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Clinical Research

Management of obesities with a cause specific approach

International Journal of Obesity (2024)Cite this article

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The etiology of obesity is multifactorial. Numerous factors that are intrinsic or extrinsic to an individual including biological, psychological and environmental may either cause or contribute to obesity [1]. Typically, causative factors of obesity are intrinsic to an individual and can be treated, but cannot be prevented. Whereas, contributors of obesity are extrinsic to an individual, and are potentially preventable. Examples of causative factors include hypothyroidism or melanocortin 4 receptor deficiency, whereas examples of contributors include high energy dense diet or sedentary lifestyle. Causes may lead to development of obesity, whereas contributors seem to work in conjunction with causes to promote obesity [1, 2]. It may be more meaningful to consider the term “obesities”, to underscore differences in causations, signs and symptoms, comorbidities, and prognosis of various “types” of obesities. Yet, the current treatment approach mainly focuses on a “blanket approach” for weight loss through energy restricted diet, physical activity and lifestyle modification, mostly regardless of the cause(s) of obesity. This may leave the underlying causes or contributors of obesity unaddressed, and hence may result in marginal success of weight loss or maintenance. For effective obesity management, cause-specific or contributor-specific treatment and addressing obesity-associated comorbidities may be needed in addition to the standard of care dietary, behavioral and pharmacotherapy.

By shifting the emphasis from a generic solution to an individually-tailored and cause-specific treatment strategy, healthcare providers may address each individual’s unique circumstances and needs, thereby enhancing long-term success in managing obesity [1, 2]. For example, consider hypothyroidism, an intrinsic causative factor, that cannot be prevented, but can be treated. Hypothyroidism is linked with reduction in daily energy requirement, which in turn can contribute to weight gain. In a patient with obesity with undiagnosed hypothyroidism, it is important to consider signs and symptoms of hypothyroidism if present, instead of only focusing on weight loss. If hypothyroidism is diagnosed, calories recommended for creating a negative energy balance need to be adjusted to reflect the reduced energy requirement. Also, obesity management needs to include treatment of hypothyroidism. The weight loss treatment is not likely to be successful if hypothyroidism remains unaddressed when present. Another example is weight gain related to poor quality or quantity of sleep due to sleep apnea, a common comorbidity associated with obesity. For effective obesity management, it would be important to first uncover the presence of sleep apnea and then address it. Similar exploration is needed for many other known potential causes and contributors of obesity including infection, dysregulated thermogenesis, impaired fat oxidation, gene polymorphisms, and endocrine dysregulation affecting hunger and satiety signals, and environmental factors [1, 3]. Collectively, these examples highlight the multifactorial nature of obesity, and the need for cause-specific treatment.

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Author notes

  1. These authors contributed equally: O. Akinsiku, M. Hefner, F. Jafari, G. Kudchadkar, M. Zaroudi.

Authors and Affiliations

  1. Department of Nutritional Sciences, Texas Tech University, Lubbock, TX, USA

    S. Ranjbar, O. Akinsiku, M. Hefner, G. Kudchadkar, M. Zaroudi, H. Booe & N. V. Dhurandhar

  2. Department of Nutritional Sciences, Penn State University, University Park, PA, USA

    F. Jafari

  3. Center for Community Health Impact, University of Texas Health Sciences Center at Houston, El Paso, TX, USA

    A. N. Nathan

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Contributions

NVD and HB contributed to conceptualization. SR, OA, MH, FJ, GK, MZ, and ANN performed the review of literature and contributed to writing. All authors contributed to the manuscript revision, read, and approved the submitted version.

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Correspondence to H. Booe or N. V. Dhurandhar.

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NVD has received investigator initiated grant and consultation from Novo Nordisk in the past for projects unconnected with this manuscript.

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Ranjbar, S., Akinsiku, O., Hefner, M. et al. Management of obesities with a cause specific approach. Int J Obes (2024). https://doi.org/10.1038/s41366-024-01539-x

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