Hormonal
For polygenic obesity, precision medicine approaches targeting specific genetic variants or phenotypes have not yet translated into reliable clinical guidance for selecting obesity medications, making early weight loss response the only consistent predictor of long-term efficacy.
Do not rely on genetic testing or complex phenotyping to choose your obesity medication right now, as it does not reliably predict success for common obesity. Instead, use a 'trial and error' approach guided by side effect profiles, comorbidities, and patient preference. The most important indicator of whether a medication will work for you long-term is whether you lose at least 5% of your body weight within the first 12-16 weeks.
At present, the only factor consistently associated with longer-term efficacy of obesity pharmacotherapy is early weight loss outcome, which cannot inform choice of therapy at the time of medication initiation. The concept of matching a therapy for obesity to the characteristics of the individual is appealing but as yet unproven in randomised clinical trials.
Why this rating
Based on a comprehensive review of clinical data and randomized trials, noting the lack of successful RCTs for precision matching in polygenic obesity.
Source
Individualised prescription of medications for treatment of obesity in adults
Samantha Hocking et al. · Reviews in Endocrine and Metabolic Disorders · 2023
DOI 10.1007/s11154-023-09808-2
More from this paper
- For patients with specific monogenic obesity syndromes (leptin deficiency, POMC/PCSK1/LEPR mutations), targeted pharmacotherapy (recombinant leptin or setmelanotide) is highly effective and should be prioritized, unlike in polygenic obesity.Strong
- Early weight loss (≥5%) within 12-16 weeks is the only consistent predictor of long-term efficacy for obesity pharmacotherapy in polygenic obesity, justifying the discontinuation of ineffective medications.Strong
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