Individual Variation in the Calories It Takes to Satisfy a Person

So many people are chasing the concept of precision medicine for obesity. Because we can easily imagine that the rewards will be great. Right now, in treating obesity the clinical approach is something of a trial and error process. But the wish is to be able to assess a patient and from the start have a good idea of what will work and what will not. One small step in that direction appeared in Cell Metabolism on Friday. Lizeth Cifuentes, Diego Anazco, Timothy O’Connor, and colleagues showed that using a genetic risk score together with a measure of the calories it takes to satisfy an individual can help distinguish whether liraglutide or phentermine-topiramate is more likely to work better in that individual.

Yes, this is a small step. But big progress often comes from a series of small steps. Certainly in precision medicine for obesity it seems like this will be the case.

Calories to Satiation

Right up front, we need to acknowledge that these findings appear to come from a post-hoc analysis of pre-existing clinical data collected for other purposes. The authors acknowledge this deep within the paper, briefly, when they discuss the limitations of their findings:

“The validation of satiation measurement by the ad libitum meal and the CTS-GRS (calories to satiation genetic risk score) as predictors of weight loss response to liraglutide involved a post-hoc analysis of a completed randomized clinical trial. To ensure our findings are robust and not artifacts of specific samples or methods, it is crucial to replicate these results using pre-specified methodological designs and conduct further prospective randomized controlled clinical trials to validate the predictive utility of the ad libitum meal test and the CTS-GRS.”

In other words, we should think of this work as the product of an exploratory analysis. Not the product of a prospective experiment.

So we can hope that this concept of calories to satisfy will indeed help to distinguish people who will respond to one therapy better than another.

The Problem to Overcome

Clearly, the vision for precision medicine in obesity is an aspiration for the future. Two of the authors of the present paper, Diego Anazco and Andres Acosta, describe the problem that motivates this aspiration in a recent review:

“Currently, the trial-and-error paradigm for the selection of antiobesity medications results in increased costs and risks for developing side effects, while also reduces engagement in weight management programs for patients with obesity.”

Indeed for now, precision medicine for obesity is more a dream than reality. Clinicians and researchers have good reason for trying to make that dream a reality.

Click here for the paper by Cifuentes et al and here for the review by Anazco and Acosta. For more on this subject, click here.

Le Déjeuner, painting by Pierre Bonnard / Wikimedia Commons

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June 8, 2025