Poster - #VH-21076 - Keywords: Phenotype Obesity Real-world Disconnect Personalized medicine

Obesity phenotyping: A real-world survey of patients and their physicians

David M. Savastano [1], Pamela Appel [1], Andrea Leith [2], Lewis Harrison [2], Victoria Higgins [2]
Currax Pharmaceuticals, Brentwood, TN, USA [1], Adelphi Real World, Bollington, UK [2]

ABSTRACT:
Introduction: The heterogeneous nature of obesity is particularly apparent when observing clinical responses to diet, medication and surgery interventions. Four obesity phenotypes, based on pathophysiology and behavior, have been identified: hungry brain (abnormal satiation), emotional hunger (hedonic eating), hungry gut (abnormal satiety) and slow burn (decreased metabolic rate). Phenotype-guided management of people with obesity (PwO) has been associated with 1.75-fold greater weight loss after one year. We aimed to describe physician- and PwO-reported phenotypes and assess physician-PwO congruence.

Methods: Data were drawn from the Adelphi Real World Obesity Disease Specific Programme™, a cross-sectional survey of physicians and their PwO in the United States from October 2023 – April 2024. PwO were aged ≥18 years, had a body mass index (BMI; kg/m2) of ≥30 (or ≥27 plus one weight-related comorbidity), were on a weight management program or using anti-obesity medications at survey. Physicians reported demographics, clinical characteristics and obesity phenotype for eight consecutively consulting PwO. PwO completed a voluntary questionnaire, reporting their self-identified phenotype. Analyses were descriptive.

Results: 65 physicians reported data for 215 PwO who self-reported data. Mean ± standard deviation PwO age was 48.8 ± 13.9 years with 65% female, 80% White, mean disease duration 3.2 ± 5.0 years and most recent BMI 34.6 ± 5.9. Physicians categorized their PwO as hungry brain (53%), slow burn (37%), and emotional hunger (35%). In 56% of emotional hunger cases, physician and PwO identifications matched. However, 45% of PwO identified with emotional hunger, with physician categorization not aligning in 57% of these cases. In cases of physician-PwO agreement vs. disagreement on emotional hunger, mean PwO age was 50.4 ± 13.1 vs. 46.5 ± 13.6 . years, respectively, with 74% vs. 69% female, BMI at diagnosis 36.9 ± 6.1 vs. 36.2 ± 5.9 vs. , BMI at most recent result 35.2 ± 6.4 vs. 34.5 ± 5.7, mean comorbidities 3.5 ± 2.6 vs. 2.6 ± 2.1, and time since diagnosis 3.7 ± 4.8 vs. 2.3 ± 4.0 years.

Conclusions: Real-world classification of obesity phenotypes revealed an opportunity for better alignment between physician assessment and PwO self-identification, particularly regarding emotional hunger. These findings underscore a need for a nuanced, patient-centered approach. While physicians assess pathophysiology, behavioral assessments like appetite and satiety can be challenging. Enhancing physicians' ability to recognize and validate patients' self-perceived phenotypes could lead to tailored interventions and improved outcomes.