Revealed: The four different types of obesity and why not all benefit from risky weight-loss surgery

  • Study of 2,400 obese people found they can be divided into four subgroups
  • Groups differ in everything from diabetes rates to prevalence of binge eating 
  • There is no 'magic bullet for obesity' and personalised treatments are needed 

By Alexandra Thompson Senior Health Reporter For Mailonline

Published: 11:08 EST, 13 November 2018 | Updated: 15:18 EST, 13 November 2018

Obesity can be split into four different types, scientists claim.

Researchers analysed the success of weight loss surgery, which can be risky, among 2,400 obese people in the US. 

Using the results, they were able to create four distinct groups of obesity - and they found weight loss surgery worked differently among them all.

They hope their discovery that there 'isn't one magic bullet for obesity' will help to develop more personalised weight-loss treatments.

Using the results, they were able to create four distinct groups of obesity - and they found weight loss surgery worked differently among them all

Using the results, they were able to create four distinct groups of obesity - and they found weight loss surgery worked differently among them all

The four groups, which have yet to be officially named by the Brown University team, differ in everything from diabetes rates to the prevalence of binge eating.

In group one, dubbed the diabetes group, patients had low levels of so-called 'good' cholesterol and high levels of diabetes.

Those in group two (disordered eating) were most likely to have unhealthy eating habits, while those in group four (early onset) were most likely to have been obese since childhood.

The scientists, led by epidemiologist Alison Field, were unable to define distinct characteristics of group three (mixed).

Groups two and three particularly benefited from going under the knife, according to the study published in the journal Obesity.

Those with unhealthy eating habits lost the most amount of weight, at an average of 28.5 per cent for the men and 33.3 per cent for the women.

'There probably isn't one magic bullet for obesity - if there is a magic bullet, it's going to be different for different groups of people,' Ms Field said.  

'We need to recognise this diversity, as it may help us to develop more personalised approaches to treating obesity.'    

Graph shows the weight change percentage patterns among the different types of obesity for men who underwent Roux‐en‐Y bypass surgery - with it proving more effective for those in group two and three

Graph shows the weight change percentage patterns among the different types of obesity for men who underwent Roux‐en‐Y bypass surgery - with it proving more effective for those in group two and three

This graph shows the same weight change percentage patterns among the different types of obesity for women who underwent Roux‐en‐Y bypass surgery

This graph shows the same weight change percentage patterns among the different types of obesity for women who underwent Roux‐en‐Y bypass surgery

Another graph shows the weight change percentage patterns among the different types of obesity for men who underwent gastric banding, which uses a silicone ring to create a small pouch at the top of the stomach

Another graph shows the weight change percentage patterns among the different types of obesity for men who underwent gastric banding, which uses a silicone ring to create a small pouch at the top of the stomach

This graph shows the weight change percentage patterns among the different types of obesity for women who underwent gastric banding

This graph shows the weight change percentage patterns among the different types of obesity for women who underwent gastric banding

WHAT ARE THE FOUR TYPES OF OBESITY? 

The four groups, which have been uncovered by the Brown University researchers, differ in everything from diabetes rates to the prevalence of binge eating.

GROUP ONE: Diabetes

Low levels of high-density lipoprotein, so-called ‘good’ cholesterol

High levels of glucose in their blood prior to surgery

Around 98 per cent of patients in this group had diabetes

GROUP TWO: Disordered eating

Distorted eating behaviours, such as binge eating

Around 60 per cent reported feeling a loss of control over grazing – eating food between meals. And 92 per cent reported eating when they weren’t hungry

GROUP THREE: Mixed

Very low levels of distorted eating – just seven per cent reported eating when they weren’t hungry

No other factors distinguished this group

GROUP FOUR: Early onset

Obese since childhood

Group had the highest BMI at age 18, with an average of 32 – the others were around 25

Also had the highest pre-surgery BMI, an average of 58 – the others were around 45

In the first study of its kind, researchers analysed patients who underwent weight-loss surgery between March 2006 and April 2009.

Some of the patients had a gastric bypass, which involves using surgical staples to create a small pouch at the top of the stomach so a person feels fuller quicker and absorbs less calories.

Others had a gastric band, which uses a silicone ring to create a small pouch at the top of the stomach.

Using an advanced computer model, known as a latent class analysis, the researchers identified four distinct patient subgroups among the participants. 

In group one, patients had very low levels of so-called 'good' cholesterol and had high amounts of glucose in their blood.

An analysis showed 98 per cent of the patients were diabetic, compared to just 30 per cent on average in other subsets. 

Group two was defined by its members' unhealthy eating habits, with 37 per cent claiming to have a binge-eating disorder.

Some 61 per cent also felt unable to stop themselves from 'grazing' between meals, while 92 per cent ate even when they were not hungry.

The researchers were then particularly surprised to discover that those in group three did not have especially worrying eating habits despite them being obese.

Just seven per cent reported eating when they were not hungry compared to 37 per cent in group one, 92 per cent in group two and 29 per cent in group four.

'Interestingly, no other factors distinguished this group from the other classes,' the authors wrote.

Group four was made up of people who had been obese since they were children.

By 18 years old, this group had the highest BMI with an average of 32 compared to around 25 for the other three subsets. A BMI of more than 30 is considered obese, while 25 plus is overweight. 

Group four also had the highest pre-surgery BMI, averaging at 58 compared to the others' 45.

'A child who becomes very obese by age five is going to be very different from someone who gradually gains weight over time and at age 65 is obese,' Ms Field said. 

The researchers hope their findings will help them identify patients who would benefit most from weight-loss surgery.

'One of the reasons why we haven't had stronger findings in the field of obesity research is that we're classifying all of these people as the same,' Ms Field said.

'It may very well be there are some incredibly effective strategies out there for preventing or treating obesity.

'But when you mix patients of different groups together, it dilutes the effect.'

Ms Field added scientists should investigate how varying obesity treatments affect different patients.

For instance, mindfulness may be effective in those who become overstimulated by the sight or smell of food but not those who do not eat when they are not hungry.

Ms Field hopes future studies will also delve into if similar subgroups exist among people who are overweight but not obese.

WHAT ARE THE DIFFERENCES BETWEEN THE FOUR TYPES OF OBESITY? 
DIABETES DISORDERED EATING MIXED EARLY ONSET
GENDER 63.7% 83.4% 80.2% 65.5%
CURRENT BMI 45.5 44.6 44.7 58.3
DREAM BMI 24.2 22.8 23.3 26.5
% WITH OVERWEIGHT MOTHERS 27.1% 29.0% 30.7% 37.4%
% WITH OVERWEIGHT FATHERS 35.0% 37.8% 32.2% 40.5%
% WITH TYPE 2 DIABETES 97.8% 27.1% 31.2% 38.5%
% WITH BINGE EATING DISORDER 19.8% 36.6% 1.9% 10.2%
% THAT ARE NIGHT EATERS 14.1% 26.0% 12.1% 14.0%
% THAT ARE GRAZERS 37.0% 92.4% 7.2% 29.3%
AVERAGE BLOOD GLUCOSE 246.5 97.0 98.0 97.0
AVERAGE LDL CHOLESTEROL 107.5 114.0 108.0 100.5
AVERAGE HDL CHOLESTEROL 37.0 44.0 43.0 40.0
Glucose average - 72 to 99 mg/dL LDL cholesterol should be less than 100 mg/dLHDL cholesterol levels should be higher than 40 mg/dL  

IS WEIGHT LOSS SURGERY RISKY? 

Obesity affects around 35 per cent of men and 40.4 per cent of women in the US. In the UK, a quarter of the population is carrying a dangerous amount of weight.

This put them at risk of conditions such as type 2 diabetes, heart disease, stroke and even certain cancers, including breast and bowel.

In the US, Medicare and Medicaid generally cover weight-loss surgery if is deemed to be medically necessary and a patient fits a long list of criteria.

The NHS offers the operations for those with a BMI of 40 or above who have tried dieting and exercising without success, and who are willing to make lifestyle changes after going under the knife.

Like all operations, weight-loss surgery can lead to blood clots and wound infections. 

There is also the chance that a gastric band may slip or food may leak into the abdomen and cause a serious infection.

Malnutrition can also occur if surgery makes it harder for the gut to absorb nutrients from food.

Patients may also be left with excess folds of skin around their breasts, torso, hips and limbs, which may require surgery to remove.  

Around one in 1,400 people who go under the knife to help them lose weight even die during or after the procedure due to complications.  

The four different types of obesity and why not all benefit from risky weight-loss surgery

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