

Data from the Longitudinal Assessment of Bariatric Surgery (LABS) study shows that some people respond to obesity surgery much better than others. The challenge now is to figure out who the responders are, why they respond, and how to personalize treatment for better outcomes.

We need to do this across the spectrum of obesity and excess weight.

Click here to read more from Field et al in JAMA, here for more about insulin secretion, here for more about responders to fullness, here for more about responsiveness to food cues, here for more about learned preferences for junk food, here for more about binge eating, here for more about food addiction, here for more about the reinforcing value of physical activity, and here for more on responder data from the LABS study.

57 Varieties, photograph © chrisinplymouth / flickr

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