One to Watch: Precision Medicine for Obesity

If you want to understand where the future lies in obesity medicine, Aaron Kelly suggests you look closely at precision medicine. At the fall summit of the Obesity Medicine Association yesterday, Kelly offered a tantalizing overview of this approach. But for now, he cautioned, clinicians have to fall back on a more pragmatic approach. In stepwise fashion, they employ the best available options to find the best combination for each patient.

Distinctly Different Patients, But One Diagnosis

Obesity seems deceptively simple. The body stores excess energy as fat. Excess fat tissue sets off a chain of events that affect virtually every system of the body. The result is a complex web of chronic health problems.

But that popular conception glosses over the diverse factors behind this disease. Genetic, physiological, behavioral, social, economic, and environmental factors all play a role. So in different patients, they play different roles. Different dynamics set up different challenges for reversing the problem. A treatment that might put the disease into remission for one patient  might have little effect in the next one.

Accounting for Heterogeneity

Kelly explained. The whole point of precision medicine is to account for heterogeneity. Provide the right treatment to the right patient at the right time. Contrast that to the current default in primary care. Brief advice to eat less and move more has no effect. But the right treatment can have a transforming effect on a person’s life and well-being.

To identify that treatment right now, clinicians are in a bind. All they have are what Kelly calls primordial predictors. They are a few objective factors that might offer clues for treatment. Things like measures of disordered eating, appetite, weight trajectory, and prior history.

Precision medicine for obesity is a far cry from the sophisticated state of play in cancer care. But, says Kelly, research is moving in that direction. As an example, he points to the NIH ADOPT project. It aims to build the data for predicting optimal treatment approaches.

In the end, the wide gap between current practice and precision medicine for obesity is daunting. But the work is progressing. The cohort of providers determined to deliver better care is growing at impressive rate. Close to 900 clinicians participated in OMA’s summit. Thousands more will gather in Nashville for ObesityWeek.

Without a doubt, we can feel the momentum growing for better care.

Click here for Kelly’s presentation slides. For more on the subject, click here.

Der Rote Faden, photograph © Pascal Volk / flickr

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September 30, 2018