Genetic architecture of obesity and advances in precision pharmacotherapy: a comprehensive review.
This comprehensive review examines the genetic underpinnings of obesity and the evolving landscape of pharmacological treatment informed by genetic insights. The authors distinguish between rare monogenic obesity — driven by mutations in single genes such as LEP, POMC, and MC4R within the leptin-melanocortin neuroendocrine signaling pathway — and common polygenic obesity, which results from the cumulative small effects of hundreds of genetic variants, including loci identified through genome-wide association studies (GWAS) such as FTO and SEC16B. The review also discusses how gene-environment interactions contribute to the heterogeneity of obesity phenotypes. On the pharmacotherapy side, the authors highlight recent advances including GLP-1 receptor agonists and dual/triple incretin agonists, noting their reported efficacy across diverse genetic backgrounds. The potential clinical utility of polygenic risk scores for early risk identification and prevention is explored. Limitations of this paper include its nature as a narrative review — it synthesizes existing literature rather than generating new empirical data — and it does not perform a systematic or meta-analytic evaluation. The authors acknowledge ongoing challenges in integrating genomic data into clinical practice and call for further research into genetic screening protocols and gene-environment interactions to advance precision medicine in obesity management.
Why this grade: This is a narrative review that synthesizes existing literature without generating original empirical data, precluding an independent evidence grade beyond that of a review article.
Obesity, a global health catastrophe, arises from complex interactions between environmental factors and genetic predispositions. This review summarizes the current state of knowledge on the genetic basis of obesity and contrasts rare monogenic forms caused by mutations in a single gene with common polygenic forms caused by hundreds of genetic variants with small effects. We highlight important genes in neuroendocrine signaling pathways, particularly the leptin-melanocortin system involving MC4R , LEP , and POMC , as well as newly identified loci from genome-wide association studies such as FTO and SEC16B . The interplay between genetic probability and environmental factors underscores the heterogeneity of obesity phenotypes. Recent advances in pharmacotherapy, such as GLP-1 receptor agonists and dual/triple incretin agonists, demonstrate strong efficacy across various genetic backgrounds and underscore the translational relevance of genetic insights. New findings from different groups support the use of polygenic risk scores to identify individuals at risk and suggest prevention strategies. This review discusses the genomic data on clinical practice and emphasizes the possibilities and challenges of precision medicine in obesity treatment. Future research should focus on length of genetic screening and elucidating gene-environment interactions to optimize treatment outcomes.
Educational summary of published research — not medical advice. License: cc by. Full text is shown only where licensing permits.