Description
Comments & Resources
Key Takeaways
The Italian Obesity Law as a Policy Milestone
The Italian Obesity Law marked an important shift in recognising obesity as a chronic, progressive, relapsing disease within national policy. It demonstrated how scientific evidence and sustained advocacy can move obesity beyond individual responsibility narratives and into structured public health and care frameworks.
Building Change Through Collaboration
Progress depended on long-term collaboration between clinicians, researchers, scientific societies, policymakers, and patient organisations. The law reflected years of consensus-building and strategic alignment across health, prevention, and non-communicable disease agendas.
Implications for Care Pathways
Legislative recognition can strengthen accountability for prevention, diagnosis, and long-term multidisciplinary management. It also provides a stronger foundation for more equitable access to evidence-based obesity care and clearer reimbursement pathways.
Reducing Stigma Through Policy
Formal disease recognition can help challenge blame-based narratives and support more respectful, person-centred communication across healthcare, public messaging, and policy.
A Transferable Model for Europe
The Italian experience offered a practical example of how research, advocacy, and patient voice can inform wider European policy development and chronic disease strategies.
Future Directions and Next Steps
- Explore how obesity is currently recognised across different national policy contexts
- Identify opportunities to connect research evidence with policy and advocacy discussions
- Strengthen engagement with national scientific societies, patient organisations, and public health networks
- Consider how chronic disease framing can strengthen research, education, and communication activities
- Build skills in translating scientific expertise into policy-relevant messages
Transcript
Transcripts are auto generated, if you spot an error, please email enquiries@easo.org
Speaker 1 • 00:01
Welcome everyone to this month, the ASO Early Career Network eLearning Hub event. We are thrilled to have you all with us today. I’m very happy to introduce you to this webinar. Our event title today is the Italian obesity law, a model for Europe. And during this event, you will gain a deep insight into the journey that led to the approval of the Italian obesity law. detailing hence the strategic combination of awareness initiative, political initiatives and scientific initiatives that made it possible. So this experience has sent us a fantastic example of how close collaboration between different stakeholders can translate into meaningful legislative achievements. And for those who are interested in knowing more, this topic has been detailed in a recently published paper, which Professor Braccia, our speaker today, will detail. Before we begin, please note that the Novo Nordisk Foundation has provided support to EAS for ECN development activities, including this webinar series. The Novo Nordisk Foundation has no influence over the content. let me introduce myself. My name is Giorgia Colleluori and I am an ECN board member and I’m joined today by my fellow board, Eugenia Romano, and we are both two ECN board members, very proud to introduce this event as we are both Italian. So let me pass the word to Eugenia who’s going to present you a few, is going to provide you a few information before starting. Thank you, Giorgia.
Speaker 2 • 01:47
So for you guys, just a few information about the ECN. Many of you might already know enough of it, but it’s never enough to repeat it. So there are many opportunities available for ECN members. There’s a link that Lisa shared in the chat. But just so you know, first of all, we look forward to welcoming you at the European Congress on Obesity, which is taking place from the 12th to to see as many of you there. And for those who are attending, you are warmly invited to join us for all the ECN activities throughout the Congress, including networking events in the dedicated ECN space, which we call ECN Lounge, and during the award sessions as well, such as the ECN Best Thesis Award, the Ezo Novo Nordisk Foundation New Investigatory Awards. And if you’ve never participated or if you have and you want to attend for them it’s a great chance to see what it is about and have a chat with the potential winners. Aside from ICO we also run a regular ECN spotlight feature which we share across the ESO website and social media which highlights any ECN member and their research and goals in the wider BC community so it’s a good opportunity to have your work featured on the EASO website, so if you’re interested get in touch. And finally we also have an ECN WhatsApp group for quick updates which is very useful during Eco, so if you’re not in it
Speaker 1 • 03:26
yet we will be delighted for you to join. So I will pass it back to you Giorgia so you can introduce today’s speaker. Thank you, thank you Eugenia. Just a quick housekeeping note, this webinar is being recorded we will share the recording and any relevant resources with you after the end. And as a reminding our early learning hub events are organized by the EECN to foster knowledge sharing and skill development among students and early career professionals with an interest in obesity. So the EECN and these monthly webinars are completely free to join and we really encourage you to invite your younger colleague to join the network. Regarding the house rules, this is an informal setting, so throughout the presentation you may ask questions through the Q&A section, but there’s going to be an actual Q&A session, which is going to be 15 minutes right at the end of the whole webinar, so you’re going to actually have the answers to your question towards the end of the presentation. And please also, since we really value your input, take a moment to complete the feedback that you’re going to have at the very end of the webinar. So you can enter your comment and provide us anything that you feel could be useful for us to improve our initiatives. But let me introduce you, our today’s speaker. I’m very happy to introduce you Professor Sbraccia, who’s a full professor of internal medicine and a world-renowned expert in the field of obesity. He is a treasurer and has served as past president of the Italian Society of Obesity. He has been a key figure in Italy for this legislative process he’s going to introduce you. So please, Professor Sbraccia,
Speaker 3 • 05:18
the floor is yours. Thank you very much indeed, dear Georgia and dear Virginia. And thank you for the invitation and I’m very happy and really good afternoon to you all. I hope this will be useful for everybody. So I’m going to share my presentation now, hoping that everything goes trade. Give me a confirmation that you can see it. Good, good enough. So let’s start. Now, before starting the policy part, please allow me to introduce some concepts related to the recognition of obesity as a disease. Because, of course, this has been and is a mantra of IESO and of many other organizations, obesity is a chronic, progressive, relapsing disease. But although I’m sure that if I’m asking you to please raise your hand, if you really believe that it is a I ask each of you why you believe so. Probably the answer will be different. And in fact, there is a lot of discussion around the concept of disease. And I would like just to present some angles from being more sure that obesity is, in fact, a disease. So here you have the bigger, the stronger root of diseases, of human diseases, infectious, oncologic and autoimmune. There is no need for a law to establish and recognize that pneumonia is a disease. There is no need for a law to recognize that colon cancer is a disease and so on and so forth. So now there is a sort of epidemiological and practical reason, because recently another route has been added to epidemiology and this route is becoming unfortunately stronger and bigger. Here you just have, you know, the typical pathway from normal weight to cardiovascular event in the so-called cardio-renal metabolic disease, but of course, the many complications of obesity and of its pandemic poses strong risk for national health system for many, many reasons. So there is a practical reason, if we have a strong enemy, we should call enemy, we should call a disease. Probably raising some doubts in some people that believe still believe stigmatising obesity as the consequence of reversible wrong choices. That is not. But I would like to go on further on the concept, just showing two typical definitions of undernutrition and obesity being malnutrition for defect and for excess. And this was actually the definition several years ago. And in fact, easily, if there is a problem of defect, then you need to give food to the person. And if there is excess, you should prescribe a diet. This is really a simplistic view. Here you have the many, many detrimental, horrible consequences of both conditions, but I would like to challenge you showing these two photographs. These two individuals are certainly affected by undernutrition. This poor child may die from undernutrition, but this is not a medical condition in the sense that it’s the consequence of a disease. It is a disease, or whatever you want to call it, I wouldn’t call it a disease, actually is a geopolitical problem. And apart from the refeeding technique, of course, you just need to give food to this poor child. Here you have anorexia. This is a completely different issue. You cannot just say eat, because he will not eat. Because it’s a disease, psychiatric disease, that affects the center that regulates appetite in society. exactly in the same way obesity affects genetically, biologically, or whatever, the regulators of appetite and satiety. And we know that from many, many aspects, from many big trials, the DPP, the look ahead, many others with drugs, we know that after a decrease in weight, and here in in these two big, big trial, there was an intensive lifestyle implemented by many, many means. But yet, after a period of almost one year, regaining weight was the rule. And regaining weight is the rule all the time that you stop anything, because we know now that this is linked to a threat that the hypothalamus sense and then push a neurohormonal response that inevitably bring the patients back to the initial condition. Therefore, this is something that for me is important to define as a disease. I don’t want to debate over the Lancet Commission conclusion but I just wanna take this picture, the one that is called preclinical. Okay, well, I think that this preclinical actually is itself a disease. Of course, it’s a risk factor, it’s a gather of many other disease, but how do you live with 20, 30 kilogram of backpack on your shoulders? What about all the other situation and mental health? We know that this is really highly affected, you know, in many, many patients. So I think it’s a disease because it’s an enemy obesity under epidemiological reason is a disease because as a genetic and biological etiology is a disease by itself, because even if you don’t have detectable complication, you really live in a body that is not, that do not enable a normal life. And of course, it’s a disease for the many, many complications. It is the more easy and obvious reason. And you will see that, unfortunately, on my point of view, the law is not really 100% clean in this sense, because it was managed. It was, you know, underwent many, many discussions. And therefore, it doesn’t really say that is a disease if you don’t have any complication, but this is all another issue. So now let’s enter in the policy arena. And first of all, I would like to thank very much Georgia Colleluori, because actually all these lights from this point on have been made by her, not by her for me, absolutely, for her, because she presented these lights in Brussels at the European Commission. And since I’m a little bit lazy and I saw the slides, I asked the permission, or probably I don’t even ask the permission, but assuming that she gave it to me to present today to you. Now, we want to consider obesity as a disease for the reason I presented. Certainly, if you do not recognize obesity as a disease, you really have a lot of critical points. Barriers for accessing care, suboptimal obesity management, inadequate prevention plans, and of course the stigma that affect many, many of our patients and continue to affect the patients because the law now is something that really is helping a lot, but yet do not provide a full consideration of all the Italian inhabitants of obesity disease. Many said, yes, it’s a disease, but, yes, it’s a disease, but then if you explain, so no, it’s a disease, dot, full dot. Now, this is the end. This is the law. But what I would like to underscore and to highlight is that this process took almost 10 years. OK, so it was really a long, long winding road. And believe me, I cannot present myself to you as an expert in policy. Probably I would rather be a policeman than a policy man. Because being a policy man is tough. I can define myself a clinical scientist, professor in medicine, you know, all these things because I’ve been done this for all my life, but I learned how to enter in this difficult political arena. Thank you to a collaboration with many stakeholders. And this has been already underscored by Georgia at the beginning. So it’s effective, obesity effective management required structure collaboration among stakeholders, scientific societies and policy makers, and this has been done. I have to confess that, this is obvious, alone I wouldn’t be able to do anything and all the many stakeholders alone wouldn’t have any success but I have also to acknowledge the fact that there was a key driver, whose name is Federico Serra, that is a sort of, in the virtuous sense, of lobbyist. He was able to talk with all the different stakeholders in the right way, because it’s not easy. And you need to be patient in order to carry on the program that lead to a success. So what is the law? Yes, it set out the fundamental principle for the prevention and treatment of obesity with the aim of safeguarding health and improving the quality of life of individuals affected by obesity. So in this sense, the law is really very good in going from childhood to elderly, from prevention to treatment, et cetera, in the different part. This is the roadmap. Everything started here in 2018, but I can tell you that we met initially in 2016. So it is exactly 10 years. So for two years we discuss how can we do that. And then in 2018, we started to produce a policy brief on obesity, the Italian Manifesto of Obesity. I am lucky because, yes, I work around that, but I received many help from others. I’m president of the Italian Obesity Barometer Foundation, and this is annual report from 2018. And now every year, the IPDA Foundation produce an obesity report. We collaborate with the statistical institute, Italian Institute to produce region by region, the prevalence of obesity. And we present the results every year in front of many policymakers. Let me go back for a moment. Yes. So going through all the single train stop, let’s say, we then arrive here. Obesity, this is the part that I, that I, as I said, I would have liked in a different, the wording initially, what we proposed was different. Obesity associated with other socially significant diseases is a chronic progressive and relapsing disease. So when you assume that we tend a little bit not to underline too much the fact that it needs to be associated with other socially significant diseases, because I I don’t believe this is a prerequisite. So barriers to accessing care, suboptimal obesity management. I think you all know the Action.io study that was a sort of survey that interested over 14,000, no, sorry, less, yes, well, around that number of individual in 11 countries. This is the Italian part, the Italian data. And you see, probably you have seen these slides elsewhere because the data are very similar in all the different countries and when you take all the countries together. So if you post 100, the total person with obesity, And then 64% discussed weight in the past five years. And then 34% were diagnosed with obesity out of 100. And then only 16% received a follow up appointment. This is a terrible disaster. This is a terrible disaster. OK, why? Well, because many doctors just say, please eat less, move more. This is not a disease. obviously, this is the consequence of your behavior, and so on and so forth. But this photograph is really terrible, and I think it’s very important for pushing hard in the direction we follow. The other result, terrible result, of the action I/O was the fact that from the first loss, the first time a person do the first attempt to lose weight until go to discuss this problem with the doctor, there is a gap of six years. I don’t I cannot imagine any other disease. Okay, it’s normal, the inertia is normal. You have something you hope that then passes that then go through you wait one week, three or two weeks, and then after three weeks, one month at the most, you go to the doctor here, we are talking about six years. So again, this is the result of barriers and suboptimal access to cure. Now, these are two important moments, two important steps, the request by the Italian Obesity Society of inclusion on what we call national chronicity plan. Consider that the Italian chronicity plan include only seven diseases. I don’t remember all. There is no diabetes because diabetes has his own chronic plan and this request that was made back in 2023 or 22 was then accepted last year. And then the request for inclusion of some procedure into the so-called essential level of assistance. Okay, so this procedure will be free for the people with the disease, in this case with obesity. This request was not yet accepted. So, obesity entered the national chronicity plan, obesity was recognized as a disease with the law, but yet there is no inclusion and we have to, you know, to push in this direction, because this is another very important point. And then there is the national guidelines, and I will talk this a little bit later. So to ensure equity and access to care, individuals affected by obesity are entitled to the services included in the essential level of care provided by the national health system. Okay, so there is an article in the law. And therefore, you imagine that if there is an article in the law, this is almost automatically, but, you know, this is the bureaucracy around is always complex. There is a sort of group of experts that that meet every six months, I would say, meet more often, but every six months they can include. And remember that any of these things goes to the Ministry of Finance of the Treasurer, because it is approved only that are the money. Okay. And, you know, we I mean, I’m not saying Italians, but we are all short of money for many reasons. So again, this is something that needs to be pursued. And I hope that maybe this year or the next year, we will succeed for the entrance of several procedures that are dedicated to the person with obesity. Education and training on obesity and overweight among university students, general practitioners, practitioners, pediatricians, NHS personnel involved in the prevention, diagnosis, and treatment for obesity, the allocation of dedicated funding is authorized. Now, funding. This is an issue. I will not go into this issue too much. Again, the money. Now, the money dedicated for this law, I have to say, it’s not enough. But in order to close the law, you need to put some money, because otherwise the law will not be approved. So the initial amount of the funding is not enough, but it’s enough for the law to be approved. Now, once you have the law, you can follow up with several actions that may obtain increase in the funding. Suboptimal obesity management, we need guidelines. I remember that when I was president of this Italian Society of Obesity back in 2014-16, I promote the publication of the first Italian guidelines, but they were not grade-based, OK, was custom-made. We were expert. We prepared these guidelines that, overall, were very nice, I would say. We put the recommendation, everything, but it was not grade-based. So they cannot be considered, apart from the fact that now they are 10 years old, that they cannot be considered for the Italian law as guidelines that need to be followed. So the Italian, not NHS, NIH, let’s say, okay, the Italian NIH, l’Instituto Superiore di Sanità, asked the Italian Obesity Society to produce the first grade-based guidelines. I was part of the steering committee. And this exactly– you see the destiny somehow. The exactly same period, September 23, a few days before the law was approved, the Italian guidelines were published into the NIH system. And then we publish it in Eating and Weight Disorder, that is the official journal of the Italian Obesity Society. And this is an important step. Of course, we couldn’t cover everything. We produce 11 PICOS that were diagnostic and therapeutic, but believe me, this was really a very important accomplishment together with the other things. Inadequate prevention plans. Prevention is very complicated. It’s something that cannot be considered easy. To do prevention, you really need to cut our well-being, our societies. And of course, these are democratic societies, hopefully, and therefore you cannot prohibit you do this and that. And you should create the condition for all those things that may reduce the prevalence of this, reduce being a genetic disease or being you cannot Yeah, you should really being not democratic, you know, in order to, but certainly, the less the besogenic is the society, the less is the prevalence of obesity as a matter of fact, United States, it is the more of a surgeon, Evan, terrific prevalence of obesity, while Italy, for example, overall and not overall, comparing with the other European countries is not in a good condition, but certainly, at least for adults, it’s not too bad for the child’s obesity, we are in a bad shape. So breastfeeding promotion, parental education, physical activity and nutrition in school, more public information campaigns, health education, all these things pursue in a very important way, because otherwise, it’s just work. Okay. And, and I have to say that things are moving. You know, so I am optimistic that something will be done. But again, we cannot believe that prevention will solve all. However, it’s important to implement it in any possible way. So back to the roadmap. Other important goals were the Italian Charter on the Rights of People with Obesity, the Open Italy Action Plan Framework, I believe it campaign, documentary free body, the Italian obesity taxonomy that was taken by was done in collaboration with the ESO and Luca Busetto was the one that mainly contributed for the production of the taxonomy. And sorry, George, I believe that you also collaborated in this, if I remember well. Promotion of information and awareness, campaign focus on the recognition of the disease, This is the adoption of healthy lifestyle and the first against stigma and social discrimination, in the fight, sorry, against stigma and social discrimination. Again, this is a law, this is Article 4, but believe me, now every time that you say sampling, you say there is a law. This helps a lot, really helps a lot. And other politicians now are much more sensible to the issue of obesity. So the law pays and talk about resolving the barriers, resolving the suboptimal obesity management and the inadequate prevention plan. So job done, I would say. The funding is the one that I was talking before. is a little bit critical point, but I’m optimistic that the funding can increase in the following years. And also, there is the creation of an observatory for the study of obesity. They are preparing this observatory. I really hope that they will include the key people inside in order really to, you know, to chase and monitor what will be done in order to promote the article of the law in any region, because unfortunately, for my, for my what, what is my idea, we are divided in 20 regions, and the region has their own strength. Okay, so if the if the Ministry of Health says that you need to do something it’s not immediate you first need to go in a conference state regions okay to to implement this but hopefully this will be achieved also in the next months years we’ll see. So this has been a very dense period consider that in many of these activities, all the societies that somehow are, you know, around obesity, not only the obesity, but the endocrinological society, the internal medicine society, the diabetes society, the nutrition society, and so on and so forth, part in some more, some other less. But this was really a strong activities that through these years went around with many, many, many activities around that. And let me tell you just an anecdote. In 2000, well, probably last year, actually, I forgot. At the beginning of last year, if I recall well, the Lancer Commission was published. And there were some policymakers that were concerned that says to some of us and to myself, but so it’s not a disease. They said that this is only, it’s not a So I was very, very angry because I felt that our project could be endangered by the fact that some key opinion leaders, world opinion leaders said that obesity is not a disease unless you have a disease. That this is something that I don’t like at all. But likely enough, they didn’t stop the roadmap toward the law. Let me just say that soon after the beginning of all this, in 2019, we all were very happy because we present a motion to the Parliament for the recognition of this. The motion is something that said, we ask the parliament to approve an idea. In this case, the idea was the recognition of obesity. Then if the parliament approved in the following period, the government should do something. But if the government end its mandate, then the motion is deleted. and you have to start all over again. So in 2019, you see here that there were 458 senators and deputy and the motion for the recognition of obesity was approved by everyone, okay? So everyone approved the motion. We were very, very happy, but unfortunately, the mandate ended and then we have to start all over again. But we did it. And actually it was not necessary to send another motion. The things moved, moved at a slow pace, I would say, because, you know, we are talking of many years and obviously you always have something more important, but, you know, at the end we succeeded. And Giorgia and Eugenia were very good in preparing this manuscript that was approved in obesity fact. And also myself with his other friends, Federico Serra, I would like to underscore because, again, he is a driving force, of course. Silvio Buscemi is the actual president of the Italian Obesity Society. You can see Luca and Iris Zani, who is the president of Amici Obesi, the patient representative. And this was published a few months ago on Nature Medicine. So certainly, Italy’s legislative initiative could catalyze policy harmonization across Europe. This is really an example and we need a law. Pneumonia doesn’t need a law, obesity needs a law, for the many reasons I highlight. The recent establishment of an interest group on obesity within the European Parliament signals a growing recognition of the issue and may represent an important first step toward a new level consensus on obesity as a chronic disease. So we highlighted that in the paper on natural medicine. I think these are very important. I think I’m going on the last slide. And the last slide is exactly the same slide with a different, you know, way of presenting of the roadmap slide. Okay, that was a line. This is a domino play. And you see that starting from 2018, we went on and on with different initiatives, different publication, different stakeholders meeting different report, policy brief, campaign, motion, and so on and so forth, till the obesity law approval. So, thank you very much for your attention. I’m ready to take your question. And again, it’s not that you tomorrow say, okay, I’m convinced I go to do policy, you really need to create a large group of stakeholders. And you need someone that is not necessarily in this case was not a medical doctor, clinical scientist or whatever. But you need something that is able to talk with the policymaker because the policymakers have their own way of interacting with each other, they have their own interests as usual, and a catalyzer could be someone that really puts together everyone and really makes a team in the sense of the acronym TOGETHER everyone achieve more. So thank you very much for your attention.
Speaker 1 • 40:47
Thank you very much, Professor Sbraccio, for this beautiful presentation and overview of what you know has been going on during these last years in Italy. It has been a huge effort, the one that you’ve been putting into this course, and it is wonderful to see how when what you just mentioned, multiple stakeholders take an action, you can actually make the difference. So I’d love to ask the audience if there’s anybody who has questions they can, he can write down in the Q&A session, but maybe to break the ice I may start with one question. I actually have multiple questions, one I believe that could be useful for the audience or any other country that would love to reply to duplicate such law in their own country. So is there anything that you have done during these last years that you would have made different if you could go back to, you know, make this possible? Or you believe that everything went smoothly and you would say?
Speaker 3 • 41:58
Okay, no, yes. No, never everything goes smoothly. And again, I confess that in the last, at least the last three years, I was somehow pessimistic, because we expect a result, a sooner result. So, you know, every time we interact the policymaker, they said, well, yes, you know, in February, and then what September and then the year after and then, you know, and therefore, I begin to be a little bit nervous, because I said, listen, this is something that we, we, we repeat and then. So, finally, we were all very, very happy because when some when you succeed after so many years, it means that everything that you’ve done was worth doing that, etc. I cannot really find something that we should have should have not done because, you know, all the single contributions every time were aimed exactly at sensitize the policymaker in making awareness. And, and I I’d just like to tell you one anecdote somehow. In one of the many, many, many activities, there was one survey in which it was asked to the policymaker, what’s the prevalence of obesity in Italy? Just to see. And actually, the average reply was a value that is higher than the truth. So we push so hard for sensitizing them that at the end we end up with a– An overestimation. The overestimation of the– So yes. And now everybody is talking. We had the World Obesity Day, March 4. And again, there was, you know, the honorable, I don’t know, I don’t remember if in English you say honorable or whatever, Pella that gave the name to the law. And, and, and then there was other other meetings around this with with, for example, local politician in the Rome area, let’s say, and I found them much, much more sensible to the issue. And they continue to repeat the law. So the law is something someone told me from abroad, you really know the law for Yes, I think we need a law. I think that would be very important for example, for the European at the European level, to they already done so I can European Commission declared obesity and disease, but something that really pushed, for example, an idea, okay, now we are living terrible times, global crisis, so it’s a bit difficult. But as for the COVID, if European Commission really believe in the obesity as a threat, and create a fund, so the money for doing those things that right now are underfunded, could, you know, can be pushed in a very important way. So I think that as Ieso and as all the single country, we really need to create the condition for the single country, we have to push at the European level for really thinking to a plan that could contribute to do those things that in the Italian law are stated.
Speaker 1 • 46:13
Thank you. And, you know, I had we had another curiosity. So so from your perspective, as you are a clinician and a scientist, a researcher, what made the evidence compelling enough for policy makers to to act? Was there anything that you could identify that made a difference? If you, if we were to provide a suggestion to any other country that wants to repeat it, what would you recommend strongly?
Speaker 3 • 46:44
During these years, apart from the activity I mentioned, there were several, several, not many, but several scientific publications regarding the cost of obesity, the incidence and prevalence of complication coming from obesity. Very recently, another publication that was done here in Torrevergata with the collaboration with the colleagues in the economy and faculty, making an estimation of the number of the amount of money that you could save that you would do a certain treatment or whatever. And we’re talking, I’m not going to details, but talking about half a billion euros per year if you do certain things. So we presented all this data many, many times. The childhood obesity was another, unfortunately, was very important to underscore because we really have bad numbers. And and yes, I mean, I, my my generation, you know, belongs to a generation of metabolists, physiologists, diabetologists, in which we believed in the last century, we believe that the type 2 diabetes, were the consequence of insulin resistance. Obesity was not even mentioned. Yes, okay, if you have obesity, you are worse, but insulin resistance, we end up understanding insulin resistance is a consequence of obesity is not the cause of any things. And, and so now the message is very strong, because the diabetes organization are very strong. In fact, there is a chronic plan, only dedicated for diabetes. And now we can say loudly that the pandemic of diabetes, that is type 2 diabetes, of course, is due to the obesity pandemic. So, you know, and the cost is very high for all the many complications and the treatments. And if you treat, if you prevent and or treat obesity, you prevent type diabetes, and cardiovascular disease. So the message was strong. And, and every time there was a publication that was important in this, we presented in this, you know, meeting with the policymakers. So the policymakers became, you know, a knowledge about all the all these, these problems. And it’s find this, this, this is obvious, sorry, to be so simplistic. This is obvious for IESO and the European Commission, that you find those politicians that are somehow willing to, to bring these ideas, maybe sometimes only because they don’t have other ideas. Okay, so they you, you know, you, they then become important because they are those that speak for, for, you know, as I’m not saying that I speak for as I speak for patient suffering person suffering from obesity. And therefore, they then they want to come back to you and ask, listen, explain this better, because I want to be convincing when I present this in the Italian Parliament in this situation, but elsewhere. So you really need a strong collaboration with policymakers that are ready to be those that bring your voice into the panel.
Speaker 1 • 50:49
Thank you. So we have a question from Jan Sloot. Some politicians are convinced that obesity is one’s own fault. How do we convince those politicians that this is not the case?
Speaker 3 • 51:03
– This is exactly the point that I made in my introduction. Yes, while we are talking, there is many people, many lay people, but unfortunately many colleagues, medical doctors, that strongly believe that obesity is just a matter of willing power, laziness, lack of this, whatever. You can go back in some article, lay journals and scientific journals in the United States after the American Medical Association in 2013 recognized obesity as a disease. And I remember some telling obesity is the result of stupidity. This was written. I don’t remember the New York, Wall Street Journal, whatever it is. Obesity is the result of stupidity, OK? We have to convince them, and we did, bringing the data. And the data are there. We have, from animal model to clinical trials, We have all the data that show very clearly that this situation is mainly due to an evolutionary mismatch. So the genome that interact with an obesogenic society. But this is– so the key word that we use was always this is a biologic problem. So hypertension is the consequence of an alteration of the mechanism that regulate pressure. Obesity is the consequence of an alteration of the mechanism that regulate energy balance, appetite and satiety. And we, every time we repeat this, this and this and this, always in the present with the patient representative. And the battle against the stigma is over there, because the stigma is this, okay? If you go on a flight, and there is a poor person, a diseased person near you, you say, I was unlucky, but poor guy. But maybe if you don’t believe that is a disease, and you and you the flight go with a obese person, you say, I was unlucky. And this is a stupid guy, because, you know, I have to travel close to him, because it creates the problem. OK, so this is the key point. This is really the key point. So I always made all the possible examples and presented scientific data and interpreted scientific data in the sense that obesity is a biologic consequence and is not related to that. And yet, many times when I present this data to colleagues, not to policymakers. There is always the colleague can say, yes, but. Always, yes, but. And we have to really be strong in convincing all the colleagues and then the policymakers. Sometimes it seems to me that Italian policymakers are more convinced than other colleagues.
Speaker 1 • 54:31
Thank you for the answer. We have here another couple of questions, one from Filippo Gordini. I have a question about when in Italy obesity got into the chronic disease, because I found a little bit of confusion got into LEA, so the level of essential care.
Speaker 3 • 54:47
So the chronic at the end, in the chronic care model, it entered very recently, very recently means months, I don’t remember exactly, the law I remember, October the 1st, more or less there. Okay. The layer is not it’s not, it’s not included yet. Okay, it’s not included. Although it is mentioned in the in the law. So because because the fact is that the law that as I said need to be funded, I mean, you cannot make a law without the word funding. So since there were no money, the funding is little, but it’s important, you know, to put the flag, okay. The LEA translate immediately on a cost. Okay. More than the inclusion into the chronic care model. So once you approve the procedures, you know that from that point on, the national health system will give a certain amount of more money, more or less. And therefore it’s a very sensitive issue. So now we have the law, we will push again and say, listen, you have to do it sooner or later, because the law said that you have to do it. But for the moment, it’s not yet there.
Speaker 1 • 56:15
Okay, thank you. I’ll move forward because there are another couple of questions. So before we run out of time, one question is, how important is it to control for the effects of weight stigma researching the impact of obesity? And then we have an additional question, I’ll read later, but if you want to answer this first.
Speaker 3 • 56:32
Wait, stigma, I don’t know if I exactly. Stigma are everywhere, okay? There is a social stigma, there is a clinical stigma, there is a stigma toward the obesity experts, somehow. I can recall the COVID period, everybody says, okay, listen, we need to do serious things, obesity, we can wait. Then, however, obesity was the priority number one, because in the intensive care unit, there was a lot of young people coming in very bad condition. So it was evident that obesity was a key factor for having a bad COVID risk to die for COVID. So yes, I mean, we have to say but again, we when you say stigma, the stigma could be somehow justified. I’m not saying, if we knew that all the person with obesity were lazy without good power, blah, blah, blah, etc. Okay, so we say, okay, I don’t stigmatize you, but come on, eat less more. Okay, this is the key question. But you don’t say to an appetensive person, come on, be calm. Don’t eat, don’t eat salt. stay relaxed, sleep well. We don’t say that. We don’t say to the type 2 diabetics, the things that you know, we should say with the say, come on, no, no. Okay, so we reserve we not not us, the stigmatising side for a person with obesity. So the battle goes on, it’s not done. We have continuously to…
Speaker 1 • 58:43
Fight for it, yeah. Thank you. And the last question I have here in the chat is, this was discussed yesterday at Allianz-Kontland AGM conference in Glasgow. Could hypoglycemia and hyperglycemia low be progressed in Scotland linked to your good work in Italy? And this was asked by Derek Bitty.
Speaker 3 • 59:05
Sorry, Georgia, I don’t understand the hypoglycemia and hyperglycemia.
Speaker 1 • 59:08
A hypoglycemia and hyperglycemia low be progressed in Scotland linked to your good work in Italy.
Speaker 3 • 59:23
So I’m I don’t understand what hypo and hyperglycemia. Are you talking about the good work in Italy made in the diabetes field?
Speaker 1 • 59:37
I’m quite not sure I would have thought that now, I don’t know if you, Eugenia, want to take over if you have anything, but I would have interpreted this.
Speaker 2 • 59:49
I mean, I was there if OK, they’re just a low and high blood glucose, so they’re trying following low and high blood glucose. And I suppose the question is whether a law about these in Scotland could be done building up on the law that just passed in Italy. Derek, correct me if I did an interview right.
Speaker 3 • 01:00:13
Okay, I’m not able to answer this question in the sense that we in Italy, not myself, I was not involved, we have done some policymaker things that we made is the screening of type one and celiacia was in English, celiacia, celiac, celiac, celiac disease. Yeah. And this was something that was very interesting for various aspects. We don’t have a law about IPO and hyperglycemia. And if you are asking if you want to make a law, like we made the law on obesity on these other conditions? Yes, I cannot tell much because this this is not that I mean, I’m also a diabetologist, but that I don’t have any experience of this regarding a policymaker connection. So I’m not sure I got the question, but I don’t think I can answer. Sorry.
Speaker 1 • 01:01:20
Okay, thank you very much. I believe that we are, you know, Derek just specified correct. I have a 47 years type 1 diabetes and 32 years cyber research. So, I believe that was just a note he wanted to add that I’m just replying. Okay, so I believe that we are about to close our session and I’d love to take the opportunity to thank you all, to thank all the attendees, to thank professors Braccia, Eugenia and Lisa for supporting this webinar. I’d love to specify that, you know, the content of the presentation, a good description of the law, including a good description of the law, and most of all, I’d love to underline all the steps that led to it are listed and very well detailed in the publication in Obesity Fact, which is the official journal of the European Association for the Study of Obesity. So you’re going to find the timeline that Professor Sbraccia presented together with the detailed tables with all awareness initiatives organized by patients representative, as well as scientific initiatives and policy initiatives that were mentioned by Professor Sbraccia. So thank you again, thank you everybody, and I hope to see you soon at ICO and during the next webinars.
Speaker 2 • 01:02:51
Thanks everyone. Thank you. Ciao, ciao, ciao. Thank you. Ciao. Arrivederci. Ciao. Arrivederci.
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