Heterogeneity in Response to Treatment of Adolescents with Severe Obesity: The Need for Precision Obesity Medicine

Justin R. Ryder, Alexander M. Kaizer, Todd M. Jenkins, Aaron S. Kelly, Thomas H. Inge, Gabriel Q. Shaibi

Research output: Contribution to journalArticlepeer-review

14 Scopus citations

Abstract

Objective: Treating pediatric severe obesity is challenging because of the complex biological, behavioral, and environmental factors that underpin the disease. The multifactorial etiology of obesity combined with the physiologic complexity of the energy regulatory system contributes to treatment variability. The goal of this secondary analysis of pooled data was to describe the degree of individual variation in response to various interventions among adolescents with severe obesity. Methods: Data from three centers across the United States conducting either lifestyle (n = 53), pharmacotherapy (n = 40), or metabolic and bariatric surgery (n = 78) interventions were pooled. Inclusion criteria were severe obesity at baseline and at least one follow-up visit > 30 days after treatment start. Results: Change in BMI following intervention ranged from −50.2% to +12.9%, with each intervention (lifestyle [range: −25.4% to 5.0%], pharmacotherapy [range: −10.8% to 12.9%], and metabolic and bariatric surgery [range: −50.2% to −13.3%]) exhibiting wide individual variation in response. Changes in cardiometabolic risk factors demonstrated similarly high variability. Conclusions: Adolescents with severe obesity demonstrated a high degree of heterogeneity in terms of BMI reduction and cardiometabolic risk factor response across treatment modalities. Reporting individual response data in trials and identifying factors driving variability in response will be vital for advancing precision medicine approaches to address obesity.

Original languageEnglish (US)
Pages (from-to)288-294
Number of pages7
JournalObesity
Volume27
Issue number2
DOIs
StatePublished - Feb 1 2019

Bibliographical note

Funding Information:
Funding agencies: Funding for the studies were provided by the following: Minnesota Obesity Center (NIH grant P30DK050456 NORC) and General Clinical Research Center (M01-RR00400, National Center for Research Resources [NCRR]/NIH); Community Health Collaborative grant from the University of Minnesota Clinical and Translational Science Institute, by award 1UL1RR033183 from the NCRR and by grant 8UL1TR000114-02 from the National Center for Advancing Translational Sciences of NIH; Vikings Children’s Fund; the National Center for Advancing Translational Sciences (UL1TR000114); an individual training grant from the NIH/National Heart, Lung, and Blood Institute (F32HL127851); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK105953); and NIH/National Institute on Minority Health and Health Disparities (P20MD002316 and U54MD002316). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication. Disclosure: JRR receives support from Boehringer Ingelheim Pharmaceuticals in the form of drug/placebo. THI has received bariatric research grant funding from Ethicon Endosurgery and has served as consultant for Sanofi, NPS Pharma, Up To Date, and Independent Medical Expert Consulting Services, all unrelated to this project. ASK receives research support from Astra Zeneca Pharmaceuticals in the form of drug/placebo and serves as a consultant for Takeda, Orexigen Therapeutics, and Novo Nordisk but does not accept personal or professional income for these activities. The other authors declared no conflict of interest. Additional Supporting Information may be found in the online version of this article. Received: 10 September 2018; Accepted: 29 October 2018; Published online 24 January 2019. doi:10.1002/oby.22369

Funding Information:
agencies: Funding for the studies were provided by the following: Minnesota Obesity Center (NIH grant P30DK050456 NORC) and General Clinical Research Center (M01-RR00400, National Center for Research Resources [NCRR]/NIH); Community Health Collaborative grant from the University of Minnesota Clinical and Translational Science Institute, by award 1UL1RR033183 from the NCRR and by grant 8UL1TR000114-02 from the National Center for Advancing Translational Sciences of NIH; Vikings Children’s Fund; the National Center for Advancing Translational Sciences (UL1TR000114); an individual training grant from the NIH/National Heart, Lung, and Blood Institute (F32HL127851); National Institute of Diabetes and Digestive and Kidney Diseases (R01DK105953); and NIH/National Institute on Minority Health and Health Disparities (P20MD002316 and U54MD002316). The funding agencies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.We would like to thank all of the children who participated in these studies.

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