Gastrointestinal traits: individualizing therapy for obesity with drugs and devices.
OBJECTIVE
The aims of this article were to review the discrepancy between numbers of people requiring weight loss treatment and results and to assess the potential effects of pharmacologic treatments (recently approved for obesity) and endoscopically deployed devices on quantitative GI traits in development for obesity treatment.


METHODS
We conducted a review of relevant literature to achieve our objectives.


RESULTS
The 2013 guidelines increased the number of adults recommended for weight loss treatment by 20.9% (116.0 million to 140.2 million). There is an imbalance between efficacy and costs of commercial weight loss programs and drug therapy (average weight loss about 5 kg). The number of bariatric procedures performed in the United States has doubled in the past decade. The efficacy of bariatric surgery is attributed to reduction in the volume of the stomach, nutrient malabsorption with some types of surgery, increased postprandial incretin responses, and activation of farnesoid X receptor mechanisms. These GI and behavioral traits identify sub-phenotypes of obesity, based on recent research.


CONCLUSIONS
The mechanisms or traits targeted by drug and device treatments include centrally mediated alterations of appetite or satiation, diversion of nutrients, and alteration of stomach capacity, gastric emptying, or incretin hormones. Future treatment may be individualized based on quantitative GI and behavioral traits measured in obese patients.
Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Michael
M
Camilleri
Clinical Enteric Neuroscience Translational and Epidemiological Research (C.E.N.T.E.R.), Mayo Clinic College of Medicine, Rochester, Minnesota, USA.
Andres
A
Acosta
D019440:Anti-Obesity Agents / Q000627:therapeutic use*; D050110:Bariatric Surgery / Q000379:methods*; D003131:Combined Modality Therapy; D003863:Depression / Q000523:psychology; D016099:Endoscopy, Gastrointestinal / Q000379:methods; D004864:Equipment and Supplies; D005247:Feeding Behavior; D015905:Gastric Balloon; D015390:Gastric Bypass / Q000379:methods; D005746:Gastric Emptying; D015391:Gastroplasty / Q000379:methods; D052216:Glucagon-Like Peptide 1 / Q000378:metabolism; D006801:Humans; D007031:Hypothalamus / Q000378:metabolism / Q000503:physiopathology; D009765:Obesity / Q000378:metabolism / Q000503:physiopathology / Q000523:psychology / Q000628:therapy*; D009929:Organ Size; D019894:Peptide YY / Q000378:metabolism; D057285:Precision Medicine; D025341:Principal Component Analysis; D012527:Satiation; D013270:Stomach / Q000473:pathology; D016896:Treatment Outcome; D015431:Weight Loss
D019440:Anti-Obesity Agents; D019894:Peptide YY; D052216:Glucagon-Like Peptide 1