Genetic test will predict the effectiveness of semaglutide for weight loss

A risk assessment biomarker that identifies the hungry-stomach phenotype can help determine how likely semaglutide-based drugs such as Vegovi are to help a person lose weight. This is according to a study presented at the Digestive Disease Week 2024.

Researchers have developed machine learning to calculate the genetic risk of a hungry stomach. This condition occurs when a person eats, but feels hungry again an hour or two later due to the rapid emptying of the stomach.

The study involved 84 people with obesity or other weight management problems. Saliva or blood samples for genetic analysis and information about the participants' dietary habits were collected.

Participants took a semaglutide-based drug for one year. Scientists recorded total body weight loss at 3, 6, 9 and 12 months. They then determined the likelihood of a positive response to semaglutide depending on the type of weight management problem.

Details of the study on semaglutide and weight loss

Researchers at the Mayo Clinic in Minnesota have developed a test called MyPhenome that categorizes the type of obesity phenotype that can help improve weight loss. There are four types:

• Hungry brain - consuming too many calories without feeling full.
• Hungry stomach - taking a full meal, but quickly feeling hungry.
• Emotional hunger is eating in response to an emotional trigger.
• Slow metabolism means burning calories too slowly.

The scientists used observations of adults undergoing weight loss treatment. They focused on those who were prescribed semaglutide.

Researchers reported that people with a positive fasting phenotype lost 14% of their body weight after 9 months, compared with 10% for those with a negative phenotype.

After 12 months, those with a positive fasting phenotype lost 19% of their total body weight. Those with a negative phenotype remained at about 10% body weight loss.

How research on semaglutide can be useful

Everyone reacts to medications differently.

But researchers say the genetic test explains the differences and allows doctors to target the underlying cause of obesity. They believe the phenotype test could be used in health care settings to determine who will respond positively to semaglutide.

The presentation indicates that the test is 75% accurate in predicting who will respond to semaglutide, without the need for trial-and-error to determine whether the drug works.

"Severe obesity is deadly," said Dr. Mitchell Roslin, chief of bariatric surgery at Northwell Lenox Hill Hospital in New York, who was not involved in the study. "It creates a phase transition. Thus, people's bodies are 10-20 years older than their chronological age. Heart disease is the leading cause of death."

Semaglutide is a relatively new drug for the treatment of obesity. Insurance companies do not always cover its cost. Out-of-pocket payments can be up to $1,000 per month.

Researchers say knowing whether a drug will work can help doctors and patients better decide whether to try it.

"Like all medications, semaglutide has side effects. People may experience gastrointestinal symptoms such as nausea, vomiting, diarrhea or constipation," said Dr. Mir Ali, bariatric surgeon and medical director of MemorialCare Surgical Weight Loss Center at the Medical Center. Center of Orange Coast in California.

"Side effects usually go away as the body adapts to the drug. However, it is important to start with the lowest dose and increase as needed," said Ali, who was not involved in the study.

Limitations of genetic testing for weight loss drugs

Not all doctors plan to use risk assessment in their practice.

"I probably wouldn't use a risk calculator to determine whether one of my patients should or should not use semaglutide," Ali said. "There are many calculators out there that may or may not be helpful. Calculators are cumbersome to use, and I probably wouldn't ask patients to spend extra money on genetic testing."

Ali said that he considers various factors before prescribing a weight loss drug. These factors include:

• How overweight a person is.
• What is his body mass index (BMI).
• What weight loss strategies have been used in the past and how effective they were.
• Do they meet the criteria for bariatric surgery?

"Weight loss surgery is still the most effective for weight loss and maintenance," Ali said. "If they do not meet the criteria for surgery, I will consider GLP-1 analogues such as semaglutide."

"It is important to remember that no matter what treatment method is used, the goal is to change habits, develop healthy eating habits and make lifelong changes," Ali emphasized.

Roslin agrees. "We strive to teach people how to use weight loss tools in the best possible way," he said.