Beyond Weight Loss: A Biology-Driven Approach to Metabolic Health – Obesity as a Systemic Disease: From Adiposity to Metabolic Dysfunction - report from EASD 2026

Uh, believe me, in this meeting, uh, obesity is everywhere.

Uh, really, um, the diabetologists now understand better what obesity is.

If you go back of 20 years, obesity was something that may interfere, uh, to the pathogenesis of type 2 diabetes, but w- was not really considered important, rather more an aesthetic problem.

Now there is a revolution.

Two revolution, actually.

The first one, what is obesity? Obesity is a chronic progressive disease, and is a disease not only because causes many complication, including type 2 diabetes, but because it's not caused by a reversible wrong choice, but is caused by genetic biological alteration of the centers that regulate intake and energy in our brain.

So this is something cannot simply be, uh, fixed up by, you know, I educate the patient, that's very important, or other things, because maintenance of the weight is extremely important, and we really need a chronic therapy.

Now, what is obesity in terms of pathology? It's characterized by an excess fat mass.

This fat mass can be sick, dysfunctional, causing cardiometabolic risk for both ectopic deposition in other organs, the liver, the pancreas, the heart, and for inflammation.

These two, lipotoxicity and inflammation, really causes all the diseases that, uh, lead to a premature death in these, uh, patients with obesity, whereas the mass, the heavy mass causes disability.

And these patients, in these patients, there is an ingre- in- increased number of years lived, uh, in disability.

The second revolution is the new venue of the GLP-1 based therapy.

Uh, you know very well what I'm talking about.

Uh, in the last, I would say, uh, 10 years, we really show advantages that do not stop, and that showed us not only that these drugs are safe and very efficacious in terms of weight loss, but also that they target the outcomes like MACE, cardiovascular disease, myocardial infarction, liver, MASH, uh, cirrhosis, uh, now even, uh, the kidney.

And you know that there is a lot of talking about the cardiorenal and the, the liver disease.

These are the diseases that really are important for us and are very important for the diabetologist.

The diabetologist should really understand both the physiopathology and the possibility to take care of these patients.

Of course, we need multidisciplinary team.

We need all the things that, uh, in fact can help managing in the long term, uh, obesity.

But certainly we should learn to use these new drugs, GLP-1 alone, dual agonist of different with GIP or glucagon, triple agonist, uh, G- GLP-1, GIP, uh, glucagon.

Um, and in this meeting, uh, interesting data came out, uh, on this, on this triple agonist, for example, but also the new orals that are now coming in many countries in terms of months, if not yet now in some.

Uh, new orals that are peculiar for various reason.

[clears throat] And we will have really, I think, a, uh, therapeutic algorithm that in one place, of course, uh, take, uh, a look and an important, uh, target of the weight loss, but really look at the comorbidities.

In this way, we could, uh, treat 360 degrees our patients, try to, uh, treat to target and treat to benefit.

This is extremely important both, uh, in diabetes, you know, treat to target HbA1c, but treat to benefit for the comorbidities, but also for obesity is the same way.

Uh, believe me, in this meeting, uh, obesity is everywhere.

Uh, really, um, the diabetologists now understand better what obesity is.

If you go back of 20 years, obesity was something that may interfere, uh, to the pathogenesis of type 2 diabetes, but w- was not really considered important, rather more an aesthetic problem.

Now there is a revolution.

Two revolution, actually.

The first one, what is obesity? Obesity is a chronic progressive disease, and is a disease not only because causes many complication, including type 2 diabetes, but because it's not caused by a reversible wrong choice, but is caused by genetic biological alteration of the centers that regulate intake and energy in our brain.

So this is something cannot simply be, uh, fixed up by, you know, I educate the patient, that's very important, or other things, because maintenance of the weight is extremely important, and we really need a chronic therapy.

Now, what is obesity in terms of pathology? It's characterized by an excess fat mass.

This fat mass can be sick, dysfunctional, causing cardiometabolic risk for both ectopic deposition in other organs, the liver, the pancreas, the heart, and for inflammation.

These two, lipotoxicity and inflammation, really causes all the diseases that, uh, lead to a premature death in these, uh, patients with obesity, whereas the mass, the heavy mass causes disability.

And these patients, in these patients, there is an ingre- in- increased number of years lived, uh, in disability.

The second revolution is the new venue of the GLP-1 based therapy.

Uh, you know very well what I'm talking about.

Uh, in the last, I would say, uh, 10 years, we really show advantages that do not stop, and that showed us not only that these drugs are safe and very efficacious in terms of weight loss, but also that they target the outcomes like MACE, cardiovascular disease, myocardial infarction, liver, MASH, uh, cirrhosis, uh, now even, uh, the kidney.

And you know that there is a lot of talking about the cardiorenal and the, the liver disease.

These are the diseases that really are important for us and are very important for the diabetologist.

The diabetologist should really understand both the physiopathology and the possibility to take care of these patients.

Of course, we need multidisciplinary team.

We need all the things that, uh, in fact can help managing in the long term, uh, obesity.

But certainly we should learn to use these new drugs, GLP-1 alone, dual agonist of different with GIP or glucagon, triple agonist, uh, G- GLP-1, GIP, uh, glucagon.

Um, and in this meeting, uh, interesting data came out, uh, on this, on this triple agonist, for example, but also the new orals that are now coming in many countries in terms of months, if not yet now in some.

Uh, new orals that are peculiar for various reason.

[clears throat] And we will have really, I think, a, uh, therapeutic algorithm that in one place, of course, uh, take, uh, a look and an important, uh, target of the weight loss, but really look at the comorbidities.

In this way, we could, uh, treat 360 degrees our patients, try to, uh, treat to target and treat to benefit.

This is extremely important both, uh, in diabetes, you know, treat to target HbA1c, but treat to benefit for the comorbidities, but also for obesity is the same way.