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

Individual Variation in Response to Different Diets

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

Variation in Individual Responses to Different Obesity TreatmentsFortunately, 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

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

  1. June 23, 2017 at 7:39 am, Angie Golden said:

    Once again your blog provides excellent information overview of a conference you are attending and I am looking forward to sharing your sage advice except for one small portion “Good obesity medicine physicians have a number of tools at their disposal.”. All providers – primary care nurse practitioners and my other primary care colleagues, as well as NPs and PAs that are obesity specialist will be able to use the tools! :). Seriously, though this is a very timely and special blog as I am sitting waiting for Dr. Melissa Davis to present on Primary Care of the Bariatric Patient: Post Surgery and Life time Followup”. Thanks for all your work!

    • June 23, 2017 at 8:14 am, Ted said:

      Thanks, Angie. I stand corrected.

  2. June 23, 2017 at 10:06 am, Stephen Phillips / American Association of Bariatric Counselors said:

    You are spot-on

    Obesities have a very common visible presentations with very invisible causations, Trained bariatric practitioners identify the biological mechanisms, psychological processes and social influences of an individual, prior to crafting a treatment plan.

    Bariatric Science is a Science Who’s Time Has Come