Research & Development, EvolvingFX, LLC., Fort Wayne, IN 46835, USA.
Department of Cardiovascular Diseases, John Ochsner Heart & Vascular Institute, Ochsner Clinical School, The University of Queensland School of Medicine, New Orleans, LA 70121, USA.
Nutrients. 2022 May 30;14(11):2286. doi: 10.3390/nu14112286.
The etiology of obesity is complex and idiosyncratic-with inherited, behavioral, and environmental factors determining the age and rate at which excessive adiposity develops. Moreover, the etiologic status of an obese phenotype (how and when it developed initially) strongly influences both the short-term response to intervention and long-term health trajectories. Nevertheless, current management strategies tend to be 'one-size-fits-all' protocols that fail to anticipate the heterogeneity of response generated by the etiologic status of each individual's phenotype. As a result, the efficacy of current lifestyle approaches varies from ineffective and potentially detrimental, to clinically successful; therefore, we posit that effective management strategies necessitate a personalized approach that incorporates the subtyping of obese phenotypes. Research shows that there are two broad etiologic subtypes: 'acquired' and 'inherited'. Acquired obesity denotes the development of excessive adiposity after puberty-and because the genesis of this subtype is behavioral, it is amenable to interventions based on diet and exercise. Conversely, inherited obesity subsumes all forms of excessive adiposity that are present at birth and develop prior to pubescence (pediatric and childhood). As the inherited phenotype is engendered in utero, this subtype has irreversible structural (anatomic) and physiologic (metabolic) perturbations that are not susceptible to intervention. As such, the most realizable outcome for many individuals with an inherited subtype will be a 'fit but fat' phenotype. Given that etiologic subtype strongly influences the effects of intervention and successful health management, the purpose of this 'perspective' article is to provide a concise overview of the differential development of acquired versus inherited obesity and offer insight into subtype-specific management.
肥胖的病因复杂且因人而异——遗传、行为和环境因素决定了过度肥胖的发展年龄和速度。此外，肥胖表型的病因状况（其最初如何以及何时发展）强烈影响短期干预反应和长期健康轨迹。然而，目前的管理策略往往是“一刀切”的方案，无法预测每个个体表型病因状况所产生的反应异质性。因此，目前生活方式方法的疗效从无效且可能有害到临床成功不等；因此，我们认为有效的管理策略需要一种个性化的方法，将肥胖表型进行细分。研究表明，存在两种广泛的病因亚型：“获得性”和“遗传性”。获得性肥胖是指青春期后发展为过度肥胖——由于这种亚型的起源是行为性的，因此可以通过饮食和运动干预来治疗。相反，遗传性肥胖包含所有出生时存在并在青春期前发展的过度肥胖形式（儿科和儿童期）。由于遗传性表型是在子宫内产生的，因此该亚型具有不可逆转的结构（解剖学）和生理（代谢）改变，不受干预影响。因此，对于许多具有遗传性表型的个体来说，最现实的结果将是“健康但肥胖”的表型。鉴于病因亚型强烈影响干预效果和成功的健康管理，本文的目的是简要概述获得性肥胖与遗传性肥胖的不同发展，并深入了解特定亚型的管理。
