TOPLINE

A real-world US survey of patients with obesity and their physicians found that the two groups often disagreed on which eating and metabolic profiles, namely emotional hunger, hungry brain, hungry gut, or slow burn, described the patient, with physicians most often pointing to hungry brain and patients most often citing emotional hunger. Patients who agreed with their physician on whether the hungry brain descriptor applied to them lost more weight.

METHODOLOGY

• BMI has long been used to diagnose obesity, but it cannot distinguish fat from lean mass or capture the full range of health risks. Medical groups, including the American Diabetes Association, have called for looking beyond BMI when assessing and managing obesity.
• In this cross-sectional survey, researchers analyzed US data between October 2023 and April 2024 from physicians and their patients seen for routine care. They aimed to determine whether both groups recognized the same four descriptors (proposed as a way to look beyond BMI): emotional hunger (eating driven by moods and cravings), hungry brain (difficulty stopping a meal), hungry gut (hunger that persists or fullness that fades quickly), and slow burn (low calorie burn from a slow metabolism).
• A total of 215 adults with obesity and 151 physicians were included; the patients had a mean age of 48.8 years, 69.3% were women, and all patients had either a current or earlier BMI ≥ 30 or a current or earlier BMI ≥ 27 with a related health condition.
• Patients and physicians each selected from the four profiles (worded in clinical language for physicians and plain language for patients) and could choose more than one.
• Only patients with both physician-reported and self-reported phenotype data were included.

TAKEAWAY

• Physicians most often flagged hungry brain (52.6%), while patients most often reported emotional hunger (45.1%). Hungry gut was chosen by 11.2% of physicians and 24.7% of patients, and slow burn was chosen by 37.2% and 33.5%, respectively.
• Agreement between patients and physicians was slight for hungry brain, fair for emotional hunger, and moderate for slow burn; the agreement for the hungry gut phenotype was not significant.
• Patients flagged with both emotional hunger and hungry brain had the greatest health burden, with a median of three comorbidities among these patients vs one comorbidity among those with hungry brain only; they also had the highest rates of depression (41.2%), stress (35.3%), and hypothyroidism (35.3%).
• Patients who agreed with their physician on the hungry brain descriptor had lost more weight, with a median of 6.8 kg among these patients vs 5.4 kg among patients who did not agree, measured since diagnosis (P = .016), and a median of 6.2 kg among these patients vs 3.9 kg among patients who did not agree, measured since their latest weight loss attempt (P = .018).

IN PRACTICE

"Incorporating phenotypic assessment into prescribing decisions could be key to selecting targeted therapies, optimizing drug response and improving long term outcomes," the authors wrote.

SOURCE

The study was led by David M. Savastano, Currax Pharmaceuticals, Brentwood, Tennessee. It was published online in Obesity Pillars.

LIMITATIONS

Physicians and patients opted in for the survey rather than being randomly selected. The requirement that at least two of each physician's eight patients be on obesity medication may have affected which descriptors were most frequently identified. The sample predominantly comprised White patients who were employed and had a high socioeconomic status, possibly limiting the generalizability of the findings.

DISCLOSURES

The study used data from Adelphi Real World's proprietary Obesity Disease Specific Programme, which has several subscribers, including Currax Pharmaceuticals. Two authors were employees of Currax Pharmaceuticals at the time of the study, and the remaining four were employees of Adelphi Real World.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.