Within the obesity field there has been increasing recognition that prevention and treatment programs should be culturally sensitive and that the prevalence of risk factors and obesity may vary by race or ethnicity, but the same basic recommendations for prevention and treatment are given in all settings. An important question is whether this is one reason for not achieving better treatment outcomes.
Currently many obesity treatment studies have overall small effects, but substantial variability in results, with some individuals having a large amount of weight loss and others gaining weight. The focus on mean overall effects may preclude identifying an effective treatment program for a specific subtype of obesity, but not others.
High insulin secretion low responsiveness to internal satiety signals, high responsiveness to external food cues; learned patterns and preference for foods high in calories, fat, sugar, and salt; binge eating or food addiction; and low reinforcing value of activity or high reinforcing value of being sedentary. However, these are only several possible subtypes but others may exist.
Currently, major advances are being made in statistical methods to understand the development of obesity, the neuroscience of eating behaviors, use of sensors to better measure exposures, and exploration into the functional role of genetic polymorphisms associated with obesity. Additional advances are needed in how to conceptualize and phenotype the outcome of obesity. The one-size-fits-all approach is yielding small average weight losses.
The molecular pathological epidemiology model has recently emerged to help address the heterogeneity of disease. Obesity is a heterogeneous and complex disease influenced by exogenous and endogenous exposures. Stratifying obesity into meaningful subtypes could provide a better understanding its causes and enable the design and delivery of more effective prevention and treatment interventions.