Genetic, epigenetic and neuro-hormonal differences between patients affect long term weight loss and weight control, according a recent study that combined perspectives from a series of experts. The report from a National Institutes of Health (NIH) Working Group, which was led by Paul MacLean, PhD, and Rena Wing, PhD, found that the challenges of long-term weight loss maintenance are due to many factors, and it suggests novel approaches able to improve obesity therapeutics, particularly emphasizing weight-loss individualized treatments and maintenance, as well as approaches such as physiology and behavioral psychology cooperation in order to determine more effective and sustainable actions.
The NIH Working Group report is the result of opinions expressed at a recent conference that gathered several experts and varied perspectives on integrative physiology, genetics, endocrinology, and behavioral and cognitive sciences as they pertain to health conditions such as obesity. “Despite advancements in our understanding of obesity, weight regain after weight loss remains the most substantial problem in obesity treatment – with both the body and the mind conspiring against individual efforts to maintain weight loss,” explained MacLean, who serves as the co-chair of the NIH working group.
“There are many differences in individuals ranging from genetic to behavioral that lead some to do well on one approach, whereas others do not. Therefore, what works for a friend or coworker may be very different from a weight-loss program that’s most effective and sustainable for you over the long term,” he added, summarizing the conclusions of the report entitled “Innovative Research to Improve Maintenance of Weight Loss,” which will be published this month in the Obesity journal.
The current treatment approaches being recommended to patients in order to improve maintenance weight loss are usually not effective and do not take into consideration patients’ physiological and behavioral changes that occur during the weight loss process, according to the group co-chair Dr. Rena Wing. “Development of more effective approaches to weight-loss maintenance requires the integration of physiological and behavioral perspectives and a more concerted collaboration between basic and clinical researchers,” she said.
The publishing of the report will also feature a commentary by research and treatment pioneers and TOS past presidents George Bray, MD, of Pennington Biomedical Research Center and Thomas Wadden, PhD, of the University of Pennsylvania, in which the two characterize individualized weight-loss strategies as “promising,” emphasizing their importance in connecting basic and clinical sciences and better targeting obesity therapies.
“In all weight loss trials, whether behavioral, dietary, exercise or pharmacological, some individuals lose a great deal of weight, others an average amount, and some even gain weight,” the commenters state. Bray and Wadden add that personalized treatment should be an “essential focus,” aiming to combine political and societal interventions in order to alter food and activity environments, which they believe currently worsen patients’ struggle to lose and maintain weight.
“Personalized medicine is not a new idea, it is one that is applied and encouraged across many areas of medicine. Why not apply it to obesity treatment?” questioned Chris Ochner, PhD, TOS Public Affairs co-chair and Assistant Professor of Pediatrics and Psychiatry at the Icahn School of Medicine at Mount Sinai. “Weight loss is not a sprint; it’s a marathon.”
In addition, the TOS applauded the initiative of encouraging partnerships between physiological and behavioral investigators in an effort to accelerate research on individualized treatments and develop better weight-maintenance strategies. “Understanding individual differences in treatment response requires expertise in biology and behavior,” said Myles Faith, PhD, of the University of North Carolina at Chapel Hill, who led a TODS Bio-Behavioral Research Section in 2013, which was dedicated to the struggle of bridging patients, ideas and methodologies from different scientific fields.
“Seasoned clinicians, who are keenly observing and working to harness the strengths of individual patients every day, are an integral piece of the puzzle. Individual responses to treatment are at the scientific ‘heart’ of the matter for understanding weight-loss maintenance,” Faith added, as she has worked on encouraging collaborative investigations dedicated to increasing knowledge on the interactions of biological, behavioral and environmental factors that affect obesity.
Finally, the authors of the NIH working group report recommended, in addition to personalized weight-loss strategies, the continued study of pharmacological therapies to combat physiological alterations due to weight loss, new methods of increasing physical activity programs adherence, the engineering of food as a way of increasing palatability and satiation, and ultimately improving long-term adherence to a lower-calorie diet.