Outcomes of a Precision Digital Care Program for Obesity and Associated Comorbidities: Results in Real World Clinical Practice

Abstract

Background: Obesity is a multifactorial disease with a complex pathogenesis and several prevalent and debilitating associated comorbidities. New genome and microbiome based diagnostic and therapeutic strategies (i.e., personalized medicine) are increasingly guiding the treatment of obesity in clinical settings, but clinical outcomes of precision digital therapeutics require critical examination.

Objective: To conduct a follow-up of participants who lost at least 5% of their weight using a precision digital care program, and to specifically examine the effect of the intervention upon participants’ fasting blood glucose, hemoglobin A1c, hypertension, and symptoms of gastrointestinal distress, all of which are risk factors for metabolic illness.

Methodology: A precision digital care program was delivered online and leveraged participants’ physiological data, genetic and gut microbiome profiles, and lifestyle habits alongside a mobile app and personalized health coaching to manage weight loss. Individuals who lost at least 5% of their starting bodyweight within 100 days of program commencement were sent a survey on comorbidities and symptoms and incentivized to report back within a week.

Results: Participants reported remission or reversal in presenting comorbidity symptoms, namely two of the most physically and financially debilitating obesity-associated comorbidities: insulin-related disorders and gastrointestinal distress. Those with insulin-related disorders experienced an average reduction of fasting blood glucose level by 17.55% and an average reduction of HbA1c level by 6.27%. Overall, gastrointestinal symptoms decreased by 7.5%, and specific symptoms were alleviated by 40-70% on average.

Conclusion: Weight loss guided by precision digital therapeutics may also improve obesity associated comorbidities, resulting in drastic healthcare savings and quality of life improvements. Further larger scale and longer-term investigations are needed to provide key insights and improve clinical guidelines for the monitoring and treatment of obesity and associated comorbidities.

Introduction

Skyrocketing obesity rates in the U.S. are driving a rapid shift in the landscape of American healthcare [1,2]. The medical system is faltering under the exponentially rising costs of managing obesity-related metabolic illnesses and comorbidities such as diabetes, cardiovascular disease, and mental health [3,4]. Obesity is a multifactorial disease with a complex pathogenesis and several prevalent and debilitating associated comorbidities [5]. In particular, biological factors interact with behavioral factors and demographic influences such as socioeconomic status, or even cuisine, to influence obesity risk [6]. Obesityassociated biological factors include, but are far from limited to, genetics and epigenetics, microbiomic composition, age, circadian rhythm disruption, pharmaceutical interactions, and comorbidities and their management [6,7].

Most current clinical interventions for obesity management focus on lifestyle and dietary adaptation with varying levels of professional guidance and involvement, short- or long-term pharmaceutical therapies, or also bariatric surgery [8]. Individual responses to these therapeutic interventions are confounding (for clinicians and patients alike) and heterogeneous for multifactorial reasons [9], making imperative the need for personalized, precision medicine courses of treatment. Eventually researchers hope to elucidate the genetic patterns that influence individual obesity and concomitant illness susceptibility, risk of progression, and response to therapy, to afford patients maximal treatment.