I recently listened to an interesting episode of #Obesity: A Disease - the official podcast of the Obesity Medicine Association. In it, Dr. Nicholas Pennings speaks with Dr. Andres Acosta about the four main phenotypes that lead to weight gain. According to Dr. Acosta, (an MD and PhD*) 85% of people struggling with their weight fall into one or more of the following four main phenotypes:

1. The hungry brain
   People in this group feel very hungry and consume more calories during each meal.

2. The hungry gut
   Members of this group eat a normal amount during each meal but tend to get hungry frequently. This may have to do with food moving more rapidly through their gut.

3. Emotional hunger
   Members of this phenotype struggle most with controlling their caloric intake due to their emotions. 

4. Slow burn 
   People in this group can do everything right but have a slower metabolism. It is very important for them to focus on burning more calories through increased activity (number of steps) and resistance exercise to build muscle.

In the study, one group of patients were treated according to their phenotypes and compared to another group of patients where phenotype was not used to direct treatment. The study found that phenotype-directed therapy leads to almost double the weight loss than non-phenotype-directed therapy. Over 79% of patients using a phenotype-guided anti-obesity medication choice lost more than 10% of their body weight compared to just 35% of those patients where phenotyping was not used.

These study results are intriguing and I am considering changing some of the questions I initially ask patients. Based on their answers, I can provide them with more tailored lifestyle changes and anti-obesity medication recommendations that may work better for them.

* Makes me want to say ‘doctor ‘ twice like in the ‘Spies Like Us’ scene where Dan Aykroyd and Chevy Chase are saying hello to a group of doctors. See the clip here: https://www.youtube.com/watch?v=hoe24aSvLtw