Are you an emotional eater or a slow burner? Discover your obesity phenotype

Obesity is a complex disease often misunderstood as a lifestyle choice. Rather, the data suggests that variants in specific genes influence the effectiveness of different dietary interventions on weight loss and metabolic outcomes, highlighting the importance of a personalised approach.

One way to better understand and treat obesity is through identifying its various subtypes, known as obesity phenotypes. These phenotypes have distinct behaviour patterns influenced by factors like disrupted hunger signals, emotional triggers, and resting energy expenditure.

Let’s take a closer look.

What are the 4 obesity phenotypes?

The 4 obesity phenotypes are:

1. Hungry brain: Characterised by a constant feeling of hunger and a need for more calories to feel full due to disrupted hunger and satiety signals.

2. Hungry gut: Defined by short-lived fullness after eating, leading to frequent snacking and excessive calorie intake.

3. Emotional hunger: Involves eating in response to emotional triggers rather than physical hunger, often for comfort or stress relief.

4. Slow burn: Marked by a lower resting energy expenditure, meaning fewer calories are burned at rest, making weight loss more challenging.

How do you know your phenotype?

Researches phenotype participants by measuring the following:

• Gastric emptying for solids: This measures how quickly food leaves the stomach. The participant eats a meal with a special marker (radioactive material attached), and then takes images of the stomach with a special camera every 15 minutes for the first 2 hours, and then every 30 minutes for the next 2 hours.

• Appetite sensation: Measured using a visual scale to rate hunger, fullness, desire to eat, and satisfaction 15 minutes before a standardised meal, then every 30 minutes for the first 2 hours after eating.

• Resting energy expenditure: Checked by measuring how much oxygen is used and how much carbon dioxide is produced within a given timeframe

• Body composition: Checked at the start of the study and again at week 12.

• Anxiety score: Assessed using the Hospital Anxiety and Depression Scale.

• Eating and weight control behaviours: Evaluated using the Three-Factor Eating Questionnaire.

This paints a more complete picture of your condition which leads to more personalised and effective treatments. 

What strategies can be used to tailor treatment?

Recent research has explored the effectiveness of phenotype-tailored lifestyle interventions (PLI) compared to standard lifestyle interventions (SLI) on weight loss.

The study found that PLI led to significantly greater weight loss and improvements in several health markers. Participants in the PLI group lost an average of 7 kg compared to 4 kg in the SLI group after 12 weeks, demonstrating the potential benefits of personalised approaches.

Let's examine each phenotype and the tailored strategies that worked in the study.

1. Hungry brain

Strategy:

• Participants were instructed to restrict their meals to one or two per day with a high-fibre diet.

Efficacy:

• This approach was effective in keeping the brain's hunger centre "switched off" for longer periods, resulting in greater weight loss. Participants following this strategy experienced a significant reduction in daily caloric intake and overall weight loss.

2. Hungry gut

Strategy:

• Participants were instructed to have three meals per day with a pre-meal protein supplement.

Efficacy:

• This strategy increased the early release of gastrointestinal hormones, delaying gastric emptying and improving fullness. It resulted in a significant reduction in daily caloric intake and helped participants feel full longer, contributing to better weight management.

3. Emotional hunger 

Strategy:

• Participants followed a standard diet (the same as the standard lifestyle intervention), avoided snacks, and participated in a 12-session intensive behavioural group therapy co-led by two clinical health psychologists.

Efficacy:

• This approach significantly improved anxiety scores and reduced emotional eating behaviours. The intensive behavioural therapy provided participants with tools to manage emotional triggers for eating, leading to better adherence to the diet and improved mental health outcomes.

4. Slow burn 

Strategy:

• Participants were instructed to follow a standard diet, plus post-workout protein supplementation and to engage in at least 30 minutes of high-intensity interval training four to five times per week, with a weekly check-in with their physical therapist.

Efficacy:

• This strategy was effective in increasing lean mass percentage and reducing fat mass. The combination of high-intensity interval training and post-workout protein supplementation helped boost resting metabolic rate, leading to more efficient calorie burning and significant weight loss.

Overall study findings

Weight loss: The PLI group lost an average of 7 kg compared to 4 kg in the SLI group.

Body composition: Greater reduction in waist circumference and fat mass, and an increase in lean mass percentage in the PLI group.

Cardiometabolic risk factors: Significant reductions in fasting triglycerides and anxiety scores in the PLI group.

Caloric intake: Significant reduction in daily caloric intake in the PLI group compared to the SLI group.

The numan take

Understanding the key differences among obesity phenotypes is essential for developing effective, personalised strategies for prevention and treatment. Obesity is often misunderstood and stigmatised as a result of poor lifestyle choices. 

However, clinical advances reveal it as a complex disease influenced by genetic, metabolic, and psychological factors. This recognition necessitates compassionate and tailored interventions for each unique phenotype.