May 23, 2023 – It seems like an easy solution to a sophisticated problem: Find out what Type A one-time genetic saliva test will determine your risk of obesity, which is able to show you how to and your doctor determine whether obesity medications or other treatments usually tend to be just right for you.
The goal of developing obesity types and tests is to extend your likelihood of dropping pounds and improving your health and well-being, quite than taking a one-size-fits-all approach. That's exactly what Mayo Clinic researchers had in mind once they developed 4 obesity phenotypes.
Obesity experts not involved within the research have some concerns and say independent studies are needed to verify the potential of this strategy.
This research could help predict who will respond best to common obesity drugs, said Andres Acosta, MD, PhD, co-founder of Phenomix Sciences, the corporate behind the tests. These drugs include a category of medication called glucagon-like peptide receptor (GLP-1) agonists, akin to liraglutide (Saxenda, Victoza) and semaglutide (Ozempic, Wegovy).
“We know that not everyone responds to GLP-1. In fact, about a third of patients do not tolerate GLP-1 well,” said Acosta, an assistant professor of drugs and researcher within the division of gastroenterology and hepatology on the Mayo Clinic in Rochester, Minnesota.
The most advanced test in development is the My Phenome Hungry Gut test for predicting the GLP-1 response. People on this hungry gut group are likely to empty their stomachs more quickly after a meal and usually tend to feel hungry again shortly afterwards, as shown in the company website.
A pilot study to check the effectiveness of this system began in April in three GP practices, and real-world testing can be expanded to incorporate these and other kinds of obesity later this yr.
The other obesity categories are:
- “Hungry brain,” where the brain doesn't recognize signals that the stomach is full
- “Emotional hunger,” where the need to eat is triggered by emotions, fears, and negative feelings
- “Slow Burn” when people have a slow metabolism and low energy levels
People in these categories could also be more more likely to profit from other strategies to combat obesity, akin to changing their food regimen or using a intragastric balloon.
Some things to think about
While the corporate's efforts to supply more precise treatment for obesity patients are welcomed, not all experts are convinced that this saliva test is the answer. The company's research could seem promising, but verification of the outcomes is required.
“Can we get better results with things like this? Well, that's the hope,” said Dr. Jaime Almandoz, medical director of Weight Wellness on the University of Texas Southwestern Medical Center in Dallas.
“We still don't have randomized trials looking at obesity phenotyping,” said Almandoz, who can be a spokesperson for the Obesity Society, knowledgeable association of clinicians, researchers, educators and others focused on the science, treatment and prevention of obesity.
There are at all times concerns when a diagnostic test is developed for business use, says Dr. Daniel Bessesen, professor of medicine-endocrinology, metabolism and diabetes on the University of Colorado School of Medicine in Denver. “What they're saying is super important. But this is a company. I think this is a company selling a product.”
In an internet search, Bessesen found no outside studies showing how well the saliva test worked. But citing the work of Acosta and Dr. Michael Camilleri, Phenomix's other co-founder, he said, “I found some work by them that I hadn't read before that is good.”
“These guys are smart guys. And they have a lot of work in [the movement of food through the gut] and how that correlates with obesity and response to some therapies,” said Bessesen, who is also a spokesperson for the Obesity Society. “So their scientific work actually fits into that area.”
Validating any research is important because the obesity industry is known for many quick weight-loss strategies, some of which have little or no scientific basis, he said.
This is also important because “any commercial action in the area of obesity must take into account that obese people are a vulnerable population group. These people are constantly confronted with stigma and prejudice.”
Eliminate the stigma
If knowing the type of obesity makes a difference, it could change conversations with doctors, Acosta says. It could also help reduce the stigma around obesity.
“We're going to change the conversation because now we can say, 'Hey, you're obese because you have the hungry gut phenotype. And that's why you're going to respond to this drug,'” Acosta said. Phenotyping suggests a strong genetic predisposition – a biological basis for obesity.
“So it's not only a way to deflect blame, but also to explain that there's a reason for the obesity,” Acosta said. It tells people, “You're not a failure.”
Cheaper treatment?
Targeting obesity could also reduce overall health care costs, Almandoz said. He estimated costs at $1,400 a month “for semaglutide forever and ever,” or at least $1,400 a month for a three-month trial to see if this drug works for a specific person with obesity.
“That's a lot of money when you extrapolate that to the number of people who probably meet the criteria for treatment,” he said. Overall, 42% of Americans meet the CDC definition of obesity.
“You can imagine the potential cost if we were to offer obesity treatment to everyone using the most effective drugs. That would be over a thousand dollars a month, indefinitely,” Almandoz said. “That's not to say we shouldn't treat everyone. That's not the message I'm trying to convey. But when we consider the benefit or utility of treating obesity in a resource-limited setting, it may be best to start with those who are most likely to benefit.”
How they created four obesity types
Starting in 2015, Acosta and his colleagues began comparing tests in normal-weight people with obesity. They used artificial intelligence and machine learning to initially classify obesity into 11 types. They realized that so many obesity types were not practical for doctors and obesity patients, so they grouped them into four phenotypes.
“The machine learning of AI was followed by what I like to call HI or human intelligence,” he said.
The saliva test checks about 6,000 relevant genetic SNPs. SNPs are “single nucleotide polymorphisms,” or changes in genes. Six thousand genetic changes may sound like a big number to check until you learn that there are people walking around with 5 to 6 million SNPs in their DNA.
The results are translated into a score that indicates a low or high risk of hungry gut or other types of obesity. “You can have all six thousand genetic mutations, or you possibly can have zero,” Acosta said.
Moving forward
Following the soft launch of the Hungry Gut test in April, Phenomix plans to continue testing its saliva test on other types of obesity.
Acosta is not aware of any direct competitors to Phenomix, but that could change. “I feel we're the one diagnostics company on this space immediately. But if it truly is a $14.8 billion market, we're going to see plenty of diagnostics corporations attempting to do what we're doing — if we're successful,” he said.
A Report from October 2022 of Polaris Market Research estimates that the worldwide marketplace for obesity treatment — drugs, surgery, and every part else — was about $14 billion in 2021. The same report predicts the market will grow to $32 billion by 2030.