Abstract
Introduction. Obesity can no longer be adequately described by body mass index alone. Similar BMI values may coexist with different fat distribution, inflammatory burden, neuroendocrine dysregulation, psychobehavioral traits, and risks of organ dysfunction.
Objective. To systematize current knowledge on the molecular heterogeneity of obesity and to show why a personalized approach should include not only drug selection, but also diagnostic stratification, phenotyping, assessment of psychobiological drivers, and prediction of treatment response.
Material and methods. An analytical review of publications indexed in PubMed/MEDLINE and peer-reviewed journals from 2021 to 2026 was performed, with emphasis on studies from 2024 to 2026 addressing clinical obesity, adipose tissue heterogeneity, neuroendocrine and immune-inflammatory mechanisms, precision obesity medicine, incretin-based therapy, and clinically meaningful outcomes. The review also integrates the authors’ concept of an integral personalized obesity index and a draft clinical case of a patient who declined GLP-1 receptor agonist therapy.
Results. Molecular heterogeneity of obesity is driven by differences in adipose tissue cellular composition, immune profile, fibrosis, epigenetic memory, central leptin resistance, hypothalamic-pituitary-adrenal axis activation, gut-brain communication, and psychobehavioral phenotypes. The efficacy of anti-obesity therapy is likewise heterogeneous and depends on the complication phenotype, body composition, adherence, risk of lean mass loss, and treatment duration.
Conclusion. Personalized obesity care should rely on multidimensional assessment, including anthropometry, body composition, molecular and inflammatory features, psychobiological factors, organ-specific complications, and expected treatment response. Moving from a BMI-centered model toward phenotype- and endotype-guided care is a key trajectory for molecular medicine of obesity.
Keywords
Authors and affiliations
https://elibrary.ru/bhtzbg
V.B. Grinevich(1), V.V. Zakrevsky(1), Yu.A. Kravchuk(1), S.P. Salikova(1),, P.V. Seliverstov(1),
K.A. Dikinova(2), I.N. Khupsergenova(3), D.I. Gorbunova(4), M.M. Khabibulina(5)
1-S.M. Kirov Military Medical Academy, Ministry of Defence of the Russian Federation, Lebedeva St., 6, Saint-Petersburg, 194044,
Russian Federation; 2-Pirogov Russian National Research Medical University (Pirogov University), Ostrovityanova str., 1, building 6,
Moscow, 117513, Russian Federation; 3-Patrice Lumumba Peoples’ Friendship University of Russia, Miklukho-Maklaya str., 6, Moscow,
117198, Russian Federation; 4-Federal State Budgetary Educational Institution of Higher Medical Education of the Ministry of Health
of the Russian Federation, Sovetskaya str., 6, Orenburg, 460000, Russian Federation; 5-Ural State Medical University,
Ministry of Health of the Russian Federation, Repina St., 3, Yekaterinburg, 620028, Russian Federation
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