Meet the EASO COMs: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany

Meet the EASO COMs: Division of Pediatric Endocrinology and Diabetes, University Medical Center Ulm, Germany

We are pleased to introduce Prof. Dr. med. Martin Wabitsch, Head of the Division of Pediatric Endocrinology and Diabetes at the Department of Pediatrics and Adolescent Medicine, University Medical Center Ulm, Germany. This COM is internationally recognised for its excellence in childhood and adolescent obesity research and care, combining advanced clinical practice with strong national and European collaborations. This COM’s multidisciplinary team includes five medical doctors (three paediatric endocrinologists and two paediatricians), two dietitians, one psychologist, one social worker, three nurses, and one physician educator, supported by dedicated clinical and laboratory research groups comprising physicians, study nurses, nutritionists, and molecular biologists.

Thank you for speaking with us, Professor Wabitsch. Could you please tell us about your COM’s patient care philosophy and approach?

Doctors, medical experts, and scientists work together in an interdisciplinary team to provide comprehensive care and education for patients and their families. The patient and family are always at the centre of care. Our team provides the best available medical and psychosocial support through an open, stigma-free approach. Patient care is guided by a holistic concept, evidence-based guidelines, and a quality assurance system. We aim to continually improve outcomes through basic research and clinical studies. Our expertise spans the full field of paediatric endocrinology and diabetology. We are part of the European Reference Network on Rare Endocrine Conditions (Endo-ERN), which strives to improve access to high-quality care for children with rare endocrine disorders. Beyond treating complications, our goal is to improve quality of life, reduce shame, and help young people participate fully in social and school life – a supporting acceptance of obesity as a chronic condition requiring long-term management.

Can you describe the treatments and services your COM offers?

Our approach follows the national evidence-based S3-guidelines for the prevention and treatment of childhood and adolescent obesity, developed under my lead within the German working group for obesity in children and adolescents (AGA), the German Obesity Society (DAG) and the German Society for Paediatrics and Adolescent Medicine (DGKJ). The guidelines are currently being updated to reflect the latest scientific and therapeutic developments. We offer both lifestyle modification and bariatric surgery, the two currently recommended therapeutic approaches. A recently published multi-stage care concept for children and adolescents with extreme and/or genetic obesity (Zorn et al.) begins with monitoring and treatment of comorbidities, followed by a multimodal lifestyle intervention including dietary therapy, physical activity, and behaviour modification. Where indicated, pharmacological therapy (stage 3) and bariatric surgery (stage 4) are added as further treatment modalities.

Our department provides an accredited one-year outpatient lifestyle behavioural-based programme for children and adolescents aged 8-16 years. This evidence-based intervention aims to change lifestyle habits through dietary, psychological, and physical activity components, supplemented by medical supervision. Most sessions are delivered in group settings, complemented by individual consultations.

In cases where conventional treatment fails, bariatric surgery may be offered. Drawing on experience from the multicentre Youth with Extreme Obesity (YES) Study, we have developed a 3-4-month pre-surgery preparation and a structured follow-up programme lasting at least two years, in close collaboration with the adult surgery unit at Ulm University. For patients with severe obesity, EMA-approved medications (liraglutide and semaglutide) are prescribed to eligible individuals alongside lifestyle modification. During dose escalation, digital follow-ups (via video or phone) are used to reduce travel time and costs, while in-person visits occur quarterly within our endocrine outpatient clinic.

We are also a specialised centre for monogenic and syndromic obesity. A standardised genetic analysis is performed in all individuals with early-onset or suspected genetic obesity. Mechanism-based drugs have been a major advance in long-term weight management: metreleptin is used for leptin deficiency, and setmelanotide is offered to patients with POMC, PCSK1, or LEPR receptor deficiency.

Aside from the group programme, most treatments are delivered individually. Laboratory diagnostics and psychological assessments are performed routinely, alongside screenings for depression, eating disorders, and metabolic complications. Additional investigations such as OGTT, 24-hour blood pressure monitoring, DEXA, and ultrasound are available. Psychological counselling and social work support are provided when needed. Patients may also participate in clinical trials on pharmacological treatments for extreme and genetic obesity.

What recent achievements and research updates can you share?

Over the past year, our centre has contributed to several high-impact publications, including:

I was also honoured to receive the ESPE Research Award 2024 in Liverpool for contributions to pediatric endocrinology and obesity research. We are part of the German Center for Child and Adolescent Health (DZKJ) – a national consortium promoting “Healthy children and adolescents through science”. Our team participates in multiple international collaborations, including the iGo Registry, ECLIP Registry, and an investigator-initiated trial evaluating semaglutide for adolescents with monogenic obesity.

Does your COM engage with the wider community and health system?

Yes. We maintain strong collaboration with local paediatricians and general practitioners, who refer patients to our lifestyle programme. Paediatricians oversee medical care, while our multidisciplinary team provides the nutritional, psychological, and physical activity components, supported by a physician educator who leads weekly sports sessions. Within the German Center for Child and Adolescent Health (DZKJ), we are also developing a digital platform on childhood obesity for families and caregivers. This platform will address medical management and psychosocial challenges such as bullying, stigma, and social withdrawal, offering practical resources and guidance for patients and healthcare professionals. Additionally, we organise biannual information events for children and adolescents living with obesity, their parents, and local healthcare providers. These sessions, held both in person and online in the evening hours, aim to improve understanding of obesity management and strengthen collaboration within the wider care network.

What are your main challenges and goals for the next 3–5 years?

A key challenge is the limited reimbursement of new pharmacotherapies such as incretin-based drugs for adolescents. Although these medications are proven effective as complements to behavioural interventions, they are often not yet covered by health insurance. We assist families with reimbursement applications and appeals. Another challenge is the growing number of referrals, which sometimes exceeds our capacity. We prioritise cases based on clinical urgency and collaborate with local practitioners to ensure timely access to specialised care.

Our main goals include:

  • Finalising the adaptation of the German S3 Guideline for the prevention and treatment of childhood obesity by 2027, aligning it with the Canadian Clinical Practice Guideline and new evidence
  • Supporting the implementation of Germany’s first Disease Management Program (DMP) for Childhood Obesity, legally approved in 2025. This milestone provides structured, guideline-based care with regular contact, documentation, training, and progress monitoring. We are working with national associations and health insurance providers to ensure effective rollout and reimbursement, establishing sustainable, high-quality care for children and adolescents with obesity

This edition highlights the Pediatric COM at the University Medical Center Ulm, led by Prof. Dr. med. Martin Wabitsch. This COM’s multidisciplinary and research-driven approach integrates lifestyle intervention, pharmacotherapy, and bariatric care for children and adolescents living with severe and/or genetic obesity. Prof. Wabitsch shared recent achievements including several high-impact publications, national leadership in updating the German S3 guidelines, and the launch of new research collaborations through the German Center for Child and Adolescent Health (DZKJ). Thank you, Prof. Wabitsch!