One size does not fit all when diagnosing and treating obesity. New research suggests people with obesity fall into six different categories, and that health professionals should tailor treatment strategies accordingly.
According to the study, published in the Journal of Public Health, people with obesity are often treated the same regardless of their health status, gender and lifestyle. Instead, researchers argue clinicians and policymakers should tailor strategies for subgroups as defined by their shared characteristics. Based on a cluster analysis of 4,000 individuals with obesity, they say people fall into six:
- "Young healthy females"
- "Heavy-drinking males"
- "Unhappy and anxious middle aged"
- "Affluent healthy elderly"
- "Physically sick but happy elderly"
- "Poorest health"
The study led by Mark Green, BA, MSc, PhD, from the University of Sheffield in the UK, examined the data of people with a body mass index (BMI) of 30 or more between the ages of 16 and 85 using the Yorkshire Health Study, which contains self-reported information on demographic, socioeconomic status and health and behavioral characteristics.
“Our research showed that those in the groups that we are identified are likely to need very different services, and will respond very differently to different health promotion policies,” said Dr. Green. “In the future, we hope that GPs will keep in mind these six groups when offering advice to their patients.”
The Six Cluster Solution -- Categories
Younger Healthy Females
The study found this was the largest and youngest group. They had the most positive health characteristics, and also engaged in some healthy behaviors, including exercise.
Heavy Drinking Males
This group was similar to “young healthy females” except for their high alcohol consumption. They were also less likely to be managing their weight, although they did report above average levels of exercise and walking.
Unhappy Anxious Middle-Aged
This group was primarily female. They had poor mental health, “high values” for insomnia, anxiety, depression and fatigue, and their sense of well-being was relatively low. They did, however, engage in healthy physical activity and in weight management, and had the lowest alcohol consumption.
Affluent Healthy Elderly
Researchers say this is the “least deprived” group. They have positive health characteristics, although had above average alcohol consumption, and a large proportion of them had high blood pressure.
Physically Sick but Happy Elderly
This group had a higher prevalence of chronic conditions including osteoarthritis, diabetes and high blood pressure, but had low levels of anxiety and depression.
This group had the highest BMI and the highest prevalence of most chronic conditions. They tended not to engage in healthy behaviors and reported high levels of pain and fatigue.
Researchers suggested messages about alcohol reduction could help address obesity in young adults, while interventions that mix exercise with psychosocial counseling could be beneficial for middle-aged individuals who are unhappy and anxious.
The benefits of weight loss and bariatric surgery have also been well documented. In 2009, a study in Lancet Oncology found that women with obesity who undergo bariatric surgery experience a 42 percent drop in their cancer risk.
John Morton, MD
“The study reinforces an important issue in that obesity is personal and there are more factors other than BMI to look at when determining treatment and aftercare,” said John M. Morton, MD, ASMBS President and Director of Bariatric Surgery at Stanford Hospital & Clinics. “America is the melting pot of the world, and exploring and respecting the diversity of people, cultures and behaviors may help improve prevention and treatment strategies across the spectrum of obesity.”