“One Size Fits All” Fails in the Age of Personalized Medicine

The Harvard Blackburn Course in Obesity Medicine never fails to nourish us with fresh thinking about obesity. In opening the course yesterday, Lee Kaplan explained that treating obesity as a disease means dealing with it as we would any other chronic health condition. And in an age of personalized medicine, that certainly means one size fits all simply no longer fits.

The Miracle Cure of Diet and Exercise

Some things endure. Brush your teeth. Get your sleep. Eat a healthy diet and drink plenty of water. Exercise. Just about everyone has heard this from their mother. Advice about diet and exercise is the bedrock of advice for weight management.

So most people who are living with obesity are very familiar with concepts of diet and exercise that can produce an average of five to ten percent weight loss. And if they can keep it up, an average person can maintain a reduced weight. As little as three percent weight loss, maintained over time, provides health benefits.

The problem comes when you are dealing with real people. Almost no one is average. A few people do great on a new diet. Some people lose a bit of weight. And some of those keep it off. But some gain it all back. And some never lose any weight or even gain weight on a new diet.

It’s not becuase they’re stupid, unmotivated, or disobedient. It’s just not working for them. For any other disease, a good healthcare provider moves on to another treatment if an initial treatment doesn’t work.

But somehow in obesity, most providers have convinced themselves that diet and exercise ought to work for everyone. In fact, most people with obesity believe that. They come to believe that there’s something personally wrong with them because their body hangs on to extra weight, despite their best efforts to lose it.

Moving On to Other Options

Fortunately, we have other options. Four new drugs have been approved in the last several years. New medical devices — like gastric balloons and vagal nerve blockers — can help. And bariatric surgery — most ofen a gastric sleeve or gastric bypass — can be quite effective.

But none of these therapies are effective for everyone. Even for gastric bypass surgery, a very few people will lose little or no weight. Fortunately, this number is small. But as you can see from the chart that Kaplan presented, it exists.

This explans why one size cannot fit all for obesity care. Good obesity care providers have a number of tools at their disposal. Finding the right options for an individual patient requres an iterative process of trial and error. And even then, relapses will happen after a treatment initially works well. Then the process resumes until the condition is back under control

Good obesity care has moved beyond a brain-dead, exclusive reliance on diet and exercise. And even so, getting to truly personalized obesity medicine will require considerably more insight from ongoing research.

For further thoughts on possibilities for personalized medicine in obesity treatment and prevention, click here.

Size to Fit, photograph © Andy Magee / flickr

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June 23, 2017