Anna Olson’s journey with obesity began in her early years, shaped by family history and persistent hunger that seemed impossible to quell. Despite trying numerous diets, medications, and exercise routines, the advice she received was consistently to eat less. “And I’m kind of like, ‘Well, it’s what I’m doing now. What else can I do?'” Olson recalls, only to hear the same advice again: “Well, you just got to eat less.”
Recent scientific insights reveal that obesity is a multifaceted condition influenced by genetic, biological, neurological, lifestyle, metabolic, and behavioral factors.
Understanding the Complex Causes of Obesity
Doctors, patients, and pharmaceutical companies have made significant progress in comprehending obesity, especially with the introduction of GLP-1 drugs. While obesity is often perceived as excess weight, it actually encompasses various types. Identifying and addressing the root causes for each individual is essential for effective treatment. Experts anticipate more personalized obesity treatments in the coming years.
For Olson, genetic testing highlighted several genetic and hormonal imbalances affecting her hunger and satiety signals. While Ozempic initially showed promise, Zepbound proved more effective in balancing her hormones, leading to a significant weight loss of 65 pounds, which Olson has successfully maintained. “I’ve been able to keep it off,” she notes.
The Rise of GLP-1 Medications
The popularity of GLP-1 drugs is growing, with new options like Novo Nordisk’s Wegovy pill hitting the market. These medications, including Ozempic and Wegovy (semaglutide), as well as Zepbound and Mounjaro (tirzepatide), are GLP-1 agonists. Tirzepatide also targets an additional hormone, GIP. In the near future, advancements are expected to allow for more precise identification of an individual’s obesity factors, akin to targeted cancer therapies.
However, GLP-1s may not be effective for everyone. Some experience side effects like nausea, while studies indicate a portion of patients lose less than 5% of their body weight, despite metabolic improvements. More information on these drugs can be found here.
Exploring Obesity Subtypes
“There are many types of obesity, and each type of obesity has a unique genetic predisposition,” says Andres Acosta, a gastroenterologist and hepatologist at the Mayo Clinic. He suggests genetic markers may soon predict a person’s response to GLP-1 medications.
Acosta also co-founded Phenomix Sciences, offering genetic testing through some doctors. The tests, which are not insurance-covered, categorize individuals into four obesity phenotypes: Hungry Gut, Hungry Brain, Emotional Hunger, and Slow Burn. Each group has distinct hormonal or lifestyle influences. Find more details about genetic testing here.
Developing Personalized Treatment Plans
Anna Olson’s genetic testing revealed her “Hungry Brain” phenotype and a predisposition to overeat due to Bardet-Biedl syndrome. Understanding her condition helped reduce stigma and guided her to a suitable medication combination. Now 36, Olson reports improved cholesterol and blood sugar levels and hopes to travel beyond her hometown, Minneapolis. Learn more about Bardet-Biedl syndrome here.
Precision diagnosis of obesity forms is still developing, according to Dr. Lydia Alexander of the Obesity Medicine Association. She notes that factors like gut microbiome composition, addiction tendencies, and hormone receptor structures can affect drug efficacy.
Challenges and Expectations of GLP-1 Treatments
Despite the promise of GLP-1 drugs, they have heightened expectations for quick weight loss. Dr. Jennifer Manne-Goehler from Harvard explains that about half of GLP-1 users lose 15% or more of their weight. However, she emphasizes that obesity is a chronic condition requiring multiple tools over a person’s lifetime. More information on the potential and limitations of GLP-1 drugs is available here.
Copyright 2026 NPR
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