A Common Language for Obesity: EASO Taxonomy

Description

This eLearning Hub webinar and journal club focussed on the importance of standardised terminology in obesity research and healthcare. Dr Jennifer Baker discussed EASO’s new taxonomy initiative, which provides a common language for obesity and a standardised and consistent framework for defining and classifying obesity. This 1-hour session featured an overview of taxonomy development, key themes, and practical implications, followed by a journal club discussion during which participants asked questions about the taxonomy development and use. More information here: https://easo.org/easo-early-career-network-october-event-tuesday-22nd-october-2024/. Read about the EASO Taxonomy, here: https://tinyurl.com/nk662j32

Comments & Resources

Key Takeaways

  • A standardised, evidence-based language for obesity is crucial for effective obesity management, treatment and policy: EASO’s new taxonomy, published in the International Journal of Obesity, used the Delphi process to create a standardised terminology framework across six themes: definition, causes, prevention, screening, treatment, and consequences of obesity.
  • EASO’s obesity taxonomy was developed with European experts: The taxonomy had input from 70 experts across 30 countries, achieving 100% consensus in its final round. It provides clear definitions and context for key obesity concepts, ensuring consistency in discussions and facilitating better collaboration among stakeholders.
  • A lexicon, infographics and flashcards have been created to support the taxonomy: These valuable resources are aimed at educating stakeholders on the language of obesity. All have been designed to facilitate discussions and promote the adoption of standardised obesity terminology in clinical practice and policy-making.

Read about the EASO Taxonomy, here.

Transcript

Transcripts are auto generated, if you spot an error, please email enquiries@easo.org

Okay, so just a very quick introduction about today’s e-learning hub. So the title is Using a Common Language for Obesity. Our speaker is Dr Jennifer Baker.

So the topic for today is, as the title says, around language. Basically, EASO launched an initiative to standardise language using obesity from policy to practice. This is to lead to better management of obesity as a chronic, relapsing, non-communicable disease, as we all know.

And consistent terminology basically is so important for diagnosis, treatment, research, communication, policy making, patient outcome, basically is to create an overall better environment to tackle obesity as a disease. I would like to say that the Novo Nordisk Foundation has provided support to EASO for ECN development activities, including this webinar series. And the Novo Nordisk Foundation has had no influence over the content.

Just a very quick introduction. I am Eugenia Romano. I’m a new ECN board member.

I will be chairing this session and Neil, my other colleague from the ECN board, will shortly share some info with you on upcoming ECN opportunities, while Fulia will kind of provide all the useful information and links in the chat. I just want to remind you all that today’s webinar is recorded. The recording and any relevant link through the session will be shared with you all after the event.

Just a few more details. So e-learning hubs are online events held by EASO ECN to promote knowledge and skill development among students and early career professionals interested in the field of obesity. ECN is free to join.

So are these webinars. So we would like to encourage you to share ECN and all the events held with your colleagues, inviting them to join it. Because joining ECN is free and so are these webinars.

What else? Just a few hours rules before we start. So this setting is very informal. It’s just going to be a very interesting chat at the end of the presentation.

Questions can be asked in two ways. You can either raise a virtual hand and use the microphone when the question and answer session starts in the last 15-20 minutes of the webinar, or you can post questionnaires in the chat through the presentation and they will be answered by the presenter or asked by the moderator at the end of the presentation. I would also like to ask you to complete the feedback form that appears at the webinar at the end of the session.

This is very important because it will help us shape in future ECN events around your interest and tailor it to the audience, basically. So I’ll quickly hand it over to Emil for a few words on ECN opportunities. Thank you, Eugenia.

I also say hello to everyone. Thank you for joining us. And some new hot topics and opportunities for all of you.

First about abstract submission is now open for the European Congress on Obesity, ECO in Malaga, Spain on May 11-14, 2025. The ECN gather at ECO to share research and participate in networking and career development opportunities. Submit an abstract by the 12th January 2025.

So we have still time now to join ECO25. Also some words about awards and travel grants, which might be very interesting for all of you. First, I would like to remind the EIASO Novo Nordisk Foundation New Investigator Awards.

There are four research grants, approximately 40 000 euros each, available for new projects in basic science, clinical research, childhood obesity and public health. The application deadline is the 16th December 2024. So still you have time to apply and the award winners will be invited to the next two ECOs to present their related research.

Another point is ECN Best Thesis Award. This award recognizes the contribution of early career researchers thesis to the obesity field. Finalists are invited to present at the next ECO and the winner receives a certificate and 500 euros cash.

So deadline is 12th January 2025. We have two separate travel grants available to ECN members, one specifically to attend ECO and the other to attend other obesity related events, including specialist training. Check the EIASO website to apply.

Also some words about training and career development. We recently launched the ECN exchange program. Accepted exchange participants will spend three-five days visiting a specialist research site of their choice in Europe to subject-specific skills to support their career.

Application deadline 1st December 2024 for visits in 2025. We also have the ECN winter school. The residential educational course focuses on the hot topics in obesity with a specially developed program for ECN members.

This year’s winter school will be held in Palma de Mallorca. Thank you to everyone who applied and if you did not receive a place yet, we encourage you to keep applying. ECN spotlight.

We regularly interview ECN members about their research and share them widely with our obesity community. If you are interested in having your research spotlighted, please get in touch with us. And the last, we also have a WhatsApp group for quick updates, sharing resources and networking across Europe.

So please feel free to join us to get in touch. Thank you, Eugenia. Hand over to you.

Thank you, Emil. So lots of opportunities. If you are interested in any of them, if you have any colleague who’d be interested in any of them, please invite them to join the EIASO ECN group.

Also the WhatsApp group has no spam, no worries about it. So I’ll introduce today’s speaker is Dr. Jennifer Baker. She’s the head of medical course epidemiology at the Centre for Clinical Research and Prevention at Copenhagen University Hospital.

I hope I pronounced it well. Bispepje and Fredrisberg in Denmark. Over to you, Jennifer.

Thank you for today’s webinar. Wonderful. Well, thank you so much for the kind invitation.

And as always, I’m so impressed by the work that the ECN is doing. And I can’t encourage everybody enough to join this really great organization. So I’m going to start by sharing my slides.

We know that’s always an adventure. We shall see if it works successfully. And I should be going full screen.

Am I full screen for everybody? Now you are, yes. Perfect. So great.

So it’s a real pleasure to be here today to have a chance to talk about the EIASO obesity taxonomy. This was a really fantastic project that we started a few years ago. And as with everything in research, things take time.

But it was really wonderful. It’s been published this year and we’re really putting it into practice and action. I have no conflicts of interest to declare today with regards to this presentation.

So we all know that there is a problem across Europe and indeed across the world in terms of the prevalence of overweight and obesity. In this map here, we see the prevalence of overweight and obesity in adults across Europe. 53% of the adult population is living with these conditions, these diseases, in fact.

So in terms of thinking about the challenge ahead of us, I think we can all agree, and especially within EIASO, we know this is a really big public health challenge, but also a personal health challenge. So when we’re looking and thinking about obesity, I always like to put a reminder slide in for everybody, but also for myself. It is important how we talk about and show obesity.

Obesity is a disease per international definitions. It’s a disease according to the World Health Organization and as well the European Commission. People first language applies to obesity.

So we say people with obesity, people living with obesity. It’s standard practice for other diseases. So for example, people now say people with diabetes and not diabetics anymore.

So language changes and it’s really important we reflect this in our work. And finally, it’s incredibly important how we show obesity. We want to use positive imagery.

It needs to be respectful and non-stigmatizing and it’s wonderful. There’s numerous free resources. So please see the link below for a photo bank offered by EIASO so that we can all work together to really change how people are talking about and viewing this disease.

When we talk about obesity, we’re always talking about first and foremost prevention. And that’s absolutely correct. We need to prevent obesity from ever occurring.

But by the same token, we also have to remember if 53% of the adult population is already living with overweight or obesity, we also have to consider treatment. I cannot say it enough. This is not either or, this is a both situation.

So I’d like to give a little quick reminder about what do we mean when we talk about promotion or in terms of prevention. There’s health promotion. This is a population level and it enables people to increase control over their own health as interventions aimed at preventing the root causes of ill health.

This is not focused on obesity per se. If we take it to primordial prevention, again, population level, but this is really specifically trying to prevent risk factors for obesity. Then we get ourselves down to primary prevention.

We’re really trying to prevent obesity in populations at risk. There’s multiple levels to this, and especially in the field of obesity, these three are often confused. And of course, once obesity has been established, we’re talking now in terms of secondary prevention.

So we’re trying to minimize obesity progression. We’re talking about early detection. We also have tertiary prevention, where we’re trying to reduce the complications of obesity and intervene on the symptoms.

So by the time we hit secondary and tertiary prevention, we are in the treatment and management part of the spectrum. The point is, again, it’s not either or, everything is needed to really help improve the lives of people living with obesity. So if for today’s topic, we’re talking about a taxonomy of obesity, we also have to think, what do we need to do to treat and manage obesity effectively? So in order to do this, we need a high performing and resilient healthcare system.

We need a healthcare system that is fit for purpose for addressing obesity as a disease. In order to get there though, we need to have a common, precise, understandable, and scientifically accurate language used amongst and across all stakeholder groups. So even if as researchers or as clinicians, we’re talking about obesity as a disease, we know exactly what we mean.

By the time this moves to a policy level or a regulatory level, that may not be the case. It may mean something entirely different. So recognizing this, we really realize just like any other policy prioritized non-communicable diseases.

So for example, cancer, type 2 diabetes, mental health, we went through and we made a taxonomy for obesity so that we can get ourselves to the point of having this high performing and resilient healthcare system, which is fit for purpose. But you may be asking yourself, what is a taxonomy? And I’ll admit when I first heard about it, I had to really think back to undergraduate education where you’re shown the different levels and frameworks in terms of the kingdom and the animals and species. So a taxonomy simply put, it’s just a framework used to classify and organize concepts into groups based upon relationships.

So it is just rather a fancy word for a framework. The reason we do it is to create an organized structure that makes it easier to understand, identify, and relate components within a system. In our case, we’re talking about obesity as a disease.

And in fact, obesity as a chronic, adiposity-based chronic disease. So the pyramid’s kind of useful to keep in mind because at the top is a very specific definition. And by the time it gets to the bottom, it’s much broader and very generalized.

So this is the approach we use going into the taxonomy of obesity. And just to pause for a second, you know, why do we need this common language? Well, you know what? Words matter. If we’re not talking the same language, which is accurate and precise and scientifically sound, in the level of society, misconceptions about obesity can be perpetuated.

We’ve all seen videos that we don’t ever wish to see again on some of the different social media outlets because there’s a lot of misconceptions about what obesity is and is not. Using a common language is really important in terms of the healthcare professionals, particularly when it comes to the patient-provider relationship. It allows two people to speak respectfully with each other.

And in fact, we do know that having a common language can actually improve clinical outcomes. EACS has participated in several stories, several studies, the Action.io studies, for example, that show the importance of language. For patients, having a common language can actually help improve their understanding of their own health.

So we’re talking self-efficacy here. And for policymakers, having a common language actually can affect how obesity is addressed in the healthcare system. For the regulatory authorities, it can impact upon approval processes and safety evaluations.

And also for research innovation, using a common language where we know exactly what we’re talking about can actually aid in the identification of knowledge gaps. So again, words really matter. So today’s topic in Journal Club is this article we just published.

It was published in the International Journal of Obesity, and this work was performed by a fantastic group of people. Jacqueline Bowen Busato is the first author, and she was the former head of policy for EASO. The second author is Lucas Schwarz, and he is a PhD student.

Wonderful, wonderful, I can’t say enough nice things about all the hard work he really, really did on this project. Jason Halford, the past president of EASO. Volk and Jumic, the current president of EASO.

Grace O’Malley, a trustee. Ewan Woodward, our executive director. Diedrich de Kock was another really main player in this paper, and he’s Lucas’s PhD supervisor.

And of course myself, and that’s probably why I’m here talking to you about this paper today. So in order to do this, we had the idea we wanted to make a common language. We wanted to use a process.

We wanted it to stand up to scrutiny. So in order to do this, we chose to use the Delphi process. And this is an established way of asking key experts and opinion leaders, what do they think about statements? How do they rank them? Then it’s evaluated, reviewed, and it goes through several rounds of a process, and then you come to the end product.

So in order to do this, we first started with a core research team that was really Diedrich, Lucas, Jacqueline, and myself. We had a lot of meetings, a lot of fantastic discussions. We had further EASO representatives who you saw, and the two independent researchers here are Diedrich and Lucas.

Then we formed a sounding board. So we used several criteria to identify experts based upon a whole range of different criteria, essentially. And we came up with 14 experts.

We invited them, and they generously and kindly gave us their time. We had engagement meetings with them, and they gave us feedback on our thoughts so we could really formulate what we were going to send out in a survey to all of our panelists, the best that we could to get the best answers, the best product, and make the best use of everyone’s time. And for the panelists, we identified 194 experts, heavily European-based, but also worldwide.

So this is the framework for the process we went through. But how did we get to the content? Because that’s really what this is about. So first, a literature review was performed, trying to identify the really large and key themes in this area.

Furthermore, there was a careful look at how other policy-prioritized, non-communicable diseases use and stage their words. So trying to map obesity onto that was really the key here. Following that, and many discussions, I can assure you, we came up with a proposed taxonomy structure.

So in other words, the statements we would have people evaluate. And of course, this is all based on the fundamental understanding of obesity as an adiposity-based chronic disease. We had a sounding board engagement meeting.

And in this, we had facilitated group discussions where it was all virtual. I mean, sometimes technology is amazing, like we can see today, where we had people sitting in different groups, really, really digging deep into every single word of the statements we had produced. And of course, we were so grateful, and we incorporated the feedback that we received from this process.

And finally, resulting from all of this, we had our first pass at a final taxonomy structure. So with these words and these phrases in mind, the next step was to really put these into different themes. So after all of these discussions, six key themes emerged.

One was a definition of obesity. Two, causes, onset, and progression factors. Three, obesity prevention.

Four, screening and early diagnosis. Five, treatment and management. And six, obesity consequences, health and socioeconomic.

So these were the main themes that this survey was mapped around. But within this, we went further. So now we had our six themes.

Within this, we had additional concepts. So for example, for the definition of obesity, we also included a definition for pre-obesity, disease staging frameworks, indicators and signs. For number two, there was a few, but not as many as with the first one.

And for number three, of course, we focused on health promotion and primary prevention. In screening and early diagnosis, sort of as the name implied, we examined those. And for treatment and management, we looked at outcomes and shared decision making.

And six, again, is rather self-explanatory. It was health and socioeconomic consequences. But we went further as well.

So within each of these sub-themes, we really broke it down. So at the top, we had the definition of the concept. In the middle, we had the scope.

Where could this apply? What does this actually include? And finally, at the bottom layer, we had context. Where might you use this type of statement? When might it be applicable? So in total, we had 54 statements for our panelists that needed to be evaluated and ranked. So this was a lot of work.

And again, we’re super grateful for all of the volunteers who participated in our survey. The survey design itself, well, we used the tool SurveyMonkey. It actually worked out really well.

I can highly recommend it. We used a ranking of agreement from zero, meaning not at all, I do not agree with what’s written down, to 10, meaning very important, and I agree. Additionally, we included a free text box.

We felt it was really important to try and gather additional feedback from the participants because they had such a wealth of experience. And just for the sake of making sure people didn’t get survey tiredness, as we might say, we had the themes presented in a random order. Once we put the survey together, we also put our analytic plan into place.

And a priori, we had a very conservative definition of consensus. We said that there had to be 75%, greater than 75% agreement, and no dissenting free text comments. And the free text comments, I can say, are rather challenging to organize and read and categorize.

But we really felt we had to listen to our participants. So at the top, we had consensus. And then other rankings, we had approaching consensus, half consensus, and no consensus.

So we combined the free text with the actual numbers in order to determine if consensus was reached. And if it was not reached, well, then we went back to the drawing board. We adjusted the statements, we took in the feedback, and we sent out additional survey rounds.

So how did this work out? In total, we ended up having 70 experts participate in our panels. We were able to cover 16 different stakeholder groups. And this included the healthcare professionals, industry, policymakers, lived experience, and researchers.

So a really wonderfully diverse group of people. And furthermore, we included, we had 30 countries represented. So we were very, very happy with the outcome.

And of course, you don’t know this until all the data are in. So it was a very exciting day when we broke open the data and saw what it showed to us. So of course, you might be thinking, was it easy to reach consensus? Was this an overnight kind of process? And I can tell you, no, it certainly took time, but that’s how it should be.

So in round one, we had 60% consensus and 30% not. And in many of these, it was quite high in terms of the percentage of agreement. But some of those free text comments, we really had to pay attention to.

So we said, you know what, we think this is such a strong statement, we need to downgrade this and say we did not reach consensus. So in round one, we sent out all 54 statements. In round two, we only sent out the ones that did not reach consensus.

And after round two, things got better, but they still were not 100%. So we had about 80% consensus and 20% not. So again, we went through and we took out these statements, and we sent them out again, after incorporating very carefully all the feedback.

And excitingly, in round three, we hit it, we got to 100% consensus. Everybody was over 75% agreement, and there was no dissenting comments. So the question is, where were the issues coming up with? I mean, it turns out, probably unsurprisingly, that it was easier for some concepts than others.

So in the first round, when we sent this out, everybody agreed the definition of obesity. So that means in terms of the definition, the context, the scope and the context, we had a bit more challenges with the other sub themes in there. For the concept of the concept number two, again, there was dissension.

It doesn’t mean that everybody disagreed with the top line of everything. It just means there could have been disagreement within the scope or the context. We had a great result for health promotion, there was complete consensus in the first round.

And we did really well in terms of treatment and management, in terms of outcomes and shared decision making. When it came down to obesity consequences, for the health consequences, again, we hit consensus in the very first round. But for the socioeconomic consequences, it took us a bit longer.

So after doing all this, what does this final taxonomy look like? So here’s an example using the definition of obesity. So this is one of the easier ones where we hit consensus in the first round. So here, the definition says obesity is defined as an abnormal or excessive fat accumulation that can impair health.

Really simple, really small, very top line, very precise. In terms of scope, obesity is an adiposity based chronic disease, which is characterized by the function, total amount and distribution of adipose tissue. Obesity is a disease that consists of different phenotypes.

And then finally, for the context, the onset development and progression of obesity can be influenced by a single or many causes or progressing factors. So this is really taking it all across the levels. And this was a great example, because like I said, it hit consensus in round one.

When it came to the concept of obesity screening, it wasn’t quite so easy, but I can say we actually made consensus in round two. So for example, for obesity screening, the definition say that screening for obesity refers to the investigation of obesity indicators and populations as to identify individuals with signs of having obesity. Scope.

Elements to consider when screening for indicators of obesity may include a person’s age, biological sex, body composition, ethnic background, family history, pre-existing medical conditions, among others. And that was a challenging statement I can tell you to get consensus on because there’s so many things everybody wanted to include. But at some point, practically, you have to put things back.

And then for context, obesity screening can lead to the identification of factors that change the likelihood of developing obesity. And give me a second to shift my screen around because I can’t see my own text. And uses of this knowledge prevent or lessen obesity by mitigating these factors.

So for each of those 54 concepts, this is what we did. So it comes together, the obesity EASO taxonomy looks like this. And again, keep in mind that each of these different dots, each of these different numbers has this exact same and very consistent setup of definition, scope, and context.

And of course, you know, as with any study, there are strengths and limitations and ours is no different. We think a great strength was we’re really proud that we were able to have such a wide range of stakeholders and countries represented. Further, we were really, really proud that we were able to predetermine stringent criteria for consensus.

And the fact that we included both a qualitative and a semi-quantitative analysis of the results. We felt it was a strength to do it this way, but of course, there’s always some degree of subjectivity. In terms of limitations, we could only put the statements in English.

So we acknowledge there may be a preponderance of English on these speakers and have we been able to translate into different languages, we might have had a wider pool of answers. Of course, that would have come with another set of challenges and trying to make the statements the same. And furthermore, as I just mentioned, there was a somewhat subjective nature of the qualitative analyses.

But if you look at the paper, we put examples of the statements that we received. And sometimes we received just like a comment saying, I completely agree. Well, a comment was received, but wasn’t something that needed to be analysed.

But this is a very different kind of project. So this is really a policy oriented project. So it’s fantastic that we have a scientific publication as academics and researchers, this is what we need to have.

But this project is really aimed at achieving action. So I’d like to share with you a little bit about what EASO is doing with this project. Right now, we’re actively working to incorporate it, especially at the EU level into different dossiers and glossaries.

By doing this, we’re normalising the language of obesity, we’re putting it actively into the hands of policymakers, we’re aiming for consistency. The true purpose of this taxonomy is to really align policy. We’ve spent a lot of time on website development, and I highly encourage you to go take a look.

So in terms of we’ve developed a lexicon, so in other words, sort of like an online dictionary at the EASO website, and the link is here. If you follow this, when you go there, it’s interactive, it’s clickable, and we’ve also taken a step further. We’ve made a very nice infographic to help spread the news in a really small, focused way.

But the key is it gives the overview of what the taxonomy is, how it was made. And really, it’s reminding all of us that the target audience for this is really for policymakers, healthcare professionals, people living with obesity, researchers, and health system users. This is a tool which is really useful for advocacy, communications, and education.

So it’s another example of what’s available at the website, but we also went a step further. We have a series of downloadable flashcards available at the website, broken down just like this, for each of the different concepts, the 54 different concepts included in the taxonomy. By doing this, we can facilitate discussions, we have material to share, and again, because it’s in a peer-reviewed international journal, it’s considered very, very strong evidence for this is the way to really go forth.

And furthermore, I can’t talk enough happily about the website. I’m really impressed by what was done. The taxonomy, when you go into there, this is what it looks like.

You’ll always know where you are within each theme. You’ll always see the definition, scope, and context. But additionally, there’s easy-to-use social media and sharing links.

You can always download the infographic, all the flashcards, but really key is you can just copy, paste the taxonomy text, click that button, you have it, you can use it. And that’s really an advantage of having a lexicon put this way and embedded into the EASA website. So this is what we’re doing to put the taxonomy into action.

And of course, I would like to encourage you to also put the taxonomy into action as well. Because now after this project, we have a common, precise, and scientifically accurate language related to obesity. And the key here is it aligns with the language used in other policy-prioritized NCDs as well.

We have a searchable and functional online lexicon for use. And that is so key because that means we’ll keep the language the same. We’ll keep the fidelity to the actual definitions.

We have a tool for educating stakeholders on the language of obesity, the lens of it being an adiposity-based chronic disease. So please do work with us to use and disseminate this resource. And with this, this is sort of a broad overview of the taxonomy.

I hope you have a generalized idea of why we did the project. An overview of how we did the project, likely all the details are in the paper, you can download it, no problems. What we created and how it can be used both by us, but importantly, also by you.

And so with that, I’ll say thank you for your attention, and I’m happy to take any questions. Thank you so much, Jennifer. It was a really interesting talk.

Okay, we have some anonymous questions here. One is, yeah, Lisa. Okay, Jennifer, sorry.

So one question is, did you see any patterns in consensus free text comments by professional country? And another one is, are there any specific examples from your own work to demonstrate the early impact of this taxonomy? Yes. In terms of patterns for the countries, not so much. There’s a another great infographic I didn’t show today where you could see where a lot of people are answering from.

So I think in a certain sense, it reflects the different countries where obesity is a really hot topic. In terms of profession, I don’t really believe so. It was kept at a higher level.

So we didn’t break the data down that way. Also on purpose, that wasn’t the focus of this particular analysis. We were after the overall outcome.

In terms of how I’m using in my own work, it’s been really useful when I give policy talks. So by that, I mean, I have something to refer to saying this is the definition, it’s set forth in this way. And this is how you can understand it through this lens of going from something very top level from the definition down to the context.

It’s worked really well. We used it about two years ago now at a high level meeting for childhood obesity and children in Spain, and it really resonated. So there’s a lot of excitement about what this can do.

And of course, I’m really excited to see what all of you can do with it. Thank you. Actually, I wish I had, like I shared this presentation just a week ago, because I happened to listen to podcasts where they did a lot of information about around obesity, but the language was sadly not appropriate.

So I wish I had these very quick and easy links to kind of share and be like, you know, your podcast is very interesting, but it could be improved by language. I actually have a question. And if anyone has questions in the meantime, please raise your hand through the reaction button or write it in the chat.

So you had representatives from different countries, and I imagine also patient representatives from different countries. Do you have any, I don’t know if there was maybe like an open ended question about feedback from them? Because I being Italian and speaking English, when I try to translate this kind of language to Italian speakers, like one of the barriers is that certain terms really sound awkward in certain languages. And we need to find a way around it.

So like, if you had any feedback from any of the participants on that matter? Yes. Going into the project, it was always an ultimate dream and goal to translate into different languages, because also sitting in Denmark, we struggle with this as well. We don’t have beautiful ways of saying some of these nice phrases we came up with.

So we’re very well aware that a local language adaptation needs to be performed. Unfortunately, it was out of the scope of what was covered by this project. But it’s one of those dream projects, which is sitting within the ESO.

So if we have, you know, volunteers out there, I’m sure we could try to put something together. Because I really understand what you’re saying. All of us need help.

Be it speaking English or Danish or Italian, we need to find a language that works. And again, also reflects obesity as an adiposity based chronic disease. So yeah, I really hear you.

And I wish I had a solution, but we don’t have it yet. Nice complex language. There’s a few other questions.

So one is from Marilyn Juliana, right? Are there any plans to have it in other languages? And another question is, do you have any feedback from the patient community on the published taxonomy? That’s a great question. Not that I’ve heard. They’re aware it’s published, they participated in the process with us.

But no, I haven’t received any direct messages about that. So I hope it was received well. But let’s hope that silence is meaning everybody’s happy.

But something we can certainly look into. That’s a really good question. Thank you.

And the other one was to think about plans to translate this to other languages. Like, is there any plans from the group that worked on this project? Within the group that worked on the project? No, we’re a little bit tired at the moment. It’s a very energy consuming project, but really worthwhile and exciting and invigorating.

But it took time. So for Lucas, it was part of his PhD. And of course, his PhD is running.

So I don’t think he’ll be able to incorporate into his program. But who knows, maybe it’ll be a great postdoc for him. That would be another big project indeed.

And yes, hopefully we can discuss it more with the representative from ECPO and ECO 2025. Just waiting if other questions come up. Just another question that popped in my mind.

From social media, you know, language around overweight and obesity is a big hot topic. And actually, whenever people first languages suggested some patients or patient representatives actually react in a very different way, they actually want to claim back the use of certain objectives and terms that we would consider, you know, like discriminatory, as they use the term fat. But actually, some people are like, I want to call myself like this, because it makes me feel like I have an ownership over it, because it’s just the word.

And I think it’s a difficult balance to strive, because in the end, you should work with the patient preference. But do you have any opinion on that? Well, I think it’s a lot of it comes down to personal preference. If that is how somebody wants to talk about themselves and feels they own it, I’m not in a position to tell them otherwise.

My focus is on making sure that we have a proper and acceptable language for use at a higher level. You know, I think a lot of these, of course, also can facilitate the patient healthcare provider discussions. But all healthcare providers do adapt to the person they’re talking to in the moment.

So I think as always, it’s adaptability and flexibility. And I mean, it’s quite interesting to point your ways because it’s not just the patient community. Even in academia, we run into a problem quite often with people first language.

So when we submit papers to journals, we have editors correcting it, we have reviewers telling us, we don’t know how to speak English, because we’re saying things in a different way. So I think it’s just another, the paper is a tool that we have to talk back to some of these issues. And again, our role is to be an advocate for obesity as a disease, and people first language.

Unless at the individual level, somebody feels quite differently, I’m not going to impress my beliefs on that. But it’s a challenge we face in many fronts. And I agree, it’s a sensitive topic.

And there’s probably not one right answer for everybody. No, indeed. We have two very interesting questions.

The first one is, what do you think are the most interesting implications on this work on language for childhood obesity work? That’s very interesting. And after you answer this one, I’ll read the next one. Okay.

I think the really interesting thing we have with this taxonomy, first, just overall, is the fact we have a solid document we can take to Brussels that we can talk to policymakers with, where we can ensure we’re speaking the same language, because this is practice for other policy prioritized communicable disease, non communicable diseases. So this is standard practice. Well, now we fit in, we are putting ourselves into the right framework to be seen in the same light, and taking the same seriousness, both in terms of healthcare access, provision, funding, and on and on.

So in terms of obesity in children, this was done at a rather broad level. So I’m not certain it would be a terribly, I don’t think it would be a separate project or terribly different. There might be some small adaptations required.

But this is really high level concepts, as far as I can see, in my eyes, apply both to adults and children. And similar question for Indies. In the meantime, we have people volunteering for eventual translation.

So the question is, how do you think the uptake of this taxonomy will be in environments such as doctor surgeries? I’ve heard that people having bad experiences around lack of person centred language in the environment such as these. There’s quite like a bad stereotype around this kind of environment is true. So what’s your opinion on that? I mean, I think, again, this is just one more tool we have.

It’s one more way we have to talk about something from a perspective of being peer reviewed, published in an international journal. It adds a gravitas and a seriousness to it that it wouldn’t if we just did a survey, you know, with some friends over the phone kind of a thing. Or if we just made a position statement saying this is how we should do things.

Here, we have agreement, we have consensus to the highest level. I mean, I do know what people will take papers like this to their doctors. So again, we can also always be advocates in our own ways, or health care professionals, if you will.

And again, you know, anytime there’s change, and this is change using people first language and obesity, we’re all learning. You know, I’ve been in the field for quite a while now. So sometimes I also catch myself not using person first language.

But we can also all learn and train and just try to do better. So again, it’s the consistency of actions, the consistency of words, and a little bit of education. Yeah, I think one great thing about it is, is actually bringing people from so many backgrounds to discuss together during events like ICO, and hopefully getting to share a similar language as well.

There’s another interesting point. So how receptive are policymakers to this taxonomy? Like, do you have any good stories, successful stories, ways you have overcome some reluctance to accept this language? Any anecdotes to share? Anecdotally, I can say they’ve been very happy. Very, very pleased and very, very excited.

Because otherwise, if you might imagine anybody out there who’s done a systematic review in this area, or any sort of deep dive into the literature, how do you disentangle what these terms mean? How do you really understand what obesity is or isn’t? Or how do you understand what health promotion is or isn’t in the context of obesity? So there’s a lot of different projects going on at the EU level, a lot of reports going on. And a tool like this, they’re very happy for and very excited about, because it ensures they’re speaking the same language. There’s something to refer back to, which is published in a national peer reviewed journal.

I can’t say that enough, because that’s really what creates a strong evidence base for policy work. So it’s been very well received. And it’s being incorporated as we speak into different documents and different dossiers.

Anna, I agree. I mean, even from writing my thesis and reading everything about obesity stigma, there’s so many definitions. So if anyone’s writing their thesis or a manuscript, now you have a great source of perfect first definitions.

Obesity is usually defined, and you put the link to Yeza in it as you work through your manuscript. Is there any other question coming up? Actually, it’s interesting how so many people are interested in how it applies to, you know, receptions, like how people received it, how they were going to integrate it, because I feel like these definitions were very simple, but very straightforward, which is kind of what you want in this kind of cases. So everyone can understand we’re talking about this, and that’s what it is.

Yes. And I think one of the really big advantages we’ve seen, because we, of course, we all know body mass index BMI as the imperfect indicator of obesity. So we really went in the taxonomy, that’s where we put most of a lot of effort, I can say a lot, a lot of effort, really distinguish between a population level type of indicator, or an individual level type of indicator.

And making this distinction added a lot of clarity for people we shared this work with. So again, I completely agree, some of these are really simple and straightforward, but that’s actually what’s needed to really put us on the same page. And then, of course, we can all explore the different nuances and different meanings.

But it’s something where we can at least come together and say, okay, when we say obesity, this is what we mean. We’re not trying to diagnose an individual who is not necessarily made for that setting. But this is made for just understanding the concepts.

Yeah, great. And by making it so simple, you kind of address it from any potential interpretation that could be stigmatizing. And speaking of that, in the chat, Fule shared a very good link for the non-stigmatizing image bank, really good, use it for your presentations.

As a final note, is there any general thought on this process you shared with us that you would like to share as a final conclusion to the work? A final message to leave us with around this great project? I mean, for me, it’s the first Delphi study I’ve participated in, in terms of actually running one. And I can say, you know what, don’t be afraid to try new things. I’m more comfortable running a Cox proportional hazard regression, quite honestly, than I am doing a Delphi consensus.

But participating in this, I learned a lot of new techniques and skills. I gained a greater appreciation and understanding of actually how to read another Delphi consensus study. And most of all, I got to work with a great group of people and interact with an amazing network of experts around the world.

And that’s an opportunity that was just wonderful, and I really appreciate. So my takeaway is don’t hesitate to undertake a new type of study, even if it’s something you haven’t done before. You know, try it, you might really like it and gain a lot.

And even personally, I can see that I have two or three Delphi studies planned for the future in different types of topics, because I found it to be such a powerful tool for bringing expert opinion together in a really organized way, and a systematic way. And I found that to be really, really interesting. So my advice is, you know, try something new sometimes, it can be really rewarding.

Someone’s got to do a first attempt on anything, right? Do you have any advice for the Early Career Network members on using Delphi in their own research, or anything you would do different with this new Delphi at all? Oh, gosh, what would I do different? I think it was a success. So I can’t think of anything major I would change. I think it was a really smooth process.

I had a great group of collaborators. Obviously, it’s the first time I’ve done it. So each time it becomes faster.

But it was so organized. Anyways, a lot of behind the scenes work goes on that, of course, you don’t see in the paper, you don’t see my presentation looks all beautiful and pretty now. But I can tell you, it is a lot of hard work involved.

And I think what we learned going along was think of the end product, the end user, and especially how to communicate it. So I mean, a scientific paper is great, you know, I’ve got it in front of me. Perfect.

But that’s not what’s going to resonate with the public with a policymaker. People do need to have digestible information and infographics, easily accessible and websites which are easy to interface with, and something online and the copy paste function I’m quite proud of. I think that was a really neat innovation to make sure that these words are used as they should be.

So my advice would be as you’re doing any project, actually think how are you going to communicate this with somebody beyond your own network of researchers, or clinicians or someone who reads a journal and infographics and it’s become more accessible as well as such great things as bio render, for example, not an advertisement for them just saying it’s a really nice tool. There’s other ones out there. But we can really start to think visually and how to give people information.

That’s really what I took away from the process. And I’d encourage all of you to think through, how are you going to share results more with the lay public or in terms of an infographic as you do your own studies? That’s actually a pretty good advice. Because we’re all too used with numbers and tables, but not everybody.

So yes, very important recommendation. I think there’s no more questions. But thank you once again for this very interesting conversation.

And to anyone who attended, please, again, feel the feedback form you’ll get at the end of this webinar. So you can share ideas about future conversations we can have. Thank you once again, Jennifer, for all that you share with us today and all your good tips and comments.

It was a very nice conversation to have with you. And thanks to everyone who attended as well and see you at the eLearning Hub. Thank you very much.

Thanks, everyone. Bye. Bye.

Thank you, everyone.