GUT MICROBIOTA AND PHARMACOLOGICAL TREATMENT RESPONSE IN OBESITY: IMPLICATIONS FOR PERSONALIZED MEDICINE

Abstract

Obesity is a chronic, multifactorial metabolic disease associated with significant morbidity, mortality, and increasing global prevalence. In recent years, the gut microbiota has emerged as an important regulator of host metabolism, energy homeostasis, inflammation, and appetite control (Gomes et al., 2018; Geng et al., 2022; Enache et al., 2024). At the same time, modern anti-obesity pharmacotherapy, particularly glucagon-like peptide-1 receptor agonists, has substantially improved therapeutic possibilities. However, considerable interindividual variability in treatment response remains a major clinical challenge. This narrative review aimed to summarize current evidence regarding the relationship between gut microbiota and pharmacological treatment response in obesity, with particular emphasis on GLP-1 receptor agonists and implications for personalized medicine. Scientific literature including review articles, experimental studies, observational studies, and clinical investigations concerning obesity pharmacotherapy and microbiota-related mechanisms was qualitatively synthesized. Current evidence suggests that gut microbiota may influence obesity treatment efficacy through modulation of incretin secretion, bile acid metabolism, short-chain fatty acid production, gut barrier integrity, inflammatory pathways, and the microbiota–gut–brain axis. GLP-1 receptor agonists may additionally modify microbial composition, suggesting a bidirectional relationship between incretin signaling and microbiota regulation (Gofron et al., 2025; Feng et al., 2024). Overall, gut microbiota represents a promising therapeutic target and potential biomarker for precision obesity medicine. Further prospective human studies are required to validate microbiota-guided approaches to obesity pharmacotherapy.