Phenotype-tailored lifestyle interventions show promising weight loss results in obese adults

Obesity is a chronic multifactorial disease, which is increasing globally at an alarming rate.

An individual with obesity is at a higher risk of metabolic and cardiovascular events. Weight loss in overweight or obese people improves metabolic parameters, reduces the risk of cardiovascular disease, and increases the quality of life.

Study: Phenotype tailored lifestyle intervention on weight loss and cardiometabolic risk factors in adults with obesity: a single-centre, non-randomised, proof-of-concept study. Image Credit: Peakstock / Shutterstock.com

Background

Lifestyle interventions play a significant role in weight management, which commonly includes the consumption of a low-calorie diet, along with moderately intense physical activity. To date, no specific diet has been designed specifically for weight loss.

Diets that are rich in macronutrients or involve specific meal timings are not associated with any superior benefits as compared to standard treatments in terms of weight loss. However, an improved metabolic profile has been observed when genetic data was considered while designing a personalized weight loss diet.

Diet-based interventions for weight loss in obese people must be based on their health status, particularly hypertension, type 2 diabetes, or cardiovascular diseases. To date, no diet-based intervention has been developed to prevent or manage obesity. Therefore, there is an urgent need to formulate a lifestyle and diet intervention that considers the behavioral and pathophysiological features of obesity. 

Based on behavioral and pathophysiologic characteristics, obesity phenotypes have been categorized into hedonic eating behavior, homeostatic eating, and abnormal energy expenditure. To date, researchers have yet to determine whether diet and lifestyle interventions customized to these phenotypes could yield a better outcome as compared to standard lifestyle interventions.

About the Study

A recent eClinicalMedicine journal study developed and assessed the effectiveness of a phenotype-tailored lifestyle intervention on weight loss, physiologic parameters, and cardiometabolic risk factors in obese adults. 

The current proof-of-concept study is a single-centered, non-randomized trial that has been associated with a single intervention team. All participants, which consisted of both men and women, were adults, and body mass index (BMI) values exceeding 30 kg/m².

The study was divided into two phases. Individuals who were associated with the first phase received the standard lifestyle intervention (SLI), whereas those in the second phase were subjected to phenotype-tailored lifestyle intervention (PLI).

Participants were assigned to respective phases based on their enrolment time. To this end, the first phase was conducted between August 2020 and February 2021, whereas the second phase occurred from March 2021 to September 2021.

Each phase comprised screening, in-person physiologic testing, two days of training on the weight loss program, and twelve weeks of tailored lifestyle intervention. At week 12, phenotype parameters were measured.

Study findings

A total of 211 participants were screened, 81 of whom received SLI, and 84 were subjected to PLI. About 88.5% of the participants made it to the 12-week weight assessment. Most of the participants were women, white, with an average age of approximately 43 years.

PLI resulted in more weight loss as compared to SLI. Furthermore, as compared to the SLI group, participants in the PLI group exhibited reduced fat mass, waist circumference, anxiety score, as well as triglyceride and cholesterol levels.

The PLI group was also associated with a lower reduction in resting energy expenditure (REE) and greater enhancement in lean mass percentage. However, no improvement was found in glycemia, blood pressure, and inflammatory markers.

These observations suggest that PLI is more beneficial in people with obesity or obesity-related comorbidities. Notably, the PLI group exhibited improvements in abnormal satiation and emotional eating related to obesity.

In the future, long-term randomized studies are needed to determine whether the positive metabolic results would persist during weight maintenance. Other physiological and metabolic variables should also be assessed to develop a better PLI protocol. 

Conclusions

The current study has many limitations, including its short study period and sequential two-phase trial design without significant baseline characteristic differences between the groups. The non-blinded and non-randomized nature of the study generated inherent treatment bias.

In addition, the majority of the participants were white women, which compromised the generalizability of the study. This proof-of-concept study also assessed the results only after 12 weeks of intervention, which is comparable to previous studies reporting significant weight loss after six months of intervention.

Despite these limitations, PLI was found to be more beneficial than SLI in weight loss among people with obesity.