By Andres J. Acosta, MD

The most prevalent and expensive disease in the world, obesity is a problem that we must aim to solve. I believe food is the way to do so, since nutrition is the cornerstone of both wellness and a spectrum of diseases. As healthcare professionals, it is critical that we learn about the nutritional status and habits of our patients and use food as medicine to help treat illnesses, especially chronic noncommunicable diseases like obesity, diabetes, and hypertension.

Unfortunately, there are many misconceptions related to nutrition and obesity among patients and clinicians alike. Many believe that obesity is a behavioral disease and that individuals with obesity simply lack the willingness to lose weight. As clinicians know, obesity is a biological disease with pathophysiological changes that predispose an individual to both gain weight and difficulty losing it.

This misconception must evolve into a new understanding of the pathophysiological changes that occur in obesity in the brain-gut-adipose axis. Once we fully understand obesity as a disease, both patients and clinicians can better seek evidence-based therapies to counter these pathophysiological abnormalities.

In the treatment of obesity, the one-size-fits-all approach is not working. I believe that precision medicine for obesity will help identify the “right intervention for the right patient.” With this approach, we can enhance weight loss and individually tackle the pathophysiology of obesity.

Chronic, relapsing, and multifactorial, obesity features significant individual variability in response to therapeutic interventions. At the Obesity Medicine Association’s fall conference, Overcoming Obesity 2022, I discussed this topic further, delving into the heterogeneity of human obesity and identifying predictors of response to weight loss interventions. Specifically, my team and I are evaluating four potential pathophysiologic and behavioral obesity phenotypes: abnormal satiation, abnormal post-prandial satiety, abnormal emotional eating, and abnormal resting energy expenditure. We hypothesize that obesity-related phenotypes may predict weight loss through an individualized lifestyle intervention based on a tailored Mayo Clinic diet program.