Obesity management has evolved significantly in recent years, moving beyond generic dieting methods and even advanced Medical Nutrition Therapy (MNT). Today, a more personalized and precise approach to weight management considers the type of hunger driving a person’s eating behaviour. This understanding has led to the concept of “Obesity Phenotypes,” which categorizes patients based on their primary hunger type, allowing for more effective, individualized treatment strategies. By recognizing these phenotypes, healthcare providers can offer tailored therapies that better address each individual’s needs, leading to improved outcomes in weight management.
How Has Obesity Management Evolved?
Historically, weight loss strategies focused on dieting, primarily through calorie restriction and food avoidance. While these methods could lead to short-term weight loss, they often result in unsustainable habits. They also failed to consider the quality of the diet or an individual’s specific nutritional needs.
As our understanding of nutrition evolved, we moved towards Medical Nutrition Therapy (MNT), which emphasized a more balanced approach by including all macronutrients—carbohydrates, proteins, and fats—rather than simply eliminating certain foods.
However, even MNT does not work for everyone because it does not account for the diverse underlying drivers of hunger across different phenotypes. This realization has led to a “nutri-conscious” approach, which focuses on the quality and timing of calorie intake rather than just the quantity.
Modest Medix applies this “Nutri-conscious” approach that focuses on the content and quality of calories, not just calorie restriction. Unlike traditional dieting, this method emphasizes personalized nutrition plans tailored to the specific needs of each obesity phenotype.
It recognizes that different macronutrients—such as proteins, carbohydrates, and fats—affect hunger and metabolism differently depending on an individual’s obesity phenotype. For some phenotypes, starting a meal with all vegetables might be more effective; for others, consuming protein before and during the meal is crucial. Some may need a post-meal snack to manage hunger better. Understanding and addressing these unique hunger patterns based on phenotypes can significantly improve treatment outcomes.
What Are Obesity Classes, Stages, and Phenotypes?
Initially, obesity was classified by “obesity classes” based on Body Mass Index (BMI), which provided a numerical categorization. As our understanding advanced, this evolved into “obesity stages,” which considered the impact of obesity on metabolic, mechanical, and mental health. This shift was crucial because it acknowledged that health is not solely about body fat presence but also about how it affects bodily functions and overall well-being.
Building on this, the concept of “obesity phenotypes” has emerged, categorizing patients based on factors such as the type of hunger that primarily drives their eating behaviour, their response to exercise, and their reaction to medications. An obesity phenotype is a specific type or pattern of obesity defined by unique characteristics such as how the body stores fat, responds to food, processes energy, experiences different types of hunger, and responds to exercise and medications.
This phenotypic approach allows for more tailored interventions, recognizing that different individuals have varying underlying reasons for their eating habits and weight gain. By addressing these specific drivers, the effectiveness of a weight management plan can be significantly enhanced, offering more success compared to the traditional one-size-fits-all approach. Understanding these phenotypes—including hunger patterns, exercise responsiveness, and medication efficacy—enables healthcare providers to deliver more personalized and effective strategies for managing obesity, leading to better outcomes in both the short and long term.
What Are the Obesity Phenotypes and Their Implications?
Recent research has highlighted the importance of understanding obesity phenotypes for effective weight management. A 2021 study by Dr. Andres Acosta and colleagues at the Mayo Clinic demonstrated that selecting anti-obesity medications based on specific phenotypes resulted in significantly greater weight loss compared to a non-phenotype-guided approach.
Similarly, a 2023 study published in The Lancet confirmed that phenotype-tailored lifestyle interventions led to improved weight loss and reduced cardiometabolic risk factors in adults with obesity. These studies underscore the value of identifying an individual’s obesity phenotype to tailor treatment strategies and optimize outcomes.
The primary obesity phenotypes identified are:
Brain Hungry Phenotype:
This type is controlled by the brain-gut axis and is characterized by an abnormal number of calories needed to reach fullness. Individuals with a Hungry Brain phenotype often continue eating because their brains do not receive the signal to stop, even when their stomachs are full. For these patients, volume-dense and nutrient-dense foods that promote satiety are crucial for effective weight management.
Gut Hungry Phenotype:
This phenotype involves an abnormal duration of fullness. Individuals with a Hungry Gut phenotype may feel full after eating but become hungry again soon after because their gut transit time is shorter, causing food to leave the stomach more quickly. These individuals benefit from dense food which stays longer in the stomach and helps maintain satiety over more extended periods.
Hedonic Hunger Phenotype:
Hedonic hunger is driven by the desire to eat in response to emotions or social pressures rather than physical hunger. Individuals with this phenotype tend to eat for reasons such as stress, sadness, boredom, joy, or social pressure. Managing this type of hunger often requires behavioural therapy, emotional regulation strategies, and mindfulness techniques to break the cycle of emotionally and socially influenced eating.
Slow Burner Phenotype:
Slow Burners have a decreased metabolic rate, meaning they burn calories more slowly than others. These individuals often find it challenging to lose weight, even when consuming fewer calories. This phenotype is commonly seen in menopausal and ageing individuals. Management strategies may involve a combination of dietary changes, increased physical activity, and potentially pharmacological support to enhance metabolism.
MNT Gap Phenotype:
This phenotype concept has emerged in clinical practice to describe individuals who have a limited understanding of nutrition or lack the knowledge needed to manage their diet effectively. These individuals are not metabolically compromised but instead are missing key information about healthy eating. When provided with proper education and guidance on nutrition, they often see remarkable success in their weight management efforts. For them, the most effective approach is bridging these knowledge gaps with tailored nutritional education, making them some of the most responsive patients to weight management programs.
How Does Modest Medix Approach Obesity Phenotypes?
At Modest Medix, our weight management program based in Mississauga, Ontario, Canada, we have embraced this advanced understanding of obesity phenotypes. Our comprehensive and holistic team, comprising medical professionals such as medical doctors, registered dietitians, social workers, and healthcare educators, is dedicated to providing well-rounded care to our patients.
We keep up with the current medical literature and offer realistic, sustainable, enjoyable, and reliable information based on the latest evidence. Through these holistic and personalized interventions, Modest Medix ensures that each patient receives a tailored, comprehensive plan that addresses their unique obesity phenotype, leading to more effective and sustainable weight management outcomes.
Emotion Regulation:
At Modest Medix, this approach helps patients change their thinking patterns and beliefs around food and eating habits, which is particularly effective for those with Brain and Hedonic Hunger phenotypes. For individuals with Hedonic Hunger, specific techniques to manage emotional triggers that lead to overeating, such as stress or boredom eating, are employed.
Nutri-Conscious Approach:
At Modest Medix, this approach focuses on the content and quality of calories, not just calorie restriction. Unlike traditional dieting, this method emphasizes personalized nutrition plans tailored to the specific needs of each obesity phenotype. Our program creates unique and individualized plans that align with the patient’s specific hunger patterns and metabolic needs.
Meal Replacement Therapy:
The Meal Replacement Therapy offered by Modest Medix is particularly beneficial for Slow Burner phenotypes, where an accurate count of calories is crucial due to their lower metabolic rates. This option supports patients who find it challenging to lose weight despite low-calorie diets by providing a reliable, portion-controlled option.
Genetic Testing:
At Modest Medix, we use genetic testing to uncover how a person’s unique DNA affects their metabolism and hunger signals. This insight helps us create tailored weight management plans, delivered through a digital app for a more personalized and effective health journey.
Wellness Integration:
Wellness at Modest Medix takes a holistic approach that extends beyond diet and exercise, encompassing nutrition, sleep, bowel health, physical activity, stress management, and lifestyle adjustments. We ensure the body is properly nourished and energized, supporting health across all phenotypes. Regular wellness check-ins and fuel assessments guide patients in maintaining their health goals.
Anti-Obesity Medications:
Medications such as Saxenda, Ozempic, Wegovy, Contrave, Mounjaro, and Orlistat are commonly used to help obesity management by controlling appetite, enhancing feelings of fullness, or improving metabolism. These medications are selected and prescribed based on each patient’s specific obesity phenotype and unique needs. By tailoring the choice of medication to individual hunger patterns and metabolic responses, Modest Medix ensures that weight loss is optimized as part of a comprehensive weight management strategy. Regular monitoring and adjustments are made to achieve the best possible outcomes for patients.
Conclusion
As a physician specializing in weight management, I see the differentiation of obesity phenotypes as a transformative step in personalized care. By understanding the type of hunger driving a patient’s eating behaviour, we can move beyond generic dieting plans and focus on customized, effective strategies that cater to their specific needs. This approach improves weight loss outcomes and fosters a healthier, more sustainable relationship with food and body.
At Modest Medix, we are committed to providing next-level, personalized care based on the latest scientific understanding of obesity phenotypes.
References:
- Acosta A, Camilleri M, Abu Dayyeh BK, et al. Selection of antiobesity medications based on phenotypes enhances weight loss: a pragmatic trial in an obesity clinic. Obesity (Silver Spring). 2021;29(4):662-671.
- Cifuentes L, Berends HJ, Schriever L, et al. Phenotype-tailored lifestyle intervention on weight loss and cardiometabolic risk factors in adults with obesity: a single-centre, non-randomized, proof-of-concept study. Lancet Diabetes Endocrinol. 2023;58:101923.
About the Author:
Dr. Saima Khan, MD, CCFP, IPM, dABOM, is an Interventional Pain Medicine Specialist and Diplomate of the American Board of Obesity Medicine. As an Acceptance and Commitment Therapy (ACT) Therapist, she specializes in guiding patients with obesity and chronic pain toward value-driven living and meaningful actions. Dr. Khan is passionate about offering realistic, enjoyable, and sustainable health solutions that address both the physical and psychological needs of her patients. Through her innovative approach at Modest Medix and commitment to holistic care, she inspires individuals to take charge of their well-being.
