We are pleased to welcome Dr Albert Lecube, the lead of the Adult COM and Head of the Endocrinology and Nutrition Department at Arnau de Vilanova University Hospital, in Lleida, Spain.
This COM’s multidisciplinary team consists of three endocrinologists, one psychologist, two nutritionists, and one exercise expert, who collaborate closely with three bariatric surgeons, the sleep unit, and the digestive department of the hospital. Together, the team provides surgical and pharmacological interventions that are always accompanied by medical nutrition therapy, psychological evaluation, and exercise training support. For patients with less severe obesity, the team works closely with primary care units to ensure integrated communication and care.
Thank you for speaking with us, Albert! Please tell us about the key principles of your COM team.
The key principle for us is changing the narrative surrounding obesity. We emphasise the importance of discussing “obesities” in the plural, as it is essential to recognise that each patient is unique and should receive personalised obesity management. Obesity should never be viewed as a moral failing or a matter of personal choice. Instead, we strive for a future where obesity is acknowledged as a serious health issue and receives the attention and priority it deserves in society as a chronic, relapsing disease. Aside from being an EASO COM, our hospital is also part of the Spanish network of Obesity Units endorsed by SEEDO, which reflects our commitment to this cause at the national level.
What news from work in your COM during the past 12 months can you share?
Over the past year, our activities have focussed on three main pillars. First, we are studying weight stigma and bias across different populations: Spain, Egypt, Latin American countries, and the United States. We strongly believe understanding how people perceive obesity and internalise stigma, and identifying the most critical situations where stigma is experienced are essential steps for developing effective public health campaigns aimed at changing societal perceptions of obesity. Second, we have been working on improving our ability to identify, through clinical-genetic scores, the types of patients in which different obesity management options will be most successful, particularly bariatric surgery (Navarro-Masip et al., 2024; Mas-Bermejo et al., 2024; Pena et al., 2024). Third, which may be the most groundbreaking, we have made significant advancements in assessing fibrosis in abdominal subcutaneous adipose tissue, which is reshaping how we understand patient phenotypes. This assessment must be conducted during the patient’s first visit to our COM. Alongside these initiatives, we are also exploring the impact of chrononutrition on obesity and weight loss outcomes, the effects of food insecurity on metabolic health, the relationship between MASLD and intermittent hypoxia with cardiovascular disease, and the influence of adiposity on chronic kidney disease (León-Mengíbar et al., 2024; Navarro-Masip et al., 2024; Rojo-López et al., 2024; Salinas-Roca et al., 2024). Finally, we also try to excel in conducting clinical trials related to obesity (Selvarajah et al., 2024).
Have you established any innovative practices within your COM?
Yes, one of the most innovative practices we have introduced is the use of subcutaneous adipose tissue biopsies to assess fibrosis. This simple yet impactful procedure helps us understand the function of adipose tissue and has become a regular part of our clinical routine. We send these biopsies first to the Pathology Department, and later to the biobank for research purposes. We have also managed to reduce the biopsy procedure time from 84 minutes to less than 25 minutes by adopting the Tru-Cut technique. This change allows us to collect more homogeneous samples. Additionally, we now use ultrasound to guide the biopsy, which helps differentiate between superficial and deep adipose tissue, improving the accuracy of the sample collection.
Technology is fast becoming an integrated part of obesity management. What role do you foresee technology playing in your COM?
Technology can complement conventional programmes, especially when those programmes are unavailable or when patients prefer technology-based solutions. We have recently incorporated body composition analysis techniques, such as bioelectrical impedance analysis (BIA), into our clinical assessments to evaluate treatment response. We are also exploring the use of mobile apps, tracking platforms, and wearable devices such as pedometers. However, we are still figuring out the best way to fully integrate these technologies into our treatment and follow-up strategies – perhaps this is a topic for discussion with the EASO COMs network.
What are the main challenges your COM currently faces, and what are your goals for the next 3-5 years?
One of the biggest challenges we face is the turnover and loss of healthcare professionals, which can affect the quality of care we provide. Finding qualified replacements is difficult, and this puts pressure on the team, impacting both patient care and research progress. It is an ongoing challenge that requires careful management. Looking ahead, our goals for the next 3-5 years include increasing our recognition within both the scientific community and the general public. We plan to continue advancing our research, especially in the areas of adipose tissue and obesity treatments. Raising awareness about the importance of obesity as a health priority is another key focus. Ultimately, we hope to make a larger impact on how obesity is perceived and managed, both medically and socially.
Read the publications Dr Lecube mentioned, here:
- Mid-term effects of bariatric surgery on metabolic dysfunction-associated fatty liver disease remission and predictive factors: A prospective study with a focus on non-invasive diagnosis (Navarro-Masip et al., 2024)
- Genetic risk score based on obesity-related genes and progression in weight loss after bariatric surgery: a 60-month follow-up study (Mas-Bermejo et al., 2024)
- Use of polygenic risk scores to assess weight loss after bariatric surgery: a 5-year follow-up study (Pena et al., 2024)
- Association between adherence to the mediterranean diet, physical activity, and sleep apnea-hypopnea syndrome (SAHS) in a middle-aged population with cardiovascular risk: Insights from the ILERVAS cohort (Salinas-Roca et al., 2024)
- Influence of nonalcoholic fatty liver disease severity on carotid adventitial vasa vasorum (León-Mengíbar et al., 2024)
- Metabolic dysfunction-associated steatotic liver disease in severe obesity and concordance between invasive (biopsy) and noninvasive (OWLiver®) diagnoses (Navarro-Masip et al., 2024)
- Mediterranean diet is a predictor of progression of subclinical atherosclerosis in a mediterranean population: The ILERVAS prospective cohort study (Rojo-López et al., 2024)
- A randomized phase 2b trial examined the effects of the glucagon-like peptide-1 and glucagon receptor agonist cotadutide on kidney outcomes in patients with diabetic kidney disease (Selvarajah et al., 2024)
This Meet the COMs edition featured the Adult COM at Arnau de Vilanova University Hospital, Spain. Dr Lecube highlighted this team’s innovative use of subcutaneous adipose tissue biopsies, focus on weight stigma research across multiple countries, and multidisciplinary approach to personalised obesity management. He also discussed their goals for advancing phenotypic understanding, integrating technology, and raising public awareness about obesity as a chronic disease. Thank you, Albert, for sharing your inspiring work and vision for the future of obesity care!