Bariatric Times

Insights into Patient Pop with Obesity 2016

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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C12 Bariatric Times • December 2016 • Supplement C look at genetics and epigenetics, but work is ongoing to better understand how these will impact clinical practice. The gut microbiome is another important part of individualized/customized care. The microbiome in the gut changes compositionally and functionally with external and internal influences. It is believed that the gut mechanisms have a direct effect on obesity by modulating energy balance and by regulating inflammation. In fact, the gut microbiome may be considered an epigenetic regulator, mediating through "back signaling" how the environment and genetics interact. 32 Inflammation and obesity are closely associated. Many diseases, particularly those with an inflammatory component, have an association with obesity. Understanding the connection between obesity and inflammation may help guide future treatment of obesity. For example, glycogen accumulation in adipose tissue may be a key feature in inflammation-associated metabolic stress syndromes of obesity. 33 A number of genes, including the FTO gene, have been identified as potential risk factors for obesity. The question arises as to how patients might respond upon learning that they had this potential risk factor—would it change their behavior? Patients who learned that they had the genotype that put them at risk for obesity and who also at the same time got information about weight management strategies, were more likely to accept treatment than those who did not get this genetic information. 34,35 When patients knew they had the FTO genotype, they were more likely to contemplate or take action about their weight than patients who did not have this genetic information. This propensity for action was more pronounced if the patient already had overweight or obesity; those who got genetic information and already had overweight or obesity were more ready for change than those with genetic information but at normal weight. Readiness to change behavior occurs on a continuum—from pre-contemplation to contemplation to taking steps and then finally to maintaining the changes. In this study, FTO genotype information and the patient's overweight or obesity status made them more ready to change, but in terms of actually taking steps, the groups had similar rates. In other words, genetic information and current weight caused the patient to contemplate change but not necessarily to implement it. This intriguing study has caused clinicians to consider what might be the next steps to causing change, such as identifying resources to help the patient lose weight, actionable education, self-monitoring of obesity-related variables, and progress evaluation. In particular, a risk scoring system that allows patients to evaluate, monitor, and understand their individual risks with obesity may be helpful. Insights into the Patient Population with Obesity: Assessment and Treatment u

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