Riding the Waves of Obesity Science – The Phenotype Breakers: Heterogeneity, Signals, and Who Might Benefit from Which Biology

Obesity looks like one diagnosis but behaves like many. Two patients with the same body mass index (BMI) can respond very differently to the same medication, and as the treatment armamentarium expands, from today’s incretins to the amylin-based and combination therapies on the horizon, the central clinical question shifts from “does this drug work?” to “for whom, and why?” Yet phenotype-informed approaches remain inconsistently applied in practice, and clinicians have few tools to predict, in advance, which patient will benefit most from which mechanism.

In this conversation, Andres Acosta, MD, PhD, joins series chair Robert F. Kushner, MD, to explore obesity phenotypes as a framework for individualizing care. Dr. Acosta examines how differences in appetite, satiety, energy expenditure, and eating behavior may help explain the wide variation in treatment response — and offers a candid appraisal of how far the science has come and how far it still has to go, since validated predictors of drug response are not yet established.

As the third of four conversations, this segment turns the series’ theme of heterogeneity into a practical lens. After framing why multiple pathways are needed and exploring the biology of amylin, it asks how clinicians might one day match patient to pathway.

At the conclusion of this activity, learners will be able to better:

• Identify obesity phenotypes relevant to mechanistically targeted pharmacotherapy
• Anticipate how emerging amylin-based therapies may fit within a phenotype-guided framework

Supported by an educational grant from Novo Nordisk Inc.

Obesity medicine clinicians [physicians, nurse practitioners (NPs), physician associates (PAs), pharmacists] involved in weight management and metabolic care, including endocrinology, primary care, cardiology/metabolic clinics, and obesity medicine settings

It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all of their CE activities. Faculty must disclose to the participants any relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and mitigated any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.

Dr. Kushner reports the following financial relationships:

Advisory Board: Abbvie Inc; Antag Therapeutics; AstraZeneca; Boehringer Ingelheim; Currax Pharmaceuticals; Eli Lilly; Novo Nordisk; Structure Therapeutics, Inc.; Viking Therapeutics; and Weight Watchers

Dr. Acosta reports the following financial relationships:

Advisory Board: Boehringer Ingelheim; Regeneron; and Stucture Therapeutics, Inc

Consultant: Amgen Inc; Bausch Health; Gila Therapeutics; Rhythm Pharmaceuticals, Inc; and Rare Disease Therapeutics, Inc.

Grants: Apollo Endosurgery, Inc; Boehringer Ingelheim; Dairy Management, Inc; Delaney Foundation; National Institute of Health; Novo Nordisk; Regeneron Pharmaceuticals, Inc.; Rhythm Pharmaceuticals, Inc.; Satiogen Pharmaceuticals, Inc./Mirum Pharmaceuticals, Inc.; Spatz Medical; and Vivus

Speakers Bureau: AstraZeneca; Boehringer Ingelheim; Currax Pharmaceuticals; Eli Lilly; Novo Nordisk; and Vivus

Employment: Mayo Clinic

Other financial or material support: Gila Therapeutics and Phenomix Sciences have licensed Dr. Acosta’s research technologies from University of Florida and Mayo Clinic.

The following individuals have no financial relationships to disclose:

Thai Nguyen, MD, MHA (Peer Reviewer)
Jessica Giddens, DNP, APRN, FPMHNP-BC, RN-BC (Peer Reviewer)
Michele Tedder, MSN, RN (Patient Planner)
Mary Gleason, PhD, CHCP (Planning Committee)
Warren Beckman (Planning Committee)
Andrea Perseghin, EdD (Planning Committee)
Sandra Caballero, PharmD (Planning Committee)
Sharon Tordoff (Planning Committee)

*All identified conflicts of interest have been mitigated.

Unlabeled Use Disclosure
Faculty of this CME/CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices. CME Outfitters, LLC, the faculty, planners, and reviewers do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.

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