Agreement between people with obesity and their treating physicians on behavioral and psychological phenotypes in real-world obesity care

Background: Awareness is growing that body mass index (BMI) alone does not capture the behavioral, psychological and physiological heterogeneity of obesity. We investigate the recognition and alignment of four existing obesity phenotype descriptor domains (emotional hunger, hungry brain, hungry gut, and slow burn) among people with obesity (PwO) and physicians. Methods: This was a real-world, cross-sectional survey study, which included elements of retrospective data collection. Data were collected from physicians and PwO in the United States between October 2023 and April 2024 as part of the Adelphi Real World Obesity Disease Specific Programme™. Physicians provided clinical data and PwO demographic information; both reported on predefined obesity phenotype descriptors. Agreement between PwO and physician reports was evaluated using Cohen's κ; PwO characteristics were compared using bivariate analyses. Results: PwO (n = 215) mean age was 48.8 ± 13.9 years, and 69.3% were female. Significant differences between comorbidity prevalence were observed across phenotype descriptors; depression, stress and hypothyroidism being notably common in PwO reporting emotional hunger or hungry brain descriptors. Physicians (n = 151) most commonly reported hungry brain descriptor (52.6%), whereas PwO most commonly reported emotional hunger (45.1%). Patient-physician agreement was slight for hungry brain (κ = 0.176) and hungry gut (κ = 0.113), fair for emotional hunger (κ = 0.207) moderate for slow burn (κ = 0.410). There was significantly greater weight loss among PwO where physicians aligned on the presence of the hungry brain descriptor compared with those who did not align. Conclusions: Obesity phenotype descriptors relating to emotional hunger, hungry brain, hungry gut and slow burn may provide a useful framework for characterizing behavioral, psychological and physiological aspects of obesity that are not reflected by BMI. However, PwO-physician recognition and agreement were limited and varied across descriptor domains. Greater concordance on selected descriptors was associated with improved weight-loss outcomes, suggesting value in supporting shared understanding of obesity presentation and management.