The Key to Unlocking Obesity Treatment

Though A1C-lowering, Ozempic, and weight-loss medication, Wegovy, have been in the headlines lately for use in losing weight (off label for Ozempic), the medications may not be appropriate for all obese patients.

In fact, there are different kinds of obesity that respond best to different treatments, according to Andres Acosta, MD, PhD, a physician, assistant professor, and obesity researcher at Mayo Clinic and co-founder of Phenomix Sciences, maker of a saliva test that determines obesity type. Understanding the phenotype is key in determining safe and effective treatment methods, according to Phenomix.

“The way obesity is understood and treated is through a trial-and-error approach, meaning that most people have been prescribed many different medications and tried various diets in hopes of getting to the right answer,” Acosta said. Phenomix’s “method of categorizing obesity into four different disease states [uses] a precision medicine approach to treat every individual according to their obesity phenotype. Phenotyping uses a patient’s DNA, behavioral assessments, and biomarkers to accurately predict their obesity type.”

The saliva test was developed by Acosta and Michael Camilleri, MD, a scientist, gastroenterologist, and professor at Mayo Clinic.

Obesity care tailored to the individual

The saliva test can guide the therapeutic path for patients, who have often spent years trying to manage their disease.

“The test will be used to individualize weight loss treatment based on the obesity phenotypic category,” Acosta said. “For the first time, individuals will better understand how their body will respond to a diet, medication, or procedure before committing to the expensive, long-term intervention. This is the tip of the iceberg for what is to come with obesity phenotyping and how the disease is understood and treated.”

Phenomix’s My Phenome Hungry Gut test utilizes saliva and other biomarkers to determine if a patient is positive or negative for that particular phenotype, and thereby if the patient is appropriate for the Hungry Gut Diet, GLP-1 medications like Wegovy and Ozempic and intragastric balloon. A patient with Hungry Gut obesity phenotype will experience fast stomach emptying and is less likely to feel satiated and may be hungry again a short time after a meal. These interventions are geared to slow the rate at which food empties from the stomach. The other obesity phenotypes, according to Phenomix, include Hungry Brain, when brain does not recognize when to stop eating; Emotional Hunger, when food cravings are emotionally driven in response to positive and result in anxiety and negative feelings; and Slow Burn, when the body requires low amounts of energy and does not burn energy well.

Avoiding waste through targeting treatment to phenotype

“We recently identified that patients with abnormal postprandial satiety, also called Hungry Gut phenotype, are the best responders to GLP-1 medications,” Acosta said. “Prescribing these medications to all obesity patients without first identifying their phenotype poses undue risks, cost, and time for patients.”

Patients not well-suited for GLP-1 treatments could include serious gastrointestinal effects, such as increased slowness in gastric emptying. He also adds that mismatched treatments take a another toll on patients.

“Most patients have been on their weight loss journey for a long time, and the trial-and-error approach is expensive and defeating for patients. By phenotyping patients, providers can get patients to the right solution faster and help them be more successful,” Acosta said.

Tests to be available in 2023

My Phenome Hungry Gut test launched in March and is being used initially among providers who are already knowledgeable about obesity phenotyping. The test is expected to expand availability to more providers later in 2023, and for additional phenotyping tests to launch in late summer.

The company was co-founded with Camilleri. Camilleri and Acosta have researched phenotyping for more than 12 years, Acosta said.

“We have tested more than 1,000 patients during a 10-hour battery of tests that can now be replicated in our newly offered cheek swab test," Acosta said. "We will continue our research with the hope to one day cure obesity.”

Phenomix also has the support of Health2047, a startup backer powered by the American Medical Association (AMA). The company has the goal of creating impactful change in U.S. healthcare by 2047, the 200th anniversary of AMA.