In conversation with Gema Frühbeck, EASO Scientific Advisory Board Co-Chair

In conversation with Gema Frühbeck, EASO Scientific Advisory Board Co-Chair

“Maintenance of weight loss is the major challenge of obesity management.” Gema Frühbeck, EASO Scientific Advisory Board Co-Chair

We are pleased to share an important new review article in the Lancet written by Dr Gema Frühbeck, MD, PhD et al.

As this review states from the outset, the goal of obesity management is health improvement. Because this goal underpins approaches to obesity care, it is crucial that obesity management pathways utilise long-term, multimodal and multidisciplinary approaches, taking into consideration individual treatment goals alongside evaluation of benefits and risks of various therapeutic approaches. Weight loss maintenance over the longer term is the crucible of obesity management; there is no “silver bullet”.

Lovely to meet with you, Gema and great to see your important new review article in The Lancet, which is particularly timely given the plethora of new pharmacologic molecules now available and currently under development.

Thank you; very nice to be able to share our work with the EASO community. You are absolutely right, this is  very timely topic because fortunately, the number of effective and safe drugs currently available for the treatment of obesity and under development is huge as compared to years ago.

Can you briefly summarize highlights of your review article on medical, device, and treatment alternatives for people living with obesity (PLwO), discussing some of the most promising medical, device, and treatment options for people living with obesity and how they contribute to weight loss?

One of the aspects that has dramatically changed in the last years is the possibility of accessing drugs which are able to obtain double-digit weight loss percentages within a safe framework. A different aspect of our review is that we have presented data on the huge inter-individual variability in response to any treatment approach. We have also established the comparison as regards the magnitude of the response that can be expected with each treatment alternative. Interestingly, the gap between bariatric surgery outcomes with those of the the new drugs is closing.

Fascinating! What are some of the potential challenges and limitations associated with using these treatments —how do they affect weight management outcomes?

The challenge with all treatment alternatives is really to identify which is the best and most effective approach for every individual patient. An important aspect to take into consideration is that obesity is a chronic and relapsing disease. Therefore, treatments need to be implemented and care managed not only with a short term perspective.

Long term care is crucial in obesity management! Can you also speak to the importance of incorporating lifestyle changes, such as diet and exercise, in conjunction with medical, device, or other treatment options for people with obesity? And how do the long-term effects of these treatments, both positive and negative, impact weight loss and overall health outcomes for patients with obesity?

Undoubtedly, a healthy diet and physical activity adapted to individual patient preferences and options should be pillars of any treatment approach. Moreover, the challenge is to incorporate these healthy lifestyle changes so that they are integrated into our lives over the long-term. The positive thing about supporting weight loss is that as soon as patients begin to experience the beneficial effects of weight loss, it becomes an additional motivation to continue. Also, improvement in the comorbidities like type 2 diabetes, HTA, OSA, NAFLD, and others are also very encouraging for PlwO

Very encouraging indeed. How you think advances in technology and research will impact the treatment of obesity in the future?

Advances in technology and research will surely help us in being able to apply precisión medicine to benefit PLwO. Artificial intelligence and machine learning will enable us to better identify the diverse obesities; this will enable us to suggest more individually-tailored treatment approaches.

Excellent, Gema; thank you. The different obesities can be overlooked in discussions about obesity. Let’s plan to follow-on with a discussion about this important topic.

Can you briefly discuss the challenge of disparities and inequalities in access to available treatments based on factors such as race, income, or geographical location?

This is one of the terrible aspects of the obesity epidemic. It is unconceivable that in most countries anti-obesity drugs are not covered by healthcare systems. As a dramatic point of comparison, if you have T2D, the very same treatment is fully reimbursed, while if you are a PlwO it is not. This is a clear case of discrimination. On top of that, education, ethnicity and socioeconomic or geographic background further contribute to this challenge, making specific groups more vulnerable to developing obesity and to lacking access to treatment.

Thank you, Gema; health inequalities across Europe are sometimes stark.

What advice do you have for healthcare providers and patients seeking to manage obesity and achieve long term weight loss?

My initial advice for HCPs is to actively listen to PLwO, to be genuinely interested in the difficulties they experience and to avoid oversimplification and stigmatizing views. For PLwO my advice is to try to find an obesity specialist with whom they feel comfortable, who will address all aspects of health management, rather than just focusing on weight loss, and also to be patient and not to try to achieve major change in just a short period of time.

Policies investing in obesity management from primary prevention through comprehensive treatment across the life-course are essential in supporting public health and prevention of related chronic disease — including Type 2 diabetes,  cardiovascular diseases and cancers.

With substantial therapeutic tools now available and others appearing on the horizon, what recommendations would you have for policymakers in European national health systems?

Policymakers should really be aware of how PLwO are being discriminated against and stigmatized. Some people continue to advocate that obesity should not be medicalized because it can be tackled through mere energy restriction and physical activity. This belief really shows ignorance of the tremendous complexity involved in energy homeostasis, which goes far beyond the “lack of will power” often b