EASO & WONCA Europe for World Obesity Day 2025: Enhancing Obesity Care

• A new framework for the diagnosis, staging and management of obesity in adults (Busetto et al., 2024): https://doi.org/10.1038/s41591-024-03095-3 
• Providing a common language for obesity: the European Association for the Study of Obesity obesity taxonomy (Bowman-Busato et al., 2025): https://doi.org/10.1038/s41366-024-01565-9
• EASO Framework for the Diagnosis, Staging and Management of Obesity in Adults: Online resources
• EASO Taxonomy: Online resources
• EASO Person First Language Guide
• 5-Minute Continuing Professional Development (CPD)

Key takeaways:

Obesity is a chronic, relapsing disease

Not a failure of willpower: Obesity is a complex, relapsing disease that requires long-term, multidisciplinary management
Impact of weight stigma: Weight-related stigma, including from healthcare professionals, can cause psychological harm and discourage patients from seeking help

Comprehensive screening and diagnosis are crucial

• Diagnostic criteria: Obesity should be diagnosed using clinical and anthropometric criteria, beyond BMI alone. Waist-to-height ratio can improve diagnostic accuracy, especially when clinical impairment is present. The EASO Framework for Obesity Diagnosis and Management outlines key diagnostic criteria for obesity
• Early identification: Regular screening is critical. Early detection, even later in life, can help mitigate long-term health risks

Early intervention and preventive strategies

• Recognising early experiences: Childhood experiences, such as school weigh-ins or dieting, can have lasting psychological impacts for individuals, including negatively influencing self-perception and increasing risk of disordered eating
• Prevention is key: Interventions should begin as early as age two to promote healthier lifestyles and reduce future obesity-related complications

Evidence-based management and treatment options

• Lifestyle and behavioural modifications: Sustainable modifications to diet, physical activity, sleep, and other behaviours should be encouraged through patient-centred communication
• Pharmacotherapy advances: New medications (e.g., GLP-1 receptor agonists) show promise in improving obesity-related conditions and should be prescribed as part of multidisciplinary care
• Defining success: Focus on functional and metabolic improvements rather than percentage-based weight loss

Holistic, lifelong, and integrated care

• Long-term support: Interventions, including surgery, are tools within a broader care strategy, not standalone solutions
• Multidisciplinary collaboration: Work with dietitians, psychologists, specialists, and allied health professionals to provide coordinated, patient-centred care
• Shared decision-making: Engage patients in developing personalised care plans that align with their individual needs and circumstances

Addressing broader determinants and systemic issues

• Social determinants of health: Consider socioeconomic factors, health literacy, and environmental influences when designing obesity management plans
• Advocacy and public policy: Obesity is a societal issue. Support policies such as food marketing regulations and urban planning reforms that promote healthier communities
• Creating supportive environments: Foster health-promoting settings within both clinical practice and the wider community to encourage long-term, sustainable behaviour change

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

Speaker 1
00:00 – 01:30
Günaydın herkese ve bu günün 4. Mart’ta Dünya Obesity Day ‘ı kutlamak için bu webinaya katılmak için bize katıldığınız için çok teşekkür ederim. Bu çok önemli bir gün. Ben Andrea Ciuddin, ABO Study of Obesity ‘nin European Association for the Study of Obesity ‘nin Obesity Management Working Group ‘un yurtdışı başkanı. from Wonka Europe. And we’ll have this afternoon excellent speakers that from the European Association for the Study of Obesity, from the World Association for Family Doctors Europe, the Wonka Europe, the European Coalition for People Living with Obesity, the ECPO, to listen to the patient voice, and the European Confederation of Primary Care Pediatricians that will share their perspectives in the event because obesity is such an important disease, which such a high prevalence worldwide and is a cause of many, many severe complications that it is important to unite forces and to work together from the very beginning, from the childhood to adulthood, all together, the family doctors and endocrinologists, internal medicine and all the clinicians. So please, Professor Petraccioli, it’s your turn. Welcome, everyone.

Speaker 2
01:31 – 02:08
Welcome. Good evening to everybody. So my name is Petraccioli. I’m a member of the Wonka Europe Executive Board. Wonka is the association of the family doctors, general practitioners and Wonka Europe is representative of the European ones. So I’m also a rural GP and the president of Euripa which is a Wonka Europe network and Euripa stands for the European rural and isolated practitioners association and back to you Andrea.

Speaker 1
02:10 – 02:49
OK, so thank you very much. We will start the program this afternoon with the patient perspective. Then we’ll have a talk on the new IASO framework and clinical application of the framework. Then a Wonka Europe case study discussion, the pediatric perspective. And we’ll have Q &A at the end. We’ll have 15 minutes. So please write your questions in the chat. So the first talk is patient perspective by Ruth Eirikstotir from Iceland. So Ruth, please. Thank you.

03:00 – 03:00
Hi,

Speaker 3
03:01 – 09:20
my name is Ruth Eirikstotir, and I’m a vice president and founder of SF4, Íslenski pæsinsorgan Það var tótt, eraser as a reward if I lost weight but it never happened. Even though after one summer vacation I had lost weight without thinking about it, but I still didn’t get the eraser because I hadn’t lost weight on purpose. Seeing the school nurse filled me with anxiety. I felt a lot of shame because of my weight and og mér sjálfstæð like many women, was always on a diet and in my memory it was the norm. “I remember counting calories at the age of eight.” That was the message my mother received and she was trying to do her best for us siblings. She was not trying to harm us. Mér fyrirtíma, þessu syrðu bætti og það hætti enn eating disorder team and was put on medication to reduce the binge eating. But at the same time I wasn’t thin and got the message from my GP and a nurse that I couldn’t have an eating disorder because I wasn’t thin enough. After I got better with my eating disorder the weight went up again og þá startum þ og það þúkst að I should be able to do it myself and that the weight gain was my fault. I had my inner stigma, so I said no to the program at that time. But there, my doctor managed to show a little seed and later in countless diets, I found that I found out that I could not do it alone and went to my GP and asked for a referral to a regulator. og tilbaka And today I have a healthier relationship with food. I feel full and hungry that many diets have damaged for me. Lifelong treatment and self -improvement are also important factors. I know that the surgery itself is not a magic solution, but I feel that I have had the opportunity to boost my health. Obesity is a chronic relapsing disease. Mjögur fyrir minn er aftur með obsesiti, þetta

09:20 – 09:27
tåle

09:46 – 09:47
My

Speaker 3
09:47 – 12:36
story went well so far, because I was lucky that my GP could open the conversation with me, and I got treatment, but many people are not as lucky as me. My brother also lived with obesity throughout his life, and his background is similar to mine. Four and a half years ago, he talked to me and said he didn’t understand why he didn t lose and that he needed help and treatment. I advised him to ask his GP for help and he did ask for help, but unfortunately he was denied. He was not lucky like me, he did not get treatment. Six months later he gave up and decided not to wake up again. It makes me very angry. And I believe obesity was one of the reasons why he committed suicide. Even after his death, he was stigmatized. The doctor who talked to his partner said he must have died of heart failure because of his weight. But the autopsy showed that he took a lot of pills and that there was nothing wrong with his heart. Hún ekki ertu diabetes eru hiper Það var mjög lökki a Together we can make things better. I truly believe we can. Bye.

Speaker 1
12:38 – 13:14
Thank you. Thank you very much, Ruth. It really takes a lot of courage to be able to give such a testimony based on experience and personal experience and to try to support other people with obesity to get their help and the proper treatment for their disease. After hearing, we’ll have the questions in the end, if you are OK with that. After hearing Ruth’s testimony, Professor Petraccioli will present some data on the dimension of a problem. So please, the floor is yours.

Speaker 2
13:16 – 13:48
OK. I just want to give you a brief overview. Sorry. Sorry, I have to close some, otherwise I cannot share my screen. Can you see my screen? No, I think that I have to

Speaker 1
13:48 – 13:49
close

Speaker 2
13:49 – 14:05
this chat. Okay. So share this. The problem is this one. Okay.

Speaker 4
14:06 – 14:06
Now we see.

Speaker 2
14:07 – 16:35
Okay. Okay. Sorry, too many pages opened. Okay, I’d like to give you a brief overview of some data on the prevalence of obesity in the world. This data derived from the World Health Organization. So in 2022, one out of eight people in the world were living with obesity. And worldwide, adult obesity has more than doubled since 1990. And adult adolescent obesity has quadrupled. In 2022, 2 .5 billion adults aged 18 or older were overweight. Of these, 890 million were living with obesity. Still in 2022, 43 of adults aged 18 years or over were overweight and 16 % of them were living with the frank obesity. 33 million children under the age of five were overweight in 2022, and over 390 million children and adolescents aged from five to 19 years were overweight, including 160 million who were living with obesity. What does this mean? That there is this huge problem. Unfortunately, as we have seen, Not so often, GPs or family doctors are able to meet patients’ expectations. Very often they fail, maybe because of the huge workload, because of, I say, the huge amount of bureaucracy. We are overwhelmed by bureaucracy, but for sure we have to improve this person -centered care approach. We have to use the so -called person -first language and to try not to stigmatize this condition. And back to you, Andrea.

Speaker 1
16:37 – 17:18
Thank you. Thank you very much. Now we’ll go on with the program. will have a talk on behalf of Dror Dickel from IASO. He’s the co -chair of the IASO comms, and he will speak about the new IASO framework and clinical application of this framework. Dror’s presentation is pre -recorded because due to an overlap with so many activities around the obesity day, hopefully he will be able to join for Q &A questions. If not, we will try to solve them, those that are present here. So please let’s share Dror’s presentation.

Speaker 5
17:22 – 39:47
– Good evening, and thank you for joining us to this joint webinar of Wonka and Iasso due to the World Obesity Day 2025. I am Dror Dikker, coming from Internal Medicine D .N. Obesity Clinic, Hasharon Hospital, Rabin Medical Center, School of Medicine, Tel Aviv University, Israel. And today I want to talk with you on the new framework for the diagnosis, staging, and management of obesity in adults that the IASO recently published. So here are my disclosures, and I don’t have any conflict of interest regarding this talk. So our new definition really tried to go beyond BMI. And we suggested that we can really define people living with obesity, even with those who have BMI of 25 and have waist to head height ratio above 0 .5 and have any other medical functional or physiological or psychological impairments. Meaning that these three criteria can define people living with obesity, even in the area of overweight. We recently published this study that really looked on adolescents on the age of 70s. So those who lived with overweight in the age of 70, five years later had high risk developing obesity complications. So this area of overweight is also an area that we should really carefully look on those who might live with obesity. Another study that highlights this point is this study where we measure the percentage of involvement of two body systems that are complicated by the weight. Meaning if you look on overweight so 8 % in the age of 25 to 29 have two systems that were complicated by obesity complication and etc, etc. But you can clearly see that this area of overweight along the years can really be very significant in producing obesity Now, we choose waist to height ratio because this is the best predictor from all the anthropometric measurements that predict visceral adipose tissue. It’s also the best predictor to predict 10 years cardiovascular risk. So that’s why we use waist to height ratio as the second anthropometric measurement with BMI. Now, after we defined the obesity diagnosis, we have to set the targets. Now obesity is the only disease that the targets are percentage of weight loss. No other disease uses percentage of something to define a target. If we look on LDL targets, it’s below 70 or below 55. If we look on diabetes, it’s below 126 or below 6 .5%. So we have a very clear target to reach. Now this very interesting abstract that was presented by Professor Luca Busetto in the last ICO really set such targets. So they suggested that BMI below 27 and waist to height ratio below 0 .53 are good indicator of low absolute risk of type 2 diabetes medicine, hypertension, knee osteoarthritis, and atherosclerotic cardiovascular disease. So this is the first attempt to really use not the percentage, rather than real targets to really treat the patients. Now, after we have the diagnosis and we have the target, we have to really look on the therapy. And of course, the therapy is based on lifestyle changes, meaning diet and physical activity. But I relate now in this talk to the pharmacotherapy of obesity that is on the changing of lifestyle. So several years ago, we used this perception of obesity as adiposity -based chronic disease, ABCD, that we really measure the adiposopathy by the amount of adipose tissue, the function of adipose tissue, and the distribution of adipose tissue. And we divided this disease, this adiposopathy into two major diseases, the fat mass disease and the sick fat disease. And in the fat mass disease, what is important is the percentage of weight loss. So let’s see some studies that really clarify this point. So semaglutase is a human GLP -1 analog that homology to the human GLP -1 is 94%. So in this step 9 trial, they compared semaglutide 2 .4 milligram to placebo in people living with obesity and osteoarthritis. And what they showed us that there was a remarkable weight loss, 13 .7 % of weight loss compared to 3 .2 % to reduction, sorry, improvement in physical function and reduction in the pain score, meaning improvement of quality of life of those patients who are treated by semaglutide 2 .4 milligram compared to placebo. But what was very important that those patients who use semaglutide 2 .4 milligram used much less painkiller as non -steroidal anti -inflammatory drug, as you can clearly see in this graph compared to this graph. So reduction of a considerable amount of weight leads to this improvement of quality of life in these patients who live with obesity and osteoarthritis. The second study that I want to show you is the study of sleep apnea that used Rezepetide. Trosepatide is a dual agonist of GLP -1 and GIP. It’s a weekly injection. And in this study, they used trosepatide in people living with obesity with sleep apnea. And again, a very considerable weight loss, 20 % weight loss leads to reduction of 20 points of, 20 events per hour of apnea hypopnea. Everyone started with 51 events per hour and those who treated with trizepatide reduced the apnea hypopnea by 30 events per hour, considerable reduction of events. And if we look on this study that was meta -analysis of surgery, drugs and lifestyle effects on people living with obesity and sleep apnea. So they showed us the lower, the higher the weight loss or the lower the weight, the improvement, the percentage of improvement is higher. Meaning if you look on 20 % weight loss as in the trizepatite study, we can expect 50 % reduction in apnea -hypopnea event. And in fact, we can see that 50 % of patients who use trizepatite really reduce the apnea -hypopnea in the range of normal range. And this is remarkable. So the higher the weight loss, the better improvement in osteoarthritis and sleep apnea. Now, I want to show you some studies that look into the effect on the sick fat disease, the metabolic disease. We know that people living with obesity have much more metabolic complication than just one complication as depicted in this picture. Now, this is because when there is increasing amount of adipose tissue, inflammation is started to develop that leads to lipotoxicity and ectopic fat. As we see here, enlargement of the adipose tissue leads to hypoxia and inflammation, And in the end, there is a vicious cycle of inflammatory response that leads to increase in cardiometabolic risk. So enlargement of adipose tissue leads to hypoxia that leads to inflammation that leads to cardiometabolic risk and harming the body systems that the adipose tissue is lying in. For instance, we can see in this remarkable study, the direct study, the fatty pancreas. In this case, in these patients, the fatty pancreas reduced the volume, function volume, of the pancreas by 40 % that leads to reduction of insulin secretion by 40%. Reduction of weight by 15 % leads to normalize pancreas volume and function. In a reduction and 50 % in these patients leads to restore the pancreas volume and restoring the secretion of insulin that leads to remission of diabetes. If we look on the heart, we know that there is a epicardial adipose tissue that lying between the myocardium and the visceral adipose tissue. Again, this process of enlargement of epicardial adipose tissue leads to hypoxia and inflammation. And this hypoxia and inflammation leads to atherosclerotic plaques and half -path, heart failure with preserved ejection fraction. How it does, how it do this? So we know that the inflammation in the epicardial adipose tissue may produce IL -6, IL -1 and TNF -alpha and these cytokines can lead to a vulnerability of the atherosclerotic plaque and rupture of the atherosclerotic plaque can lead to coronary event. So enlargement of epicardial adipose tissue, inflammation production of cytokine can lead to coronary events. We can see this in this unique study, a case study that measure the perivascular inflammation of the left anterior descending artery, one of the coronary arteries. So the red is inflammation, the yellow is much less inflammation. And we can see here the perivascular fat around the left anterior descending that is very inflamed. After nine months of treatment with semaglutide one milligram there is much less inflammation and really healing of this perivascular inflammation. So treating patients that lives with obesity and metabolic complication by GLP -1 can really increase cardio protection. So let’s see some of the studies. The FLOW study took patients living with obesity with chronic kidney disease, treat them with semaglutide one milligram as type two diabetes patient, compare them to placebo. So type two diabetic patient living with obesity and chronic kidney disease were treated with semaglutide one milligram compared to placebo. And they showed us a remarkable reduction in the primary endpoint that deterioration of the kidney function and kidney death by 24%. Remarkable result. And this was by only reducing weight of 5 .5 % group compared to 1 .45 kilogram in the placebo, difference of 4 kilogram, meaning a very small weight loss leads to very dramatic reduction of kidney deterioration and death. In fact, these results bring the researchers to suggest that semaglutide will be one of the pillars of treatment of people living with obesity and type 2 diabetes patient with chronic kidney disease. What about the heart? So I assume that everyone heard about this remarkable study, the SELECT study, which people living with obesity and cardiovascular disease were treated by semaglutide 2 .4 milligram compared to placebo. And those who were treated with semaglutide showed reduction of 20 % of three -point MACE, meaning non -fatal MI, non -fatal stroke, and cardiovascular death. And this effect started very, very early. But what was more surprising is that those who lost even less than 5 % of weight even had the same result. So there was no difference between those who lost more than 5 % and those who lost less than 5 % of weight, meaning the effect of weight loss was not the main driver of the result. Now, what about heart failure? So pooled analysis of all the results of StepHealthPath reusing semaglutide in heart failure with preserved ejection fraction with or without diabetes showed again a remarkable reduction in cardiovascular death or worsening heart failure when using with semaglutide 2 .4 milligram compared to placebo. Very recently, trizepatide in a prospective study 38 % reduction in composite of death from cardiovascular cause and worsening of heart failure in those patients living with obesity, with heart failure and preserved ejection function. This is the first prospective study that showed us that using trizepatide and leading to remarkable weight loss can really lead to reduction of a composite point in those patients living with obesity and have PEF. Now move to the liver. So we know that patients that lived with stato -hepatitis, metabolically associated stato -hepatitis, MASH, can lead to cirrhosis or even to hepatocell carcinoma and death. That’s why it’s crucial to treat those patients who really showed MESH in the grade of F2 /F3. Very recently there was a publication in a congress, not yet in a paper, of the ESSENCE study that showed that semaglutide 2 .4 mg compared to placebo in patients with metabolically associated with thyroid hepatitis in the level of F2 -F3 fibrosis compared to placebo. They showed us the remarkable reduction of fat, but what was in the first time, the result of reduction of fibrosis, which we never thought that we can really regress fibrosis. This study showed us that using semaglutide 2 .4 mg really reduced fibrosis in those patients with MeSHF2F3 grade. Now we know from this study that the weight loss was only 10%. Again, not a very considerable weight loss, lead to a very substantial result. Another study, a phase two study with trizepatide showed the same thing. In those patients we do mesh in the F2F3 grade of fibrosis, 64 % of patients really reduce the level of fibrosis with using trizepatide much higher compared to placebo. So this remarkable effect of the GLP -1 analog and the GIP -GLP -1 analog on metabolic complication can be explained by reduction of the amount of adipose tissue, but more than that, the reduction of inflammation. And these two studies by Drucker that was published very recently really explain to us, how they’re doing this. So GLP -1 can directly affect T -cells and reducing inflammation. But GLP -1 analogs also indirectly cause weight loss, but also CNS activation of GLP -1 and reduce inflammation. And in this very interesting and very recently study, Drucker and his team showed in animal study that activation of central GLP -1 can activate a GLP -1 receptor, central GLP -1 receptor, but also alpha adrenergic receptor and mu opioid receptor. This activation of the central receptors can really reduce inflammation in the periphery, meaning giving GFP1 in the periphery, activate those receptor centrally, and this activation centrally reduce peripherally inflammation and contribute to healing the metabolic complication of adiposopathy. Now, I want to thank my colleague, Professor Van Rossum, that gave me this very interesting and important slide They told us that for every complication now, we have evidence -based study that showed which drug we should use. And our work become very complicated now because we have to decide according to the complication, which drug we should use, because those drugs or these drugs showed evidence for improvement in this complication. To the end, I want to also mention that very recently, Professor Rubino and his colleague published the United Commission definition of obesity. And they divided the diagnosis of obesity to preclinical obesity and clinical obesity.

Speaker 6
39:54 – 39:58
anthropometric measurement or two anthropometric measurement

Speaker 5
39:58 – 42:38
without BMI or using DEXA. So if we found obesity, then we have to look on sign and symptoms or limitation and according to this we have to define if those patients living with preclinical obesity or living with clinical obesity and And according to this, they can define even not just calling the BMI, if the patient have preclinical obesity or clinical obesity. So I want to conclude and say that the new EASO framework really go beyond BMI and suggested to define a new standard 25 to 30 with a waist to height ratio above 0 .5 and another complication of obesity. So these three criteria will define a new area of people living with obesity. It’s important because there is studies that shows that this new criteria can identify people living with obesity that have high risk for morbidity and mortality. Now we really aspire to go beyond percentage of weight loss as a target and use ways to hide and BMI below 27 and ways to hide below 0 .53 as a target as Professor Busetto suggested. We have to look if it really consolidates this result and will be the targets in the future. We have to set individualized treatment goals. And most importantly, we have to treat people living with obesity with a multidisciplinary team in order to reach all these targets. We have to set a multidisciplinary team in order to tackle such a big problem as obesity disease. As our logo this year says, addressing obesity together, changing systems, healthier life. I want to thank you for your listening. Wish all of you a very healthy life. Thank you very much.

42:43 – 42:43
Okay,

Speaker 2
42:44 – 42:57
thank you very much, Professor Deeker. And now the next presenter is Professor Otzden Gokdemir from Wonka Europe. Please, Otzden, the floor is yours.

Speaker 7
42:58 – 43:30
Thank you very much. After all those precious presentations, it is hard to talk, but thank you for your resilience this beautiful day that you are with us. I am trying to share my presentation if these thoughts could work a little bit. I guess we can do it now. I hope you may see the presentation. I am not sure. Could you see?

43:32 – 43:32
Just

Speaker 2
43:32 – 43:40
a few seconds maybe. Because it seems that something yes now it is okay.

Speaker 7
43:41 – 48:50
Great. So now we are coming. While we don’t want to lose time, I’m working in Izmir University of Economics Faculty of Medicine. I did my PhD for physiology and my trainship has finished about family medicine. I am delighted to work with Ferdinando Petruzoli in Europe. We were working together for many years, but really it was fantastic to work with him. And also I am the chair of Volga Working Party on Planetary Health. It’s a great committee with great colleagues. How can we just talk about obesity as a disease? We just want to look around a little bit of the lifestyle medicine perspective too while we are talking about obesity. How can we define? The truth is there is an excess of adenose tissue that we don’t want because we wouldn’t use it for energy and just throwing away our homeostasis and we should do something to manage it. Who are we? Not only our patients, but also we the physicians together. I just want to remind you the framework of the European Association of Obesity and also some data, evidence -based data about it. If you have got the tools, you can use it. And that means we can just do the things, good things together. We don’t need to struggle by ourselves. In this framework, you may see that first the definition is very important. Awareness, yes, but afterwards the definitions. By this way, we can measure. And while we are measuring the things, we can give a feedback to us, to the framework, that if it is working or not, and can keep on going with this plan. In here also, we can see that long -term multidisciplinary approach is needed. Yes, we did the awareness, we have that framework, and we will do it together with multidisciplinary approach. Another part is behavioral modification. It is not easy because while we are doing all those things, maybe the poet just says that the girl has just became once and the boy has just became once, a Turkish poem. But the truth is we all do know that it has got a beginning and coming to in different phases. Nothing is happening in all ones. We are just figuring out once, but have a long time to make it so. In obesity related complications, this is the same. To figure out maybe has got a time, but the complications and the reason and bad things are happening, our target organs, our eyes and our liver and our life. In here, there’s another part. This is a piece of rodent. And also it is in the way of in Istanbul, Bakırköy hospital, a thinking man. The thinking man is thinking to have the communication for the person first language. How can we do that? In here, person first language says that we should use the framework of person with obesity because we will fight with obesity. We are not fighting with people. So which is your target? Which is your first? Person is first. And also there are some myths that we should fight through. Like what? Let’s say that we have got an old male patient. We may say old after 75 years or 65 years, it says so for the WHO, but maybe it might be very young, why not? Has got dysuria and has attended the family health clinic. And we figure out that for the history, there has been a reparation for the prostate carcinoma. And we look at the vitals. Who are the vitals? Body mass index are the vitals. blood pressure, or the vitals. In this bridge that we are going through with our patients, we may figure out that, although the reason why he attacked to our surgery wasn’t by the mason dicks, that has increased, abdominal obesity has increased. So in here, what else we should learn from our patients? We may have blood detects for the analysis. As you may see, the pinkish ones are the ones that are not so going goodly part. How can we do something? What are the points? While he was so healthy, although years ago for a prostate operation and nothing else, what happens to this

48:50 – 48:52
patient?

48:53 – 48:54
What

Speaker 7
48:54 – 01:06:17
should we do for this patient? If we just get a little bit closer, are there only the numbers? What about the patient -centered care? What should we ask to our patients? In this part, there should be have some guidelines. One of them is national, the Turkish Entrepreneurship, we may say. The other could be the European Obesity Association guidelines. It says that if LDL cholesterol is high, if the triglycerides is high, so we should do something about it. And not only the things about lifestyle changes could help it if you want to get a little bit closer, we can use other parts like making a recipe. We can measure the cardiovascular risk. So the hypertension, smoking, diabetes, and also obesity will be the things that we will be searching about. Triglyceride if so high, that means in the longterm our patient will have cardiovascular risk. For the primary prevention, we can use statins for this patient because the results seems to so high. And also we should ask about smoking too. Can we focus on metabolic health? Yes, because of the elevated triglyceride levels we should. Have we got anything to do with our patient? How can we make a plan? In here, we need a clinical judgment. In here, we also talk about lifestyle changes too, because in the long -term, we mustn’t use so many, so many drugs for our patients. As you may remember, if we are getting more than five drugs in a kind for a patient, it is polypharmacy. And we just want to get away from polypharmacy too. And also we should just look at the liver enzymes for our patients. So in this case, we are talking about statins. Can we make the recipe in primary care? Most of the countries we can do it. In Turkey, yes we can. And also we can use the guidelines for this patient. The next step could be the reject for our patients. It is not only one time boundary. we, if we looking at for a patient, we are making the recommendation, we are getting it through all together, not only by ourselves saying, do that, do this, but with our patient, if he can use those remedy, if there will be something happen, if there’s an obstacle for the two together decision we are making, so we are making decision with our patient. Afterwards, the follow -up is very important. Most of the drugs are not like painkillers for headaches. You should just use for a time, then afterwards we should get the follow -up. For triglyceride levels, it is the same. And then we should just offer other things for the lifestyle and also the healthy diet, like what? Fiber -rich diet and to limit the raffinic carbon, which is all sugars. In here, while we are talking about the patient -centeredness, the social determinants of health will be very important too. We are talking about increasing health effects or reducing trans -centric effects, all right, but if the patient could reach that. If not, there should be other recommendations, other ways, other plans to do that. The other part is for mate management. We measure and we will measure later too after our recommendations while we are doing the follow -up. Have you got additional consideration? Yes, because fat is very problematic for the vascular disease, but also smoking too, also stress too, also couldn’t having got good sleep issue too. So the monitoring and follow -ups will be needed in our patient. We cross the bridge with another patient who, this is a young female, has come for a license report in our center. And when we look at the records, we have find that she has been diagnosed with hypertension. She is young, but she has been diagnosed with hypertension. She is using some medication, but couldn’t remember the name. What could have been done when we are cruising this healthy village. Again, we are using the same vitals. What is the hay height? What is the kilograms? In Turkey, we have got nutrition clinics and also some obesity centers that we could use. Not only every family medicine centers, family healthcare centers, we have got dietitian, but we can refer to. As you may see, she has just go to the dietician, but she lost it. That means in the behavioral change, she is in a way in the five stage, one and two has crossed over, but we are stepped down in the third. How to make the things that we should do and how can we make it in sustainability? In here, we figure out something else. She’s young, she’s married, she wants children, but there’s no children. That means the metabolic problems are going to another problem with us. Now we will have another problem, so we should get and do some help for our patients. In this patient, you may see that there is an illiterate young woman and trying to quit smoking too. So when we are talking about health literacy, there will be also another root reason, maybe we couldn’t reach our patient about this trouble. Again, what would we like to ask, well, how can we learn something from our patients? We have got another test report, as you may see. In here, let’s remember the myths. Can we say our patients, please eat less and make lots of exercise that you can just get rid of your fats. In this pattern can we say this so? If you see the pinkish part there’s another problem in here, it is not only about eating, it is not only about doing exercise. As you may see thyroid stimulant hormone has got something saying to us as an alarm. In here we can use also statin therapy because there’s a narration about it. And also we have got subclinic hypothyroidism in this case. As she is illiterate and as she has got some other problems, this could be not only solved by asking your patient. We could get a little bit deeper with her. In here, more of the treatment of hypothyroidism will help our patient to get the other problems, to solve the other problems. Iron deficiency is also another problem in this patient. That means maybe she could not get enough healthy food as maybe there is another problem or maybe we should just investigate about gastrointestinal system. maybe she is losing. Lifestyle modifications is needed in here too because it is something that we could do for a lifelong period. Exercise and also Mediterranean style diet could be used in here. In here, as we said, with patient -centered care, the question is if the things that we are asking and planning for our patient could be done by the patient. We know that she hasn’t got ever for that she gets salary for, she is just going to a school but at night, she hasn’t got children, but maybe she is looking after for somebody, if so, how can she just go on out for exercise, maybe something else could have been done for her to make it so, to make it real. If in this patient things hasn’t been just planned with the physician and the patient together, in the near future, this young lady will have a problem with diabetes too. Well, you might say that being diabetes or not to be diabetes, whatever, we have got lots of drugs and so on. In family medicine, isn’t there holistic prevention, holistic approach? The first thing is prevention. If we can prevent our patients not to be, live with diabetes, we can do that, why not? So the history taking for our patient will be important and we understand that she has undergone a total tracheotomy. She couldn’t use her pills promptly and good, she couldn’t use other things because she is illiterate. That means she needs help. If she gets the help, there will be no problem about metabolism. Can we do this? Yes, of course. If not, the young lady will be having type 2 diabetes in the near future. And the type 2 diabetes, maybe you may say as a jargon, never walks alone. It just comes with atrial fibrillation and afterwards we can see this young lady with transient ischemic attack. That means there is a thing that we can solve when the trouble was so little, but if not, we will have other troubles and also organ damages. Is it only for the individual stage? Can we talk about much more in macroeconomic stage? Yes, it is. Not only in low -income countries, but also for high -income countries, in macro level, obesity and couldn’t deal with obesity is a great problem. And we have got case 3. A 48 -year -old woman, pain but couldn’t remember only one side, everywhere, she has got flushing, losing hair, the menstrual sequestration changed and that’s why she came here. She said that there has been prescribed SSRIs, but three months ago, her psychiatrist has said enough is enough. And when we look at it, find out that her secret time is so high, the things the job is with screen on TV or so on, and the joy on screen when she is watching TV, so there’s no problem with sleep, but physical activity is so less because work is done with PC and the phone is just done with PC. We are getting the past medical history as we asked, we are getting a little bit detailed if what can we learn about her. We figure out that there is a junk food history, although she eats fish and the other things, and regular meal maybe. And here we have got smoking too. We are asking habits also. What can we do? What can we learn from our patients? We are doing the physical examination too. And we figure out that we need to reduce the body weight so we can lead her to obesity centers, why not? Decreasing self -conception will be very good because she has got hypertension. And also as the screening time is so high, we can make her to exercise. But if the patient hasn’t done exercise for years, it won’t be easy to make him or her walk and do this exercise. So we shall just begin slowly, slowly. It will be better to make a plan, not to make a plan. And also we shall share the decision with our patient. As we figure out that she has got upper body mass index and normal blood pressure and has that abdominal obesity, can we do a recipe for her? Metformin could be used for these cases, it would strike and in Turkey, we can write, give the recipe for this, we can give the recipe. As you see, it’s just also beginning little amounts and just coming a little bit more, if there’s no problem, like what? We can just begin with a 500 milligrams dose and then we can just make it to two days and one 500 milligrams. So the thing is there should be some side effects if you’re using something. What could be the side effects? Stomach pain, GRA could be one of them and some of the patients couldn’t use metformin because of this reason. As you can see on the slides, It is very important that we can’t use metformin for all our patients. Why? Because glomerular filtrate rate is very important. If there’s problem about it, we can’t use it. So the follow -up has to be done with this part, never ever forget it. Can we talk about other side effects? Yes, of course. Vitamin B12 is very important. It also has that muscle weakness. So while we are trying to make good things for our patients, side effects could be an obstacle for us. I again put the GFR results here just to remind again and again. And after eight months, our patients has lost some of the weights and it is sustainable, still the normal blood pressure. And now the lifestyle changes will be very important because we wouldn’t like to live with all those drugs forever. We are talking about arterial blood pressure, it is needed. And also follow -up for the bottomase index is needed. And then the screening will be needed for this patient too as we are reaching for a holistic approach. And also quitting smoking. Please don’t be just thinking so much things we should do lots of lots of things. It won’t be a problem if we do it all together with the motivational interview techniques we can use. And maybe there could be some smoking session units like in some countries, for example, Turkey. And we can talk our patients about our obesity. This is a problem, not only for the patients, also for the physicians, because we should just look at our faces to be a role model, healthy life choices is needed for us too. In summary, let’s make an open question with our patients. We need a reflective listening to understand our patients and make the signposting and summarizing if we do understand right, if everything is in details. Lifestyle medicine approach could be used and we have got some resources about it. bonka has got that too, as exercise is very important, it’s also saves our brain and neural system, cognitive system. Z -exercise could be used as I said before, but if your patient doesn’t do any exercise to make it slowly, slowly and make the change in a slow motion will be good. Sleep HHN could be asked in only one minute time. If the patient is a good sleeper, no nothing wrong with it, the glucose metabolism will be much more safe. That’s the reason we are asking. And we have got some models that we can use about lifestyle medicine. The pictures that are from the Dublin Congress, we talk about lifestyle medicine there too. And there are some associations about lifestyle medicine. Maybe you would like to get some information from them. and also online free courses that could be used to get more information. What can we do? The last but not least, we can get this information and use for our patients so we are not alone and we are free online. Thank you very much for listening.

Speaker 1
01:06:20 – 01:06:55
– Thank you. Thank you very much for this great presentation and very practical tips for general practitioners, for GPs. For the interest of time, we’ll move quickly to the last presentation of the webinar. On behalf of Laura Reali, she will talk about pediatric perspective. Actually, we left at the end what should have been the beginning, because it’s about children. And then we’ll try to answer at least one question for each speaker, if the time will allow it. So please, Dr. Reali, the floor is yours.

01:06:58 – 01:06:58
Thank

Speaker 4
01:06:58 – 01:07:10
you. You’re welcome. With a minute. Do you see my screen?

Speaker 1
01:07:18 – 01:07:19
Yes, it’s okay.

Speaker 4
01:07:20 – 01:29:59
Okay, thank you. Well, first of all, good evening to all of you. I’m very proud to be here. I’m only a primary care pediatrician, but at the moment I’m also the president of the European Confederation of Primary Care Pediatricians. And as you can imagine, not only general practitioners, but also pediatricians that have firstly an ambulatory practice had a lot of contact with children with this kind of issue like obesity. So some numbers about this issue, but you have already seen that, so I will go very far, very rapid. Childhood obesity is one of the most serious challenges of the 21st century and this is what WHO said in 2024. From ’90 to ’22, the obesity prevalence more than doubled globally. And this rise occurred similarly among both boys and girls. But the number is amazing. More than 390 million children and adolescents aged 5, 19 years were overweight in 2022 globally, and 37 million children under five years were overweight globally in 2022. It’s really a hard problem. And it is not a problem only of the welcome countries. In low and middle income countries, the overweight is also on the rise, especially in Asia and Africa. So we have a problem, and this problem can’t be only for simple origins or problems. And the impacts of this obesity epidemic, if we don’t do anything, will arrive to 3 per year by 2030 and more than 18 trillion by 2060 as WHO wrote, but also in the World Obesity Atlas 2023, the numbers are very, very high. I have seen with very pleasure this IAO taxonomy because it’s very clear and fair and it’s in my opinion, also a perfect outline of the obesity issue in pediatric age. So I will try to follow it. Firstly, definitions, because in pediatrics, obesity and overweight are a bit different, because for children age needs to be considered when defining overweight and obesity. Children under five years of age, for example, are in overweight when the weight for height is greater than two standards deviations above WHO child growth standards median. Obesity instead is weight for height greater than three standard deviations above the WHO child growth standards median. And in children aged between 5 and 19 years, overweight is BMI for age greater than one standard deviation above the WHO growth reference median and obesity is a BMI for age greater than two standard deviations above the W child child growth reference median. So we can summarize that overweight is a condition of excessive fat deposits. Obesity is a complex chronic disease with children at risk for various health issues, but note that body mass index is normally used to assess excess weight even though in children its accuracy is limited due to their rapid growth rate and mostly this problem is under the 2 years of age. Children with BMI higher than 80 % or 90 % of their peers are considered overweight or with obesity respectively. And these are the child growth charts. Oh, sorry, they are from CDC, not for WHO that I previously said, but they are very similar. WHO charts are very close to the European population. They are our paper to follow the growth of our children. And activities in pediatric practice. And I deeply suggest to do the same in the general practitioner practice. Which are the obesity causes? Well, I have shown here this very complex model, because it’s evident in his complexity. And it shows us that public policy, society, community, and built environment, childcare and school, family and peers, and the individual, the patient, all are deeply involved in a very closed relationship. So it’s very difficult to counteract all this. It’s evident that obesity is a complex problem that needs a complex answer from all the health professional and not only from family, from school and from public policy to be solved. In any case, this is a socio -ecological model where personal, environmental and social factors are integrated. And we have to consider this, but we have to consider also the causes of obesity in children from the genetic point of view, that it is not the most important cause, but it’s very relevant for its hard effect. And even though genetic obesity is traditionally classified into two categories, monogenic, I mean inherited in a Mendelian pattern, and polygenic, so caused by hundreds of polymorphisms, it is not really exactly so, because mutation causing monogenic obesity and may be influenced by an individual’s polygenic susceptibility. So there is like a continuum from the one to the other, and it is not so simple to define the genetic monogenic or polygenic origin. In any case, obesity, in most cases, è una malattia multifattoriale a causa di ambienti obesogeni, fattori psico -sociali e varianti genetiche. Ovviamente, i fattori strutturali come la mancanza di cibo affidabile e ambienti illegali e regolatori inadeguati anche exacerbano l ‘obesità. Ma c ‘è anche una causa genetica epigenetica di obesità nei bambini And this is a link, a very important link between general practitioners and pediatricians, because everything can begin before birth. Environmental and dietary factors, for example, parental overnutrition, can influence transgenerational inheritance of environment exposures, passing down to the offspring. So this means that epigenetic mechanism and obesity in children have, for example, a positive correlation between rapid growth gain and DNA methylation of CHFR gene, one of the genes involved in obesity. Environmental disruptors like bisphenol, phthalates, parabens and phenols, common in personal care products and plastics, every kind of packaging, for example, are very present in our life. And they are in case of exposure of prenatal exposure. They can affect fetal growth and children’s BMI after birth. They can also promote epigenetic and androgenic change, obesity, adipogenesis, obesity related metabolic condition. they can impair glucose metabolism and contribute to adult chronic diseases affecting both individuals and offspring. So we have to consider this and we have to to teach, to inform, to counsel the couple, father and mother, that their life is very, very important for the future life of their offspring. Other interesting epigenetic connections are about the fact that fetal and early postnatal period may play a critical role in childhood adipose tissue and obesity. Animal models have shown that there is a link between paternal obesity and change in sperm cells DNA methylation profile, so we have to check the weight of the mother but also the weight of the father. And high fat and low protein diets can cause epigenetic changes too in spermatozoal and cRNA content, leading to metabolic health issue in offspring. Sorry. Then there are factors contributing to pediatric obesity and long -term effects. In this complex series of interaction, there is the possibility of different factors that can interact in a so complex pattern that it is difficult to identify one specific mechanism responsible for one long term consequence or other. And you can see a lot of factors that are in the matter of the problem. A transversal sign is the low intensity inflammation. Inflammation is one of the most important causes in obesity and in many other chronic disease. This is able to cause obesity in young children already contributes to many obesity associated diseases. And then what about the screening? You know, we are pediatricians, so prevention and screening are very important in our practice. Early diagnosis is our credo. We are convinced that to prevent is better than to cure. But it’s very depressing the fact that even though obesity, sorry, we know that obesity is becoming much more common in childhood. And most often it begins between the age of five and six and in adolescence. But we have to check the children before, because health care providers should assess obesity at the age of two and then at least annually in pediatric practice. We do it very often, twice in a year or more, especially when the children have suspect BMI. And then we have to talk with children and teens about healthy growth. So we have to learn also counselling and communication with children and parents to begin to speak obesity and overweight problems very early. What about prevention? Overweight and obesity are preventable and manageable by adopting preventive intervention at each life cycle stage and setting to reduce the risk. But it’s complicated because, you know, intervention is changing in the age between birth to two years of age and from two to 12 and from 13 to 18 because it must be a tailorized according to the age of the child. And then we have also to check about the setting because parents, their weight control, if they are fat or not, nutritional education, and we can go on with a lot of factors that we have to check. So we do well -baby check visits. During that we tell anticipatory guidance to the parents, but it’s very important if this kind of habit is shared with parents, with their doctors, and if we all together the same things to the family and to the children. Preventive intervention include ensuring appropriate weight gain during pregnancy, exclusive breastfeeding in the first six months almost, and possibly continuing breastfeeding until 24th month or beyond if needed. children’s healthy eating, speak with him or her, and request for physical activity, but free activity, pleasant one, not only in predefined sport or whatever. Reduce as possible sedentary behavior and optimize sleep and reduce as possible screen times. Limit is gently, I prefer to say, reduce or avoid till the age almost of four or five years of age, and then consume less sugar, sweetened beverages and promote healthy eating behaviours. There are a number of requests, a number of situations. This is a complex situation and we need the help of everyone of the school too. Then, enjoy a healthy life, limiting energy intake and engage in regular physical activity is important, in my opinion, from this point of view. We have to enjoy, yes, to be with a Weight problem is a heart problem, but we have to try to find a way to arrive to smile, to be happy, to enjoy the life. Because if you are in a very pleasant mind, you can surely obtain your result better. Then there is the stigma. This is a very problematic point that we need to treat in the school, firstly, in the family too, because obesity in children can negatively impact social interaction. And this is a problem for the neurodevelopment of the child. And there is the possibility to arrive to bullying, eating disorder, social isolation, reduced physical activity, that is really the opposite that we need, depression, till Because, you know, children can begin very early to be overweight or to have problems with obesity. This is a hard problem for them and for their relation in the society. Health care should use non -biased language. This is important, but not so often respected. We need to avoid stigmatizing obesity and evaluate psychosocial risk and potential health benefits of childhood obesity treatment, but it’s a very hard matter in all the societies. This is another complex infographic, but very useful from the pediatric guidelines about obesity treatment, because we are speaking about treatment and management at this point. These are the five most important interventions that are connected with some kind of efficacy, but this efficacy is not so high. And we well know that obesity is a cyclic disease all along life. And we have to go on to share decision, to treat, to listen to the child needs and problems and to ask in an active way if he or she needs some help. Because sometimes it’s very difficult to speak about this for the child. All these treatments, of course, are to be delivered in a non -stabilised family -centred manner, ideally within the context of a medical home that provides coordinated ongoing care. This means that the treatment is in primary care with the general practitioner or the but it’s a primary care problem that can be sent to the second level when there is no result or when there is a very hard kind of problem. But we need to learn how to treat this problem in primary care. Condition caused or worsened in children with obesity are, of course, numbers. organ system are affected. And we have to consider that childhood obesity now is a condition, a complex condition. But throughout the last 100 years, it has transformed from a sign of wealth and health to a disease. So there is a cultural problem and there is an obesogenic environment, not only done by food or bad habits about the food, it’s also done by environmental exposures to toxicants and the crime disruptors are not the only one. While the health hazard decreased over 25 % between 19 and 2015, risk associated with high BMI increased over by 25 percent. And the association is, as you can see from the infographic and read rapidly here, increased risk of premature death, insulin resistance, cardiovascular disease, the type two diabetes and so on. You know very well all these diseases in adult age, but they can begin from the early stage of children age and adolescent age. And this is a very unpleasant way to live and to be sick. So just to end this short speech, what we primary care pediatricians and general practitioners can do? Well, first of all, we have to work together. We have to do our job involving every health professional and not but stakeholders and involved in treatment to ask the children, to the family to do the same things and ask to the institution for orienting the marketing and pricing policy. For example, we have the evidence that sugar tax goes on, it’s able, and we have to address the wider determinants of health to treat as better as possible obesity. Because obesity is a societal rather than an individual responsibility. If someone has a problem with obesity, the society, the family, the environment where he or she is living has a problem and we have to treat it. Solutions can be found through a creation of supporting environments, where communities embed healthy diets, regular physical activities and the most available and affordable behaviours of daily life in a pleasant way. Stopping the rise in obesity demands multisectoral actions. Food manufacturing, avoiding packaging with plastic for example, marketing and prices in a very wide and wise way, and other than SIGG, such as poverty reduction and urban planning. Thank you for your attention.

Speaker 2
01:30:03 – 01:30:33
Thank you very much, Professor Riavi. Now we have only a few minutes for questions and answer session. So the first question was for Rath Eriksdotir, and was about what can be done in the school environment to help children with this condition and to fight stigma, etc.

Speaker 3
01:30:34 – 01:30:57
Thank you. I think the presentation from Laura went through it. It was a really good thank you, Laura, and the slides for prevention. So hopefully we can use those slides. Thank you. You’re welcome. It’s my pleasure.

Speaker 1
01:31:01 – 01:31:27
Well, great answer. Very collaborative initiative, actually. I think this is all about. Let’s move to another question. Dror, are you online and able to take to answer some questions? Otherwise, maybe we’ll wait two minutes for Dror to join. Are you here?

Speaker 5
01:31:27 – 01:31:29
Yes, yes, I ran to the…

Speaker 1
01:31:29 – 01:31:30
Okay,

Speaker 6
01:31:30 – 01:31:31
welcome.

Speaker 1
01:31:33 – 01:32:17
Welcome. There are actually two questions that go in the same line, so I will combine them to you. because one is about the metabolic set point theory and the theory that the body defends against fat mass reduction and induces the metabolic adaptation. And the other one is that many people with obesity hesitate to begin drugs or Zempik or Monjaro because they don’t know how long they will have to take the treatment. So I think that these two questions actually refer to the same concept. So please try to to synthesize them in one answer. Thank you.

Speaker 5
01:32:18 – 01:35:49
Thank you. Thank you very much. And I again apologize that I couldn’t give my talk live. So I think the question is because we don’t really accept obesity as a disease, because We won’t ask this question on hypertension or diabetes or asthma or any other chronic disease, which the patients really understand that he has to take the medication for life because it’s a chronic disease. So I think our mission is to really, in the beginning of the treatment, clarify to the patients that this is a chronic treatment for life. because we now really understand the physiological maladaptation or physiological problems that brings to obesity as a disease. For instance, people living with obesity have much less GLP -1 level. People living with obesity, with hypothalamic obesity, have higher GLP -1 level, but the GLP -1 doesn’t work, meaning they have resistance to GLP -1. So this is one example that shows us that if people do not have signals of satiety, So the set point, what we call the theory of the set point, is that they have higher set point because of this malfunction of the GLP -1. And this higher set point brings the system to really acknowledge obesity as a normal physiological weight. So in order to tackle this, we have to treat those patients with low level of GLP -1 or those patients with resistance to GLP -1 with GLP -1 under loan. So this is not surprising because people with hypothyroidism are treated with replacements hormones for the thyroid. People with type 2 diabetes are treated with insulin because they have a lack of insulin. People with lack of treated with testosterone as a hormonal treatment. So I think we have to really explain our patients that obesity is a physiological malfunction of some systems that we are trying to really treat and sometimes cure. And if the patients really understand this, and if the physician really understand this, So I don’t think people will ask this question anymore. Now we have to really escort them and really support people living with obesity to treat a chronic disease for life. We have to maintain the treatment, the holistic treatment, not just pharmacotherapy. I’m sure that you talked about it, the diet instruction, the physical activity, the social psychological support and pharmacotherapy in order to really maintain health and maintain weight loss.

Speaker 1
01:35:51 – 01:36:43
Thank you for a very good point. For the interest of time we will move quickly and since we are in the field of drugs treatment and diagnosis of obesity there are three questions for Laura. I regarding the framework, the YASO framework for the diagnosis of obesity. The question is if this kind of framework can be used in pediatric population. And then another one was screening for obesity in children has to start at two years of age, but how to approach and treat at such a young age? And what about pharmaceutical treatment options in children with obesity? So I think that we can give a holistic answer, a complete answer.

Speaker 4
01:36:44 – 01:38:45
Yeah, thank you. Very rapidly. We use normally checklists about the habit of the children during the well baby check visit that we do at two years of age, for example. We ask freely to the mother, how is the habit about the food? how the child is eating and if he’s able to do it by him or herself, or if the mum is giving him the food and so on. Then, after having had the weight and the height and the circumference for the last time, we try to define the profile of the child from the weight as for the neurodevelopment and give some suggestions that are listed in this kind of checklist that are the, for example, AAP well baby checklist visits. The possibility to give drugs or surgical bariatric treatment, there is also in pediatric but a different age, there is different treatment. Of course, we are not speaking about children of five, six years of age. Bariatric surgery is after 13 years of age almost. And for the drugs, there is a very strictly situation. And it has been every time to share this decision with the second or third level of a special a specialistic center because it’s not up to us. We can only tell to the family and the children, please, we are not solving your problem. We have to need to go to the specialist.

Speaker 2
01:38:48 – 01:38:55
Okay. Do you want to add something, Professor Vicker?

Speaker 5
01:38:58 – 01:40:42
I am reading a very interesting question about menopause. Since International Women’s Day will be on the 8th of March, I think it’s very adequate to say something about menopause. This is a very interesting, let’s say, age because there is a shift from fat mass from the lower part of the body into the visceral part of the body. And this of course, increase the cardiovascular risk of those people. And there is some very interesting studies that really look into the effect of pharmacotherapy, mainly GLP -1 and GLP -1 and GIP. there is difference between ages or premenopausal, postmenopausal and permenopausal. And there was the results was that there is not difference in the effect. What they found is that there was much higher fat loss in women in those age compared to men. What we have to stress in this age is that the weight loss with pharmacotherapy is also leading to muscle loss. And the sarcopenic effect of this very effective drug should take into account, especially in the menopausal women. So it’s very effective in this age. It should be taking into account in the holistic treatment and the issue of the muscle health should be taken very seriously in those ages.

Speaker 2
01:40:44 – 01:41:23
Okay, thank you very much. And the real last question is for Professor Gokdemir. It is about lifestyle medicine. So we all know that in the trans -theoretical model of health behavior change, it shows that it’s not so easy to change behavior. And the last step is a relapse. And to avoid this relapse, some technique such as motivational interviewing can be used. Can you tell a little more very quickly about the use of this technique?

Speaker 7
01:41:24 – 01:44:09
– Thank you very much. First of all, I just want to thank you. First of all, Laura, because although I am the chair of ONCA Working Party on planetary health. I did not talk about microplastics, but she did. Thank you. And also we are talking about tobacco smoking sessions and so on for the holistic approach, but we didn’t talk about the junk food and it is all around us. It is so hard to close your eyes, close your mouth and don’t eat or don’t take, don’t consume, so, so hard. And so as we look at from that side, we are survivors because we survived through all those environmental issues, all those economic and advertisement issues, and here we are as survivors. So the motivational interview is very, very important. By this way, we can understand our patient and understand ourselves. It is just like the smoking sessions. If your physician is smoking while you are telling you don’t smoke, quit smoking, it wouldn’t affect your patient. It is just a little bit same. So the role modeling for the physician is very important at that part. And we can’t be angels. (laughing) And this is the same thing because we have got role offices too. If something happened in life, it is not only affecting our patients, it is affecting us too as a rural physician. Maybe Ferdinando, you will say this too because we are living in the same world in real room mostly. For the motivational interview, the very important part is we should be at the same page. If I am talking to only by myself, that means it is a radio head. It doesn’t, you are listening or not, I am only talking by myself in a room, just surrounded. But if my voice is reaching to the patient and I can hear, so signposting, summarizing to understand right very important. Maybe you made a great picture, a great plan for your patient, but the patient couldn’t make it that’s because of the things that couldn’t be overcome with the policymakers stakeholders only could be. So the rollouts could be yes, but if we work together with our patients, we can overcome those rollouts as to so open, open mind to be on the same page, patient -centeredness, holistic approach, make decision together, not only by yourself, together, and summarizing signposting. By this way, we talk about picking one.

Speaker 2
01:44:10 – 01:44:27
Okay, thank you very much. What do you think, Andrea? Can we consider close this session? I hope that all the audience have enjoyed this webinar as much as I have. Please, Andrea.

Speaker 1
01:44:28 – 01:44:49
Yes, thank you. It was a great webinar and thank you all for staying after the schedule, let’s say, for the debate. It was very interesting and very useful, I think. So I think that we can close together. And let’s thank you very much. Thank you all. Bye bye.

Speaker 6
01:44:49 – 01:44:50
Bye -bye.