Phenotyping the obesities: reality or utopia?

Abstract

In this thematic issue on phenotyping the obesities, prominent international experts offer an insightful and comprehensive collection of articles covering the current knowledge in the field. In order to actually capture all the polyhedral determinants of the diverse types of obesity, the granularity of the phenotypic information acquired must be expanded in the context of a personalized approach. Whilst the use of precision medicine has been successfully implemented in areas like cancer and other diseases, health care providers are more reluctant to embrace detailed phenotyping to guide diagnosis, treatment and prevention in obesity. Given its multiple complex layers, phenotyping necessarily needs to go beyond the multi-omics approach and incorporate all the diverse spheres that conform the reality of people living with obesity. Potential barriers, difficulties, roadblocks and opportunities together with their interaction in a syndemic context are analyzed. Plausible lacunae are also highlighted in addition to pointing to the need of redefining new conceptual frameworks. Therefore, this extraordinary collection of state-ofthe-art reviews provides useful information to both experienced clinicians and trainees as well as academics to steer clinical practice and research in the management of people living with obesity irrespective of practice setting or career stage.

Long-term complications of significant weight loss: lessons learned from bariatric surgery

“…Understanding the long-term consequences of significant weight loss after bariatric surgery may help prepare clinicians and patients as the treatment with anti-obesity medications expands. Undoubtedly, the benefits of bariatric surgery include significant control of the disease of obesity and associated complications, including diabetes mellitus, cardiovascular disease, and various cancers [10,147,190] .…”

Revisiting the beyond BMI paradigm in excess weight diagnosis and management: A call to action

“…Unassailable evidence for the misdiagnosis of the BMI as opposed to actual body fat assessment shows that 29% of the people within the normal BMI range and 80% of those within the overweight category actually exhibit adiposity in the obesity domain 39–41 . Furthermore, the BMI‐based classification of excess weight does not reckon the diverse obesity subtypes 16,19,42–46 . In fact, a range of other anthropometric determinations that more precisely captures adiposity, fat distribution, musculoskeletal system and hydration may better provide the means to assess the health status.…”

“…In practice, characteristics underlying adipose tissue integrity, biology and functioning will need to be addressed 75–77 . Amidst the precision medicine era the dynamic interplay between adipogenesis, 78–80 lipolysis, 29,81–84 inflammation, 28,85–87 secretory profile, 88–90 and fibrosis 91,92 determines individualized responses that shape a holistic understanding of energy homeostasis, 93–95 which needs to be contemplated 46,96 . On the other hand, knowledge needs to be expanded as regards the active crosstalk among metabolically relevant organs like skeletal and myocardial muscles, liver, kidneys, pancreas, gastrointestinal system, bone and the vasculature within an internal milieu characterized by inflammation and oxidative stress (Figure 3).…”