Can a saliva test predict the best way to manage obesity?

May 23, 2023 – It seems like a simple solution to a complex problem. good obesity based on a one-time saliva genetic test. Then you and your doctor can get a better idea of ​​whether obesity medications or other treatments are more likely to work for you.

The goal of creating obesity types and testing is to increase your chances of losing weight and improving your health and well-being, versus a one-size-fits-all strategy approach. That’s what Mayo Clinic researchers had in mind when they created four obesity phenotypes.

Nonresearch obesity experts have some concerns and say independent studies are needed to test the strategy’s potential.

This research could help predict who will respond best to popular obesity drugs, said Andres Acosta, MD, PhD, co-founder of Phenomix Sciences, the company behind the tests. These drugs include a class of drugs called glucagon-like peptide receptor agonists (GLP-1s), such as liraglutide (Saxenda, Victoza) and semaglutide (Ozempic, Wegovy).

“We know that not everyone will respond to GLP-1. In fact, about one-third of patients do not respond well to GLP-1,” says Acosta, assistant professor of medicine and research fellow in the Department of Gastroenterology and Hepatology at the Mayo Clinic in Rochester, MN.

Furthest along in development is the My Phenome Hungry Gut test to predict GLP-1 response. People with this group of hungry guts tend to empty their stomachs more quickly after eating and are more likely to feel hungry again shortly after, as explained: company website.

A pilot study to test how well it works began in April in three primary care practices. Plans are to expand real-world trials of this and other types of obesity later this year.

Other categories of obesity are:

  • “Hungry brain” where the brain does not recognize the signals that the stomach is full
  • “Emotional hunger” where the urge to eat is driven by emotions, anxiety and negative feelings
  • “Slow burn” where people have a slow metabolism and low energy levels

People in this category are more likely to benefit from other obesity management strategies, such as dietary changes or meal replacement. intragastric balloon.

Some things to consider

While welcoming efforts to more accurately treat people with obesity, not all experts are convinced that this saliva test will be the answer. The company’s research may sound promising, but verification of the results is warranted.

“Can we get better results with things like this? Well, that’s the hope,” says Jaime Almandoz, MD, medical director of Weight Wellness at Texas Southwestern Medical Center in Dallas.

“We still don’t have randomized trials where we look at obesity phenotyping,” said Almandoz, who is also a spokesperson for The Obesity Society, a professional group of doctors, researchers, educators and others focused on the science of obesity. treatment and prevention.

There’s always concern when a diagnostic test is developed for commercial use, said Daniel Besesen, MD, professor of endocrinology, metabolism and diabetes at the University of Colorado School of Medicine in Denver. “What they’re talking about doing is extremely important. But this is a company. This is a company that, I believe, sells a product.”

In an online search, Besesen couldn’t find any outside research showing how well the saliva test worked. But referring to the work of Acosta and Michael Camilleri, the other co-founder of Phenomix, he said:

“These guys are smart guys. And they’ve done a lot of work [the movement of food through the gut] and how it correlates with obesity and response to certain therapies,” said Bessesen, who is also a spokesperson for The Obesity Society. “So their scientific work is relevant to this field.”

Validating any research is important because the obesity industry is known for quick weight loss strategies, some of which have no science behind them, he said.

It’s also important, he said, because “any time you do something commercial in obesity, you have to recognize that people with obesity are a vulnerable population. These people face stigma and prejudice all the time.”

Eliminating stigma

If knowing your obesity type ultimately makes a difference, it could change the way people talk to their health care provider, Acosta said. It can also help eliminate the stigma associated with obesity.

“We will change the conversation because now we can say: “Hey, you’re obese because you have the ‘Hungry Gut’ phenotype. And because of that, you’re going to react to this drug,” Acosta said. Phenotyping suggests a strong genetic predisposition to the biological basis of obesity.

“So it’s not just a way to deflect blame, but to explain that there’s a reason you’re obese,” Acosta said. It tells people: “You are not unlucky.”

More cost-effective treatment.

Treating obesity can also save overall health care costs, Almandoz said. He estimated the cost at $1,400 a month “for semaglutide forever and ever,” or at least $1,400 a month for a 3-month trial to see if the drug works in a specific person with obesity.

“That’s a lot of money when you break it down to the number of people who probably qualify for treatment,” he said. A total of 42% of Americans agree CDC definition for obesity.

“You can imagine the potential costs if we were to give everyone an obesity therapy, and we used the most effective class of drug, which is more than a thousand dollars a month,” Almandoz said. “It’s not that we shouldn’t treat everyone. That’s not the message I’m saying. But if we’re looking at the cost-effectiveness of obesity treatment in a resource-limited setting, it’s best to start with who is most likely to benefit.”

How they created four types of obesity

Starting in 2015, Acosta and his colleagues began comparing the tests in people with normal weight and obesity. They used artificial intelligence and machine learning to initially classify obesity into 11 types. They realized that these types of obesity were impractical for doctors and people with obesity, so they grouped them into four phenotypes.

“AI machine learning was followed by what I like to call HI, or human intelligence,” he said.

The saliva test tests about 6,000 matches genetic SNPs. SNPs are “single nucleotide polymorphisms” or changes in genes. Six thousand genetic changes might seem like a large number to check for, until you know that people walk around with 5 to 6 million SNPs in their DNA.

The results are converted into a score that indicates a low or high risk for obesity or other types of obesity. “You can have all six thousand genetic mutations, or you can have zero,” Acosta said.

Moving on

After a soft launch of the Hungry Gut trial in April, Phenomix plans to continue to explore their saliva test in other types of obesity.

Acosta is not aware of any direct competitors for Phenomix, though that could change. “I think we’re the only diagnostics company in the space right now. But if it really is a $14.8 billion market, we’re going to see a lot of diagnostic companies trying to do what we’re doing if we’re successful,” he said.

An October 2022 report Polaris Market Research estimates that the global obesity treatment market—drugs, surgery, and all—will be around $14 billion in 2021. The same report predicts that the market will grow to $32 billion by 2030.

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