People living with obesity are urged to seek treatment

Good morning, everyone.

We’re here with Professor Gerhard Prager to discuss obesity and medical and surgical management of it.

My name is Andrew Jenkinson.

I’m a consultant bariatric surgeon at UCLH in London and author of Why We Eat Too Much.

This conversation is encouraged by worldobesityday.ae.

We’re trying to raise the awareness of obesity treatments.

So Gerhard, if you could just introduce yourself first to the audience. – Thank you, Andrew.

Yeah, my name is Gerhard Prager.

I’m a professor of metabolic and bariatric surgery at the Medical University of Vienna.

And I’m the immediate past president of IFSO World and the past president of IFSO European Chapter.

I myself am a metabolic and bariatric surgeon and heavily involved in that field, of course.

And it’s my big pleasure to be here with you today and to discuss with Andrew, who is an absolute expert in the field, the treatment modalities and options we have in to treat obesity. – Yeah.

So I think patients are sort of concerned about various different aspects of treatment and whether treatment works and whether they should be really trying to calorie restrict and diet and go to the gym and things.

In my view, those things, those interventions tend not to work very well, But, you know, our interventions that we can offer, medical and surgical intervention, particularly the new drugs and the new types of surgery as well, are really evolving.

What are your thoughts about current treatments and outcomes and safety for patients, Gerhard?

Thank you.

This is, of course, an excellent question.

With the new drugs, we have new options in the treatment of obesity.

And this gives us, of course, more and more opportunities.

I think that the longest data we face now from OMMs, obesity management medications, is up to four years.

And what we can see is that they work.

They do not work in all patients.

And this is maybe also one of the beautiful things we can offer different patients, different treatment options.

And I think we have to rethink the disease obesity.

It’s in my mind, more comparable to cancer.

So having different treatment options, we have a staged approach to the disease, which means you might start with something that is dieting or changing your eating behaviour, exercising, and then you scale up to obesity management medications.

And of course, surgery is not the first treatment options for everybody, but maybe for patients with extremer forms of obesity, like stage four, stage five obesity.

Yeah, I think it depends on, as you say, the degree of obesity and whether, you know, someone’s suffering with other metabolic problems, diabetes, high blood pressure, high cholesterol, they’re giving them cardiac risk.

So yeah, I think, you know, for someone who’s really suffering, you know, quite badly with a high body mass index, and maybe diabetes, what type of operations are effective, and what’s their safety profile go hard.

Overall, surgery is extreme, bariatric surgery is extremely safe.

This has been proven over and over again.

So people really don’t have to be afraid.

If you surgeons apply enhanced recovery protocols, patient stands up within 60 minutes after the operation and can leave the hospital within 24 hours.

So surgery is extremely safe.

What are the best studied types of surgery?

It is clearly sleeve gastrectomy and Roux-en-Y gastric bypass, followed by one anastomosis gastric bypass.

And there is now a new kit on the block that is the SADIS that shows very promising results, especially for very high BMI patients.

But we clearly have the best long-term data on Roux-en-Y gastric bypass.

Yeah, and I think for the viewers who may not be, you know, offe with the various different nuances of the different types of operations, they’re all keyhole surgeries.

So small cuts, operations take about an hour, an hour and a half under anesthetic.

You stay in hospital one night, some units actually send people home to a sort of local hotel or something.

And, you know, if you worked in the office, you don’t need to really take a week off.

If you’re working from home, you can literally take two or three days off.

So recovery is amazing.

And just to put it into perspective, I mean, I think probably on average, my patients are around about, you know, 120, 130 kilograms, and I’m sure you would concur with that guard, these people will go down and reset their weight to around 75 kilograms within a year of surgery.

And it’s not like you feel after you had lost that weight, for instance, by dieting where you’re constantly craving food, it feels really natural for the patient, they’re a different person and the struggle is gone.

There’s a lot of sort of prejudice against obesity and it sort of not being recognized as a disease but I think there was some interesting developments published in the Lancet recently Gerhard, could you just expand on that?

Yeah the Lancet commission came out with a new definition of obesity differentiating between preclinical obesity where you have no harm or disadvantages to the excessive fat accumulation and clinical obesity that clearly states that it is an illness, which means you have some disadvantages from that excessive fat accumulation.

This can be of course like diabetes, joint problems, also psychological problems or being short of breath when exercising.

So it depends very much on the individual.

And I think this is a very important step in the right direction to recognize obesity as a disease and giving more and more patients access to treatment.

And this is the crucial point.

This does not mean only surgery.

I think we have to rethink the whole concept of treating obesity by different treatment modalities and give our patients access to all the options.

Yeah, I mean, I agree.

This is the crucial part is, you know, recognizing for governments and even actually doctors, because we know we’re not properly taught about obesity in medical school even now, to recognise that obesity is a metabolic condition caused by dietary and lifestyle measures, not caused by a certain population greed or laziness.

And I think there is an increased understanding that it’s the metabolic effect of processed and sugary food and snacking, it’s the effects that has on blocking our natural weight regulation pathways that causes a disease of obesity.

And we know some people can, you know, and it’s very heterogeneous, people are very different.

So some people can eat rubbish all the time and, you know, stay in bed and not put weight on.

But others can’t, you know, it tends to be very familial.

And I think this recognition of it as a metabolic disease, and a disease just like cancer, is very beneficial, whether that will come through into the mainstream thinking or not, is another conversation.

Now obviously the press and media are very very interested in the new weight loss drugs.

My experience is people are very interested in it, some people tolerate them very well, some people don’t, people are worried about the side effects and the risks of these procedures.

What’s your experiences on those Gerhard?

Number one, the availability is not entirely given.

Some of the drugs are available, others are not.

They still cost a lot, so not everybody can afford it and our public health care system does not cover it at the moment.

Furthermore, when you look at real world data, but first one has to say that these new medications work quite well under study conditions, but when you look at real world data, more than 50% of people taking these drugs stop within one year.

And this of course can have different reasons. and you mentioned already side effects.

A lot of patients are pretty much constipated and feel that, of course, you have to take care of that.

So I think one has not to be worried about side effects like possibilities of cancer.

There are really good data now that these medications are very safe.

The question is, of course, how long do they work?

And you need to take them lifelong.

When you stop taking them, we see that you regain weight.

And another important thing is when you lose quite a big amount of weight, you lose or you are in danger to lose muscle mass, lean body mass.

It’s the same when you have an operation.

We as surgeons take a lot of care for that.

We encourage our patients to take a lot of proteins, to exercise and to think our colleagues from the internal departments really must encourage the patients that take these drugs also to have an higher protein intake to minimize the lean body mass loss. – And then I think a big study from America showed that within a year of coming off the drugs, people would put on at least two thirds of the weight.

Now, I think, you know, if you look at two years, people are going to be heavier than they were before the medication.

The other slightly worrying thing is that when you regain the weight, you tend to regain it centrally, which is a much more visceral fat, that dangerous fat, we all know causes diabetes and things.

I think also, I mean, what’s your experience, some people, you know, after some types of bariatric surgery can start to regain weight.

And I think they’re They’re good agents, aren’t they, for those people? – Yeah, we had an IFSO World Consensus Conference with the opinion leaders and researchers and experts from internists’ side in the field.

And we came out with a clear recommendation.

When you have a recurrent weight gain, and it’s of course more likely to have that after sleeve gastrectomy compared to Rheumagastic bypass, in the first attempt, you should use the new OMMs.

And the studies we have now show that you can lose two thirds of the regained weight using the new OMMs.

So it’s definitely worth to give that a try.

I think once more, these new drugs add our possibilities, our armamentarium to treat obesity.

Definitely true. – Yeah, I mean, I think the drugs, they definitely work for a large proportion of people, but I think they should be used to smart way.

So people shouldn’t go on them thinking they’re gonna be on them for years.

You should probably go on them with a view to using them to help with a sort of weight reset and a habit reset.

You know, a lot of people can’t change their habits because you know, appetite and ingrained behaviors, very difficult to change.

But if you have a drug where your appetite is just taken away and switched off in your brain, then it’s much more easy, for instance, to stop mindless eating in the evening, which a lot of people have difficulty stopping.

So I think it’s the smart way.

My project, mymetabology.com is looking into this, so how to use them the smart way.

And I think that increasingly will be the way that we’re encouraged to use them. – With metabolic surgery, we of course change a lot of these hormones, satiety, hunger factors, as you know.

And the interesting thing is that these drugs work at least as good as without an operation after the operation.

So it does not seem to have a big influence if you have had an operation on how these drugs works.

And I think this is another very interesting finding that we do not completely understand currently. – Yes, yeah, exactly.

I think probably we’re running out of time, Gerhard.

It’s always a really good pleasure to see you.

You’ve done great work for IFSO and for the scientific progression of the understanding of obesity.

Have you got any final things you wanna say for people watching this who are suffering or living with obesity for World Obesity Day.

I think we have in 2025 more options to treat this disease than ever.

And people should really look for this help, for this treatment.

The platform ECPO gives, of course, wonderful possibilities and access to experts that can treat the disease.

And I encourage people suffering from obesity to look for treatment.

And I think you do a wonderful work with your book, with your content in social media to help people to get a treatment of the disease.

Thank you Gerhard, it’s a pleasure.

I will probably see you in, I think it’s Venice this year, isn’t it?

Venice, it’s the European IFSO Chapter Congress and we expect more than 1000 participants.

So I’m very excited about that and I’m looking forward to see you there.

Good.

Have a great day ahead.

Thank you.

You too.

Bye bye.

Hello and welcome to this year’s patient lounge for World Obesity Day in 2025.

Now, my name is Vicky Mooney and I’m going to be your host for the next hour.

And I’m a patient with obesity and other chronic diseases, but I’m also the executive director for ECPO, which actually have the best team on the planet, I would say.

And it’s a big hello from all of them who are incredibly busy at the moment today, beavering away in different countries and different organisations and at different events for World Obesity Day.

Now why is it important for us to actually be this busy?

And why is it important that you stay with us for this next hour and watch our patient lounge?

Well, we need to increase the awareness of obesity as a chronic disease.

And we need to ignite the urgent action across Europe on that.

We need to mobilise and amplify those tremendous voices of patient advocates from the obesity community and the caregiver community and the NCD, the non-communicable disease community.

We need to amplify them across Europe.

We need to give them their voice, their time, their platform.

We also need to drive for robust policy action.

And when I say robust, I mean, we want action as patients.

We don’t just want, yes, obesity is a chronic disease.

There’s our little fantastic plaque.

We want to see it, as Suzy would say, actioned in the health care system.

We want to see the waiting lists go down.

We want to see the treatment actually brought in, the management plans.

We want to see more obesity management clinics across Europe.

We want to see waiting times cut down.

We want to see reimbursement.

We want to see all of that.

We may be asking for a lot, but we deserve it.

We also, of course, want to eradicate weight bias and stigma and discrimination, which is very prominent, unfortunately, still this day and age in our policies, our healthcare systems, within families and communities, and unfortunately is still acceptable as a narrative within society.

So really and truly, you don’t have to listen to me for the next hour.

You’ll be happy to know because what we have coming up is on your screen right now.

And you’ll see that we are focusing on the World Obesity Federation’s changing systems and healthier lives by addressing obesity together.

Now, how are we going to do that?

We’ve got a number of segments.

I’m really excited about it because we have the importance of the book for education and awareness of obesity as a disease, which is “Mom, what is obesity?”

And joining us, we will have mom and patient Bernadette from Ireland, but we’ll also have Ruth, who is one of our fantastic healthcare professionals and also a patient from Iceland.

We will listen to one of the authors of the book, Martha, who is 18 years old from Portugal, and she will share some of her thoughts with Constantine, who is our youth leader in Bulgaria and a patient himself.

So we’ll get an insight into that younger generation and what their thoughts and experiences are.

I’m 47.

My experiences are very different to what Marta’s are at 18, or are they?

So we can delve into that.

And then we will move on to policy change.

Now, Brussels last year, and the parliament and the commission, when it came to Earl of Beesley Day, it was very quiet.

Very.

It’s like tumbleweed quiet.

So what we’re doing today is very, very different.

And I’m going to give you an insight into the event that is going on later today, hosted by MEP Castillo and Iazzo, and inclusive of the patient community where a number of myself and my colleagues actually are now.

And it’s very, very exciting for us to have this step up in this platform and our voices heard.

Now, why is that actually important?

Well, I think the great thing about this is that you’re going to hear from Jamie from the Netherlands, who’s about 30 years old, and Sven from Iceland, who’s 18 years old, talking about their experiences with obesity.

And that is going to highlight what that policy change can actually impact for those generations going forward and what that treatment can actually do. and you’ll see that yourselves in their recording.

What else do we need?

We need to talk about treatment.

How do we talk about treatment?

Well, hey, we got some of the best speakers from the surgical community, from the IAASO community and patients, of course, sharing on the various different treatments that are available for obesity.

Now we have Dr.

Gerhard, I call him Gerhard, but I will say officially Dr.

Gerhard Prager, and he is interviewed by Dr.

Andrew Jenkinson, who is the lead for “Obesity, The Big Truth”, has written a number of books, and they’re both in the surgical community, and they’ll have a conversation around that.

But then we have Susie Burney, who is my arm and arm girl in ECPO.

And Susie actually had a really exceptional conversation with Jason Halford on the pharmacotherapy, which is a hot topic at the moment, right?

Everybody is talking about weight loss drugs, as they call them, or skinny jabs, as they’ve been named.

Here in ECPO, we call them obesity management medications, because it’s not just about the weight, it’s about everything that’s involved in obesity.

So Susie has a great conversation going on with Jason on that, and then to wrap it up to ensure that we’re inclusive of all of the treatments and the management of obesity, we have Ken Clare sharing his thoughts as well.

And then we will move on to how we’re driving awareness and education today.

What’s happening in Europe?

So you’ll get insights from various countries across Europe where they will share for a few seconds what’s going on, whether it is a launch of the book, “Mom, What is Obesity?”

in Icelandic, whether it is NCD awareness over in Slovakia or Romania, whether it’s in-person events in Germany, what’s going on in Portugal, what’s taking place in France, what are colleagues of the Nordic countries doing?

So you’re gonna see all of that and we’ll hear obviously from some of the presidents as well just to give us a little bit of an oomph for Royal OBC Day ’cause it is an amazingly busy day.

Now, in order to get in touch, we need you to use the hashtags that are appearing on your screen right now.

I’m not going to name them because I will actually name them incorrectly because there’s three of them.

But it’s really important that you actually use those hashtags so the team can pick up your comments, re-share them, the activities that you’re doing, re-share those, let’s really and truly like come together and drive change today.

Make an impact, make a statement, okay?

So you can do that across all of the social media platforms.

If you want to watch this back, you can of course, It will be available on our websites and our social media channels as we are recording it, of course.

And you can also join us in actually thanking those who support eCPO as partners.

And you can see all of our partners on the screen there.

Without them, we would not actually be able to do these productions.

We would not be able to support our team here in Brussels and activities across Europe.

So please, please, please join us in thanking them.

Right, so let’s get to it.

First up, as I said, we are talking about the book, “Mum, What is Obesity?”

And this is quite personal for me, because in the book, the young girl was actually named Mia, and that was named after my daughter, Mia, my young daughter, Mia, who’s 18 this year.

So let’s have a listen to what Bernadette and Ruth had to share and talk about as Ireland and Iceland launched a book, Mum, What is Obesity, in their native languages.

Hi, Bernadette, how are you?

I’m fine, Ruth.

How are you?

I’m great.

Thank you.

I wanted to ask you about the book, Mum, What is Obesity?

Yeah, we had our launch last night.

We officially launched the book in English for Ireland, but also in the Irish language, which is great because it can reach places in Ireland that kind of not all English books would reach.

But the importance about this is the fact that it teaches parents, it teaches children what they live with.

I think so too.

And also to open the conversation about obesity as a chronic disease and for healthcare professionals to have something that they can, you know, use to open the dialogue.

And also for parents to talk with their children, that it’s not their fault.

It’s nothing that they have to be ashamed about.

But it’s a disease that can be treated and has to be treated.

So I think it’s really important to have it in our, in Icelandic for, you know, if many people you know read and speak English but it’s not our first language so I think it’s really important that also children can read the book but also with their you know parents and healthcare providers so I think it’s you know good for nurses in school and you know family doctors And everybody to have a book.

I’m lucky I have a GP who’s very understanding and who’s always seeking information from me, like leaflets that we would produce, magazines that we produce.

So this book is going to be so good for him, but also for the rest of the doctors in the practice who may not be as understanding as he is.

And that’s why, as I said, with the launch, it’s so important for us to have stakeholders from across the board, the healthcare professionals, the ones who understand obesity, you know, and those who are coming to that understanding, who are now learning because of the science that we now know.

And that brings it back to the book.

I mean, obviously, the book is aimed at young children.

So it’s not scientific, but without it being scientific, it does get across the point of what this child may live with, you know, and why they shouldn’t be made one of them’s in-school, why they shouldn’t be stigmatized because of the shape of their body.

I think this book is really good to open a conversation, as I mentioned before, and I would have loved this book to have been when I was a child.

Ruth, I agree with you.

The same, like when I was a child, it was my fault.

It was my mom’s fault.

It was, you know, so the link was there and having a book like this, I think it just makes it so much easier for anybody to realize that they live with something like they may live with asthma, like they may live with psoriasis, you know, that it’s a medical issue which needs medical treatment.

And a chronic disease.

The disease is nothing is saying what they are.

They are person first.

It’s something they have, not that they are.

Absolutely.

That’s why the language is so important as well.

And especially when you’re talking to a child, if you can teach them at a young age, the correct language to use surrounding a disease that they live with, it makes it easier going forward to not accept being stigmatized, even in healthcare settings.

If they understand what they have, then it does kind of improve, hopefully, how people will address them.

Yeah, I think it can help, you know, to reduce stigma and bias and more people can learn about what obesity is, that it is a disease.

Yeah, I agree.

There’s still so much out there in the media where people believe the wrong things about this disease because we’re taught the wrong things and quite often by, I don’t know, health and fitness because, you know, it’s a financial issue.

Whereas obesity is different and obesity is an actual disease.

And I think that’s where we need to improve how the media would address these issues, even down to the images that they would would use, like a picture of a child in an ill-fitting outfit.

It’s so sad to see that in this day and age, when that child doesn’t have a choice of what they live with.

And that’s why, as I said, this book, again, is so important.

And to get it into schools, to get it into healthcare settings.

This is not just about launching the book, Us, Last Night, You, Today.

OK.

No.

Yeah.

It’s not just about launching and then letting it be.

This is about carrying it forward so that people will learn from it.

And we can open the conversation.

Exactly and the more people talk about things, I think the less stigmatized they become.

And especially if we all use certain wording around it, I think then it becomes habit for other people as they hear that or as they read it.

And we do know there are parents out there that may not be like us, that may not have lived with obesity as a child or may not to this day.

And they need to understand as well what their child is.

Yes.

Rather, again, than thinking that it’s their child’s fault or that it’s their fault.

Yeah, as parents.

Yeah.

And I think that’s why the book could encourage that kind of parent to bring their child to seek medical care as well.

Yeah.

So, I’m looking forward to see what book and that everybody reads it.

Many people?

I’m sure your launch will go as well as ours did last night.

It was a wonderful night for everybody.

So, the best of luck with your launch.

Thank you.

And good to hear from you.

Well, a huge thank you to Bernadette and Ruth for their insights, their conversation.

I was at the Irish book launch myself last night, and I can tell you now that seeing the lead of the HSE, Dawn Lauscha, seeing the junior minister for health, seeing the ASOI community, the patient community, all of these vital and key people in the community that we need, Dr.

Stuart Flint, It was just remarkable to see that many people turned up to support the book launch in Ireland.

So to colleagues in Reykjavik and in Iceland, Solveig, who was our past president, I wish you all the very best.

Ruth, thank you so much, and enjoy your book launch, and I hope it goes as successfully as the Irish one did.

Now, this book would not be here with us without Marta, who is one of our youths, and a tremendous advocate for obesity with her own voice at only 18 years of age.

So let’s have a listen to Constantine and Marta and their conversation. – Guys, this is Constantine and by my side, I’m joined by one of my guests from the Voice of Youth podcast, Marta. – Hi, I’m Marta.

I’m 18 and I’m here to share my experience. – Talking about sharing your experience of living with obesity with other people, How do you think obesity affected you and when do you think it all started for you?

I’ve always kind of like been aware of obesity in my life because from a pretty young age I was around the Portuguese Association, APCOE, and my maternal grandma she dealt with it during her life so I was always aware of what it was but personally when I realized it was also was something I dealt with.

It was about like first grade, second grade, I’m not quite sure.

I used to be a pretty active kid and I don’t know, some friends just started asking me like “Oh, like can you run as fast?

Can you do this?

Can you do that?”

And I was like “Yeah, why are you asking me that?”

And then I just, you know, I just kind of started carrying those doubts in me and started noticing that maybe I was a bit different from the rest and yeah, then I started associating things and that’s I think when I first realized there was something I was dealing with as well.

Yeah, I’ve noticed that school is a huge part because you notice the difference between you and your friends, classmates, etc.

And that was it for me as well actually.

So school was the time that I started to notice that I was different but the realization of “oh wait, I really need to do something” for me came through probably in high school, so during teenage years.

So as we discussed self-realization and the influence of going to school at a young age and seeing the differences, this is a very important place for the parents to step in, in my opinion.

So from my personal experiences I always had the support of my parents and they were always pushing me to to do better, to exercise, to do physical activities, to eat better and to find opportunities for me to deal with this possible issue at this point because we were not really certain if it was going to be an issue dealing with obesity.

But I always had the support, so it’s interesting your perspective on that topic. – I will say it’s kind of a tough topic for me because my family was always supportive the sense that they wanted me to get better and you know eat better, exercise, I always have that support from them.

But there was also a lot of weight bias and stigma involved, you know, it was very internalized.

And so it was kind of a mix of that, you know, like they were trying to do their best, but it did come with a lot of stigma and bias, which also I ended up internalizing a bit, which didn’t really help.

But overall, they were very supportive, they were doing their best.

That totally makes sense and I’ve noticed it myself.

I really don’t comment much on it because I’ve came to acceptance.

I’ve accepted it, you know, I was like, you have to just deal with it.

It’s their generation, it’s their opinion and their way of functioning.

And I think we’re moving away from it, which is good.

No, yeah, I’ve accepted it and I’ve always realized it wasn’t malicious.

Yeah, it was, it came from a good place, you know, they were doing their best.

They were just, they didn’t really know how to deal with it.

Exactly.

That’s why we are here to provide some answers and support.

So Marta, how do you think that obesity impacted you?

Like your total, your total image of yourself, your total idea of who you actually are?

And do you think it shaped you in any sort of way?

Definitely.

Yeah.

I’ve always been a very insecure person because I was very insecure about how I looked.

And so I was just like, I was like, I didn’t want to be perceived, you know, I didn’t want people to notice me.

I became very anxious about being noticed by any other people.

And yeah, it’s just, I was very conscious of how I looked, of how I presented myself that ended up revealing itself also in school.

I didn’t like doing presentations in front of the class because that would mean people would be looking at me.

I didn’t want that.

In PE class, I had a lot of anxiety around it because not only could I not do the things, I didn’t like to do the things.

And people were looking at me and I felt judged, which probably wasn’t happening as much as I thought it was, but I felt really judged.

And I think only in the recent years have I finally started to come out a bit of that ideology. – You think that people care more than they actually do. – Yeah, yeah. – In that way. – Yeah, it did lead me to developing a lot of anxiety about everything because of that.

So yeah, what about you? – So for me, much of the same.

Honestly, it’s obesity shapes the way you think even if you believe that you have dealt with it.

So let’s say that you’re no longer considered to be living with obesity or no longer perceive yourself that way and others no longer perceive you in that way.

But the mentality of it still sticks with you.

So the way that you think it’s already pre-shaped and there’s no changing that.

And as you’ve said, anxiety will follow you.

At this point I think I’ve dealt with it completely.

I have grown out of the mentality of worrying about how others perceive me.

I have…

I think it just took some time to grow up honestly.

And you start to definitely feel comfortable in your own skin to accept yourself and that confidence just builds up and it builds up and it builds up and at a certain point you no longer care.

But even once you no longer care, certain habits that you used to have are still persistent.

So you still think about eating in front of others, for example.

And you are always feeling shameful when you’re growing up with obesity to eat in front of others because, you know, everyone is going to point a finger at you and laugh at you. – I really care about, and I feel like some of my friends don’t really care about it as much as like clothes.

‘Cause for a long time, I wasn’t really able to wear what my friends were wearing or wear it the same way.

And I still think about that a lot.

Even like when I go shopping, I still think like, oh, I really like those jeans.

Maybe it won’t work out.

And I’m like, no, wait, but maybe now it will.

It’s still something that like really affects me, clothing. – Yeah, clothing was a big part of it.

I always remember growing up, for example, there were always some trends in school, in high school, for example, the way, a certain way that people dress, and it’s just what’s trendy at the moment.

And I remember not being able to fit in those clothes.

Like my parents, for example, they would want to purchase them for me, but I could not fit inside them.

I could never find good jeans.

I could never find nice jackets or whatever.

And it was always, for me, for example, to buy pants, it was always about what will fit me.

And it was never about what I will like.

So leading forward a couple of years when I lost like 90 kilos, and it was when I first started working ’cause we were making my own money, I was spending so much money on clothes because for the first time in my life, I could actually fit into everything.

So I started choosing what to buy and what not to.

That makes a lot of sense.

Yeah.

Now that I’m in uni, I get a monthly allowance.

I do sometimes go shopping.

I approve.

Okay, so whenever we discuss living with obesity and the way that we manage it, the way that we find our answers, we always have to speak about our interactions with HCPs.

So how has your opinion on HCPs changed throughout the years?

Has it changed and how would you rate your interactions with the doctors?

I will say I never had much medical help, but I also didn’t really seek it because when I was like really young, you know, I had my pediatrician and he was a great man, but then he had cancer and he died, and his successor, I had a few appointments with her, and you know, they took my BMI and all of that, and it was always like over the ideal value, but the only answer my parents got, because you know, they were just like “oh okay, so maybe we should deal with this, what can we do?”

and they were like “oh, she’s really young, she’ll grow into it, she’ll be fine, don’t worry about it, you’re worrying too much.”

And so I think that also kind of discouraged them from seeking medical help because it was just like, they’re not doing anything, I’m not getting any answers, I’ll try something else.

So they kind of like, I’m not going to say they gave up on doctors, but it was just not something that was very present in my life.

And also on my mom’s side of the family, we have three nurses, so two of her brothers and one of their wives.

And they also told her like, not, they were just like, “Oh, I think you’re worrying a bit too much.

You know, maybe, maybe that’s, that’s putting a lot of pressure on the situation.

Don’t worry about it so much, like, she’ll be fine.”

Not like, not dismissing her completely, but also trying to like, ease her worries a bit.

To re-insure her.

Yeah, exactly.

And so I never really had much medical help in that sense.

I did go to a nutritionist for about two years and she was lovely, lovely woman.

She helped me a lot.

And throughout all these years I always did have like psychological help.

So I don’t really have much of an opinion because I didn’t have much of an experience.

And the one that I did have was very unhelpful.

Okay, but one thing I find interesting here is that you say that you never really seeked medical assistance.

Do you believe that you or your parents were responsible in the first place to search for it?

I think so.

I think it was, it would have probably helped, but I’m not sure that in Portugal the resources existed to actually get the help.

Okay, that’s an entirely other issue and topic but the problem here in what you say in my opinion is that you are you think that you were responsible to seek help or your parents were responsible for it I think it’s a you don’t the minor in this case the adolescent is never responsible to seek a healthcare professionals help the responsibility I I believe is shared between your parents and the HCPs.

So I think that they are the ones who should recommend solutions to you.

They’re the ones who should approach you in a, obviously the correct way to do it, in a nice and non-shameful way, obviously, but you were never responsible for that.

And this is the self-blame that we always discuss.

And you’re still not out of that mentality, which is crazy after all this time.

It was never your fault.

It was never your responsibility.

And yeah, it’s a shared responsibility in my opinion.

And in my personal journey, I was also never approached by a healthcare professional, by my GP or whoever in a professional setting or manner with and given some advice or solutions.

I was always told that, oh, he’s going to grow into it.

He’ll, he just needs some exercise or whatever.

Those were not solutions.

But as you say, at that point in Bulgaria, I don’t think that people had much other options.

There were no solutions.

There are still in many cases, not enough solutions for the people.

But yeah, we are aiming to change that and to strive for better.

So when we’re talking about that, what would you like to see change?

For example, not only in Portugal, but on European level, let’s discuss it that way.

As far as programs, as far as possibilities, as far as solutions for people who are struggling with the same stuff we did back then. – Well, I think there should be more available information.

Like readily, ’cause when you go to the pediatrician, for example, you usually have like outside those little pamphlets and they have like different topics, you know, maybe sometimes like diabetes, I don’t know, like chickenpox, just stuff that kids might go through, you know, and the parents might need that information. – There’s never one for obesity. – I’ve never seen one for obesity.

So I think like that information being more available would help and also you know the the fact that it is a chronic disease and you know just not it yeah it’s a chronic disease it’s not just a choice because i feel like a lot of people still think it’s a choice it’s just about what you’re eating your diet and everything and i also think that mentality change in society and in doctors would help a lot yeah i totally agree in my opinion we definitely because in some countries it’s obviously already recognized as a disease but you’re further you’re one step ahead on that in Portugal but in most countries obesity is still not recognized as a disease and even if you if we wanted to make any step in the right direction this is our first goal and our first absolutely necessity that we have to deal with Because you say that people still believe that overweight and obesity is a choice How can it be a choice like if you ask yourself this question?

No one would ever choose to live with what we’ve had to live with no one would make that decision ever in any Situation no one is going to do that to themself.

So if no person ever Is going to make that choice.

How can we still believe that it’s a choice?

Yeah, but something that I think is also like, for example, when kids start showing signs of obesity, their parents don’t have the information, so they will just think, “Oh, maybe it’s what we’re feeding her, like we’re feeding the kid.

We need to change the kid’s diet.

They need to be more active and everything.”

And since they don’t know it’s a chronic disease and not just a lifestyle choice, because that is what society has told us, they don’t also know how to, you know, find information, seek some sort of help, that type of stuff.

Yeah, definitely.

I totally agree.

Finding the correct information currently, it’s the biggest problem because we have sources that are not being verified.

We have widely available information on the internet that’s actually wrong, that we have official researchers that prove that it’s wrong, but again it’s about clicks, it’s about what gets pushed and what collects the most views.

And currently the information that collects the most views is not the right information.

But we are moving once again, we’re taking the right steps and we’re promoting the correct studies, we’re promoting the correct information.

And I believe that in a couple years, parents will have access to more than they ever did.

And they should be our main focus of people to influence and to show that there are multiple factors in the issues with living with obesity for their children.

And continuing on our conversation about finding the correct information and not knowing where to look or what to do, where to start.

So here we can definitely promote eCPO’s website, the European Coalition for People Living with Obesity.

You will find some much needed information over there.

You will also find the podcast that we do and there are many episodes where you guys are actually the youths are giving advice on what you needed on what you would have liked changed and yeah just some generally good information also can be found on a Azos website.

There are many independent studies that are not influenced by big companies by other people’s interest and there are publications that share the many aspects of obesity and how you can help.

Maybe one final advice from you to someone who might be in your shoes currently and who might be struggling.

Well I think that anyone that’s you know struggling with you know dealing with it and how they see this helps and everything just you know it’ll be better you know you’re in a dark place right now, you’ll be fine.

Don’t give up and you know, like don’t, it’s not that deep, don’t focus so much on it.

There’s other stuff in life that’s better to focus on.

I think. – Definitely, don’t let a disease shape the person that you actually are. – Yeah, yeah, you have a whole personality, a whole mentality, just find other stuff to focus on. – Find other stuff to focus on and also make sure to make your own judgment, to do your own research, to find the correct people around you and to make informed decisions.

Don’t just make a decision for your future based on something you’ve read on the internet or something you’ve heard.

Make your own research and informed decisions and yeah. – Yeah. – Take care of yourself. – Welcome back and I can tell you now that I would not have had a voice like that when I was Constantine or Marta’s, especially Marta’s age.

So kudos to both of them for just being tremendous advocates for themselves and for generations to come.

And thank you to Marta for the work that she’s done on the book.

And just seeing that roll out across Europe is quite fantastic.

Now we are talking about, we’re moving on, and we’re talking about, well, what do we need to see change?

We have some awareness with the book.

We have some advocacy efforts going on, but where is the opportunity to drive this at a different level?

And that is where we have this MEP hosted event by MEP Castillo and Eazo in the parliament today.

This event is going to be very high level.

You can see the agenda there, it’s MEP hosted, and it’s going to be what I hope a step in the right direction for all of us.

We hope we’ll create the momentum we need, but what does that treatment and management in the healthcare system look like?

How does it actually affect patients?

And this is where I think it’s really important that we will obviously feedback later on how the event went, but that you hear from and listen to the conversation that Jamie and Sven had.

Now, Jamie is from Netherlands.

He works with the NVOO group there, and he is 30 years old and just a tremendous and gorgeous advocate of a person for obesity.

And he had a great conversation with Sven in Iceland, who’s 18 years old and received treatment for obesity and had great success as a teenager, which is very, very rare.

So let’s have a listen to what the conversation went like and let’s hope that we see more of that after this policy event. – My name is Jamie Wiefeltjes.

I’m 30 years old from the Netherlands.

I’m a board member for the Dutch Association for People with Overweight and Obesity.

I am a patient or someone who has obesity himself. – My name is Sveet and I’m from Iceland.

I am 18 years old. – Ever since I was a baby, I’ve always been heavy.

When I was five years old, my doctor said that I was obese.

So that’s a label that I’ve been carrying all of my life.

And in a way that also made things difficult of like for one part my mom, she was really always concerned about my weight.

So, uh, she always tried to maintain a healthy weight, but then when I got into puberty, um, and I had more opportunities, uh, yeah, it’s sort of just, uh, spiraled to in the wrong direction, uh, which made me gain a lot of weight.

I, when I was a kid and used to be on a certain level and I was always bigger than the rest.

You know, when I started until now, it has been, you know, just a little more than two years.

And how much weight did you lose in about those two years?

I’ve lost like 55 kilos. 55 kilos.

Yeah, that’s different for me.

When I was younger, I always got a lot of negative comments from people all around me and it really stuck by me.

So even now, I’m 30 now and I still get the feeling that I take up too much space in a room.

Like when I go out for drinks with friends and it’s a busy club or whatever, I’m not comfortable.

Because then I would feel that I would be too big for the space, even if it’s not True, I’m starting to get more comfortable, but yeah, I’m not there where you are.

You know, I took the bullying to motivate me to keep going.

I just proved them wrong.

Well, you did.

What do you see for your future?

Like, because now you’re using the medicine, and how do you portray that into the future?

I know just for a fact that if I would quit those medicines, I stopped taking them, I would gain some weight.

But like with obesity being a disease, for me, losing weight and staying a healthy weight and all those things, it’s a lifelong burden, sort of.

It’s also something that’s part of me, part of who I am.

What do you want to do with the story you have and the things that you’ve been through as a person?

I really want to inspire young people.

Yeah, well for me, it’s sort of the same.

I want to help people, make them feel that they’re not alone.

And that their struggle is not just their struggle and the things that they feel that they are allowed to feel those things and that if they are said that they are Struggling with weight loss or with their feces or with all the diseases that come with it that it’s not their fault because a lot of times People will hear that it’s oh you need to exercise more you need to eat less and then everything will be fine But it’s most of the times there can be so many different things that play parts in it, like medicine use or anything else.

So what I really want to do is inspire people and be their like listening partner in a way and making them feel that so that they don’t feel alone.

Yeah I want to use that to really help all those people and there’s a lot of those people.

So if I would have to give advice to people who are living with obesity, it will be that it’s okay to not be okay.

And it’s okay to feel stuck at some point.

But it’s the drive inside of you that you need to use to speak up and go to your general practitioner or go to your doctor or maybe to a friend or to someone and make them a part of your story and make them a part of your struggle.

You don’t have to carry the world on your shoulders and make people a part of this so that you get the help that you deserve.

Vine is really simple.

It’s just never give up.

So welcome back and a huge, massive thank you to Jamie and Sven for their conversation.

I truly hope that inspires people to get behind World OBC Day and advocate for that treatment and management that we need.

And just listening to the conversation between the guys, it just, it inspires me so much.

They are tremendous advocates.

They are wonderful human beings and I am so happy and grateful that they are part of our obesity community.

Now keep using, one thing I will say, keep using, please keep using all of the hashtags, please keep retweeting and sharing and commenting on social media.

We haven’t had any negative commentary at all, which is so good to see the comms team are watching behind the scenes.

However, what does that treatment look like?

So we’ve heard about the awareness, we’ve heard about obesity as a chronic disease and the book launch, and we’ve talked about the need for the policy action.

We’ve talked about and heard from Sven and the, I suppose, the impact that his treatment had on him as a very young man in Iceland.

Now what does that treatment look like?

So let’s have a listen to a few different segments from my colleagues.

So we have Dr Gerhard Prager, and you will see his title on screen and all of his wonderful work as if so president.

We have Dr Andrew Jenkinson as well, who is the lead for obesity, the big truth, which if you have not seen it, please check it out.

That’s where you will find all of the factual information on obesity and the conversations he has with other professionals.

Then we hear from Susie and Jason.

Susie Burnie over in Ireland, patient wing woman and a great colleague that I work with, and Jason Halford on the pharmacotherapy because obviously our surgeons are going to talk about bariatric surgery, but where is all of the conversation on the skinny jabs or the hot topic, as they say, which is obesity management medication, right?

And then we’ll hear from the wonderful, and one and only Mr.

Ken Clare, my dear friend and colleague who has been a mentor for many, many years. as he rounds it up and says, “Hey, let’s not forget that we have endo-bariatrics as well.

What is non-invasive surgery?”

I’m like intrigued.

“Holistic, what is the use of the MDT team, the multidisciplinary team?

Why do we need them?

Why do we need more of them?”

And obesity.

So let’s have a listen to my colleagues and friends and thank them all for actually giving their time, but let’s be educated a little bit.

Good morning, everyone.

We’re here with Professor Gerhard Prager to discuss obesity and medical and surgical management of it.

My name is Andrew Jenkinson.

I’m a consultant bariatric surgeon at UCLH in London and author of Why We Eat Too Much.

This conversation is encouraged by worldobesityday.ae, who are trying to raise the awareness of obesity treatments.

So Gerhard, if you could just introduce yourself first to the audience. – Thank you, Andrew.

Yeah, my name is Gerhard Prager.

I’m a professor of metabolic and bariatric surgery at the Medical University of Vienna, and I’m the immediate past president of IFSO World and the past president of IFSO European Chapter.

I myself am a metabolic and bariatric surgeon and heavily involved in that field, of course.

And it’s my big pleasure to be here with you today and to discuss with Andrew, who is an absolute expert in the field, the treatment modalities and options we have in 3-topicity. – Yeah.

So I think patients are sort of concerned about various different aspects of treatment and whether treatment works or whether they should be really trying to calorie restrict and diet and go to the gym and things.

In my view, those things, those interventions tend not to work very well, But, you know, our interventions that we can offer, medical and surgical intervention, and particularly the new drugs and the new types of surgery as well, are really evolving.

What are your thoughts about, you know, current treatments and outcomes and safety for patients, Gerhard? – Thank you.

This is of course an excellent question.

With the new drugs, we have new options in the treatment of obesity and this gives us, of course, more and more opportunities.

I think that the longest data we face now from OMMs, obesity management medications, is up to four years.

And what we can see is that they work.

They do not work in all patients.

And this is maybe also one of the beautiful things we can offer different patients, different treatment options.

And I think we have to rethink the disease obesity.

It’s, in my mind, more comparable to cancer.

So having different treatment options, we have a staged approach to the disease, which means you might start with something that is dieting or changing your eating behavior, exercising, and then you scale up to obesity management medications.

And of course, surgery is not the first treatment options for everybody, but maybe for patients with extrema forms of obesity, like stage four, stage five obesity. – Yeah, I think it depends on, as you say, the degree of obesity and whether, you know, someone’s suffering with other metabolic problems, diabetes, high blood pressure, high cholesterol, they’re giving them cardiac risk.

So yeah, I think, you know, for someone who’s really suffering, you know, quite badly with a high body mass index and maybe diabetes, what type of operations are effective and what’s their safety profile, Gerhard? – Overall, surgery is extreme, bariatric surgery is extremely safe.

This has been proven over and over again.

So people really don’t have to be afraid.

If surgeons apply enhanced recovery protocols, patients stand up within 60 minutes after the operation and can leave the hospital within 24 hours.

So surgery is extremely safe.

What are the best studied types of surgery?

It is clearly sleeve gastrectomy and Roux-en-Y gastric bypass, followed by one anastomosis gastric bypass.

And there is now a new kit on the block that is the SADES that shows very promising results, especially for very high BMI patients.

But we clearly have the best long-term data on ruined y-gastric pipers. – Yeah, and I think for the viewers who may not be, you know, okay with the various different nuances of the different types of operations, they’re all keyhole surgeries.

So small cuts, operations take about an hour, an hour and a half under anesthetic.

You stay in hospital one night, some units actually send people home to a sort of local hotel or something.

And, you know, if you worked in the office, you don’t need to really take a week off.

If you’re working from home, you can literally take two or three days off.

So recovery is amazing.

And just to put it into perspective, I mean, I would think probably on average, my patients are around about, you know, 120, 130 kilograms, and I’m sure you would concur with that, Gerhard.

These people will go down and reset their weight to around 75 kilograms within a year of surgery.

And it’s not like you feel after you had lost that weight, for instance, by dieting, where you’re constantly craving food.

It feels really natural for the patient.

They’re a different person and the struggle is gone.

There’s a lot of sort of prejudice against obesity and it sort of not being recognized as a disease.

But I think there was some interesting developments published in the Lancet recently, Gerhard.

Could you just expand on that? – Yeah, the Lancet commission came out with a new definition of obesity, differentiating between preclinical obesity, where you have no harm or disadvantages to the excessive fat accumulation and clinical obesity that clearly states that it is an illness, which means you have some disadvantages from that excessive fat accumulation.

This can be of course, like diabetes, joint problems, also psychological problems or being short of breath when exercising.

So it depends very much on the individual.

And I think this is a very important step in the right direction to recognize obesity as a disease and giving more and more patients access to treatment.

And this is the crucial point.

This does not mean only surgery.

I think we have to rethink the whole concept of treating obesity by different treatment modalities and give our patients access to all the options. – Yeah, I mean, I agree.

This is the crucial part is recognizing for governments and even actually doctors, ’cause we’re not properly taught about obesity in medical school even now, to recognize that obesity is a metabolic condition caused by dietary and lifestyle measures, not caused by a certain population greed or laziness.

And I think there is an increased understanding that it’s the metabolic effect of processed and sugary food and snacking.

It’s the effects that has on blocking our natural weight regulation pathways that causes a disease of obesity.

And we know some people can eat, and it’s very heterogeneous, people are very different.

So some people can eat rubbish all the time and stay in bed and not put weight on, but others can’t.

It tends to be very familial.

And I think this recognition of it as a metabolic disease and a disease just like cancer is very beneficial.

Whether that will come through into the mainstream thinking or not is a different, is another conversation.

Now, obviously, the press and media are very, very interested in the new weight loss drugs.

My experience is people are very interested in it.

Some people tolerate them very well, some people don’t.

People are worried about, you know, the side effects and the risks of these procedures.

What’s your experiences on those, Gerhard?

Number one, the availability is not entirely given.

Some of the drugs are available, others are not.

They still cost a lot, So not everybody can afford it and our public health care system does not cover it at the moment.

Furthermore, when you look at real world data, but first one has to say that these new medications work quite well under study conditions.

But when you look at real world data, more than 50% of people taking these drugs stop within one year.

And this of course can have different reasons.

You mentioned already side effects, a lot of patients are pretty much constipated and feel that.

Of course, you have to take care of that.

So I think one has not to be worried about side effects like possibilities of cancer.

There are really good data now that these medications are very safe.

The question is, of course, how long do they work and you need to take them lifelong.

When you stop taking them, we see that you regain weight.

And another important thing is when you lose quite a big amount of weight, you lose or you are in danger to lose muscle mass, lean body mass.

It’s the same when you have an operation.

We as surgeons take a lot of care for that.

We encourage our patients to take a lot of proteins, to exercise and I think our colleagues from the internal departments really must encourage the patients that take these drugs also to have a higher protein intake to minimize the lean body mass loss.

And then I think a big study from America, you know, showed that within a year of coming off the drugs, people would put on at least two thirds of the weight.

Now, I think, you know, if you look at two years, people are going to be heavier than they were before the medication.

The other slightly worrying thing is that when you regain the weight, you tend to regain it centrally, which is much more visceral fat, that dangerous fat we all know causes diabetes and things.

I think also, I mean, what’s your experience, some people, you know, after some types of so you can start to regain weight.

And I think they were good agents, aren’t they, for those people? – Yeah, we had an IFSO World Consensus Conference with the opinion leaders and researchers and experts from internists’ side in the field.

And we came out with a clear recommendation.

When you have a recurrent weight gain, and it’s of course more likely to have that after sleeve gastrectomy, compared to Roux and myogastric bypass, in the first attempt, you should use the new OMMs.

And studies we have now show that you can lose two thirds of the regained weight using the new OMMs.

So it’s definitely worth to give that a try.

I think once more, these new drugs add our possibilities, our armamentarium to treat obesity.

Definitely true. – Yeah, I mean, I think the drugs, they definitely work for a large proportion of people, but I think they should be used to smart way.

So people shouldn’t go on them thinking they’re gonna be on them for years. you should probably go on them with a view to using them to help with a sort of weight reset and habit reset.

A lot of people can’t change their habits because appetite and ingrained behaviors are very difficult to change.

But if you have a drug where your appetite is just taken away and switched off in your brain, then it’s much more easy, for instance, to stop mindless eating in the evening, which a lot of people have difficulty stopping.

I think it’s the smart way.

My project, mymetabology.com is, is looking into this, how to use them the smart way.

And I think that, you know, increasingly will be the way that we’re encouraged to use them.

With metabolic surgery, we of course, change a lot of these hormones, satiety, hunger factors, as you know, and the interesting thing is that these drugs work at least as good as without an operation after the operation.

So it So it does not seem to have a big influence if you have had an operation on how these drugs works.

And I think this is another very interesting finding that we do not completely understand currently. – Yes, yeah, exactly.

I think probably we’re running out of time Gerhard.

It’s always a really good pleasure to see you.

You’ve done great work for IFSO and for the scientific progression of the understanding of obesity. got any final things you want to say for people watching this who are suffering or living with obesity for World Obesity Day?

I think we have in 2025 more options to treat this disease than ever and people should really look for this help for this treatment.

The platform ECPO gives of course wonderful possibilities and access to experts that can treat the disease and I encourage people suffering from obesity to look for treatment.

And I think you do a wonderful work with your book, with your content in social media to help people to get a treatment of the disease.

Thank you Gerhard, it’s a pleasure.

I will probably see you in, I think it’s Venice this year, isn’t it?

Venice is the European IFSO Chapter Congress and we expect more than 1000 participants.

So I’m very excited about that and I’m looking forward to see you there.

Good.

Have a great day ahead.

Thank you.

Thank you, Andrew.

You too.

Bye bye.

Hiya, Jason.

It’s great to chat with you for this patient lounge that ECPO are running.

So nice to see you.

Hi, Susie.

How are you doing?

Good.

Good.

Well, listen, Jason, today we’re going to talk about from the psychologist perspective about obesity medications and the importance of these as a treatment for some people who live with obesity.

Would you chat to us about that?

Yeah.

Well, the obesity medications work or targets the biology of the appetite system.

And we know for people living with obesity, that appetite system is not functioning properly.

Food is not impacting on the appetite system the way it should do.

So what these drugs are doing are working on the same systems that food would do and boosting those signals to the brain.

So turning off the hunger, building up that fullness and satiety, which puts people back in control of their eating behaviour.

That’s a word we hear in the patient groups.

People call it food noise and they find it hard to explain that sometimes about the food noise in their head.

And when they’re using these obesity treatments, they don’t constantly think of food.

It’s not always there, that drive for hunger.

It’s really fascinating.

Food noise is an interesting concept.

We’ve heard a lot more about it over the last 18 months.

And it is literally the experience of what is an obesogenic environment, which is constantly stimulating consumption.

In fact, commercially, it’s deliberately driving consumption, if you think about food marketing.

And when you’ve not got a functional appetite system, that noise, that pressure gets in your head, and it is constantly distracting.

We know people on diets are distracted by such noise.

And when you’re living with obesity, and you’ve already got an appetite system that’s compromised, you’ve got double the problem.

So it’s a very interesting way of looking about almost kind of cancelling, like noise cancelling earphones.

It’s not for everybody, but it’s very interesting that boosting that appetite system can reduce that noise, that distraction.

And I think just to bring into, I guess, the conversation are the assumptions so that people can have.

And because we know that, you know, they’re widely talked about obesity medications and there’s always something, you know, being talked about.

But to get into this a bit deeper, it’s not just about that they’re for weight loss.

You know, people assume like we’ve heard the skinny jabs and all the stigma behind it.

But for many people who are taking these medications, I don’t think they understand that it’s not only about getting to a number on the scales.

Like I like give my own example.

For the first time in my adult life, for the past three years, I am maintaining.

So I haven’t been either gaining stones or losing stones.

But yet, if a person on the street was to look at me and make an assumption on my body shape and size, they would think possibly that I’m unhealthy and I need to go and lose some weight.

But yet I’m the healthiest I’ve been in my adult life.

And I think there’s a huge assumption that these medications are only just about weight loss.

Well, I’ll unpack that first two ways.

Weight loss is an outcome of appetite control.

But weight loss is a mediator of health.

And I think many people living with obesity actually would like their obesity and their discussions around their medical condition to be around health and not just around weight and not to be reduced to their weight.

And their weight be a number, and their successful failure be judged about that.

But also, maintaining a weight.

We know that weight management is difficult.

Some people lose weight, and then they regain weight.

They lose weight, they regain weight they move from different solutions or attempts themselves or through different treatment regimes.

And actually maintaining weight and maintaining health through maintaining weight is a successful therapeutic outcome. – I love that.

And the quality of life is definitely something we hear from the patients a lot.

And another assumption is that it simply just reduces your appetite, that you just eat less.

And I know from my own experience that isn’t true because if I’m eating out and I say I’m at a conference or I’m traveling and I eat out in a restaurant and for me, say if I have a hamburger and if that’s processed meat and I’m halfway through the burger, I actually get a completely different sensation in my mouth.

It’s like there’s increased saliva.

I start to feel a little bit ill.

I can’t finish the burger for one.

My appetite is definitely not there.

But if I’m eating at home and I go to a butcher’s and I make my own good quality mince burger, I can eat the full burger and actually feel a lot better and full and satiated after that.

And I think people assume it’s only just about reducing your appetite when really it’s more complex. – Yes, and the appetite system is more complex than simple hunger and satiety.

There are reward mechanisms which drive eating behavior even in the absence of hunger normally.

And there’s cognitive processes such as inhibitory control.

Now in your scenario, in both cases, in the processed meat burger and in the homemade burger, higher quality meat, your appetite is suppressed. eating less, you’re in control.

Whereas what’s interesting is, is perhaps the processed burger, which is less rewarding, less tasty, you’re actually getting a greater suppression, because actually, it’s actually turning you off foods which are not rewarding.

So it has to be quite rewarding, even for you to consume a relatively reasonable amount in the healthy burger.

And that’s because the society system is connected to the reward system.

And the society system can dampen down that reward system.

So for less, less rewarding foods, you got to get little enjoyment out of them and relatively less enjoyment per se.

Yeah.

And I think this is something a lot of people using these medications don’t understand.

Unfortunately, we need to raise this awareness.

Okay.

So at last assumption, just to chat about briefly, Jason, if you will, um, there’s this sense of that if you are prescribed obesity medications after you’ve had bariatric surgery as a treatment, that somehow you failed that either surgery itself has failed to continue to work or that you failed in your behavior and that you’ve, you know, regained and needs the medications.

What do you think about that?

Yeah, failure, failure is a very loaded word, isn’t it?

And we know that bariatric surgery is a very radical intervention.

And, you know, there are more radical techniques within bariatric surgery.

Different people respond to those, those interventions in differing ways.

But rarely results in lifelong permanent weight reduction.

You have to carry on doing other things, and surgery, and surgery is an intervention.

Drugs are interventions.

Obviously you take drugs for a period of time.

Surgery is a one-off, or there may be a correction.

But living with obesity is lifelong management.

And if you think about lifelong management, you will use a series of interventions, be it behavioral, nutritional, pharmacological, and surgical over the life course to manage your obesity.

So nobody is failing, but what it speaks to the fact is there is no cure.

No surgical intervention is a cure.

No pharmaceutical intervention is a cure, even while you’re on it.

Certainly when you come off, there is a rebound because you’re losing the pharmacological effect.

So what we’re talking about is using tools throughout your management journey.

So there will be weight fluctuations, but failure is, as I say, a very loaded word.

What it means is that intervention has not worked for you at that time.

And there’ll be reasons for that.

It’s much more complicated. – And I think really that to me sums up what the term living with obesity means.

And people rightly know that the word means about not using language we prefer not to use, like obese people.

But living with obesity is that manage it when change is coming your way.

So for me, possibly menopause now is going to play a part in changing how I am reacting to my treatment right now.

That’s not a failure on my part.

That’s a reaction to my treatment based on how my body is changing.

And that is because it’s true, the life course.

And I just I hope that we can raise more awareness about this.

But the one worry is here, I feel is what about people who are using medications who maybe don’t have supervision?

And I think the role of being supervised while on these, because we do hear some people who start out and it doesn’t suit them, it doesn’t suit everybody.

And there’s that assumption again, that it will work.

And maybe some people continue to take it if they’re having the side effects and feeling too ill.

I think it’s really important that people have a health care provider monitoring them.

What would you think on that?

I think first of all, to explain what they’re likely to expect from the treatment, both in its effects, in terms of your appetite and things like that, but also the side effects and how those will be experienced and how to manage those.

And the fact is if you’re working with a clinician they can lower the dose again before raising it.

These things are titrated up generally because of the side effects.

They’re very powerful and about half of people drop out before they reach the full titration and that’s because the side effects because they’re not managed properly.

But also remember there’s a great deal of variation in people’s responsiveness to this medication as well.

Some people seem to be very, very responsive.

Other people don’t seem to respond as well at all.

And without that being explained, without that being monitored, it’s problematic.

You do need support.

You need that medical support.

You also need that nutritional support as well.

You’ve got a very radical reduction to your energy intake and you’ve got to keep that diet quality up.

So obviously you’ve got reduction in calories, but you’ve got to think about the micronutrients.

You’ve got to think about the protein.

You’ve got to think about things like sarcopenia, lean body mass loss as well.

So there’s lots of things you need to think about.

These are much more powerful drugs, you know, coming to the range of some of the less invasive surgeries now.

And so we need to think about the nutrition.

We also need to think about the psychology as well, because the same as with bariatric surgery, people have a lot of expectations around weight loss and what it’s going to bring them.

And even if you do successfully lose that weight, it doesn’t necessarily bring around the changes in your life that you might expect.

And those expectations also need to be managed.

People need to be aware of that as well.

Weight loss does not solve everything.

In fact, it might reveal things.

I think you’ve summed that up well for us, Jason.

And we see that people do have high assumptions, because I think they compare to each other.

Quite often, social media can be a problem for that.

People can say, well, I saw somebody else lost X, Y, Z.

And this really highlights that actually, as individuals, we’re all very complex.

We all have different reasons for our obesity, and we have different reactions to the treatments.

Jason, thank you very much for chatting today.

I’d love to stay on and chat, but I think we’re going to have to hand back to Vicky now.

Take care, and we’ll talk soon.

Thanks, Vicky.

Thanks, Susie.

Good afternoon, everyone, wherever you’re watching this fantastic patient lounge.

I’ve really enjoyed seeing it taking shape and my job is to sum up and review the comments from our four previous experts talking about developments in treatment and management.

We started with Gerhard from Vienna and with Andrew from London and they really expertly and succinctly put across to us the changes and the things that are happening currently in bariatric surgery and also tied that into obesity management medications which we all know are making a big difference and a big impact to how people living with obesity are currently managed.

There was also discussion around new procedures, SADES, which is going to be heard of more and more I’m sure in the future.

We were then followed by two experts, our very own Susie Birney from ICPO in Ireland and Jason Holford from the University of Leeds and they had a fantastic conversation which for me really got to the bottom of some of the physiology, the brain chemistry and the feelings around taking obesity management medications and Susie as ever put across so with such clarity the way that she spoke about her experiences as a person living with obesity.

There’s no doubt in the future there are going to be more medications coming over the horizon and that is great news.

It’s going to be more choice of people living with obesity, more personalized tailored care but that also brings with it an issue about access to care and I think that’s something we’ll all be talking about in the future.

I also want to pick on some other areas just to try and tease out some issues.

One is about the increasingly developing area of endobariatrics.

Many people and even members of our local support group here in England have undergone the vertical sleeve gastroplasty, a procedure which some people say is new but has not been around for quite a while now.

It’s seen as an alternative for people we want a less invasive organ sparing no incision procedure and we’re going to see more and more of that I’m sure and again it’s great it’s another choice in the whole range of treatments for people living with obesity.

I think that I also want to just pick out some issues around the way that the multidisciplinary team support is developing, particularly around psychology and you might, like me, might think that that’s really important in your care and for me that’s really at all stages in my health journey being so important from CBT, CAT and now some compassion-based therapy.

For me you’re never too old or too far along your journey to benefit from that.

It would be wrong not to mention that the role of dietitians and nutritionists in what we undergo and it’s interesting that our experts talked about that being important not just in surgical cases but also for anyone who’s undergoing treatment with obesity management medications.

So that’s really important hang on to.

We’re all activity specialists as well in helping us to move more and sarcopenia is an issue that is becoming more and more prevalent in our community and I think that’s really important that people pick up on that.

And the one big thing that I want to leave with you last of all is peer group support.

I would not have got through the last 22 years of my journey without the support of people like me.

That support has always been given freely, it’s been given, everything I’ve given I’ve always got back tenfold and I’d recommend any of you who don’t currently attend a support group to go and seek one out.

If you’re a professional listening to this, see where the local peer group supports are and I’ve been really lucky over the last couple of years to develop a training manual for peer group support facilitators and I think that’s been really valuable for me in some learnings.

So I want to leave you tonight or this afternoon with the message that things are improving, things are getting more choice, access can still be an issue but that together we can address obesity.

Thank you.

So there you have it, everything that you need to know and probably a lot of questions that I’m seeing on social media that we also need to answer and we will ensure that we do as somebody had suggested.

Thank you very much Claire for the suggestion on a patient lounge that is dedicated to treatment and management of obesity so all aspects can be covered.

A full 360 on surgery, on pharmacotherapy, on holistic care, on the multidisciplinary team, on everything that we need to know.

So yes, we will follow up on that.

So thank you for the question and the recommendation.

A huge thanks to everybody who’s actually messaging in.

I can’t keep up with all the comments that are going on.

The team are on them and I hope they’re getting to respond to many of you as they’re busy and different events and that.

But we really wanted to kind of just switch over now and look at what’s taking place in Europe.

What So let’s have a look at what is taking place today in various different countries in Europe.

Hi everyone, my name is Lorenzo.

I am recording this in Bucharest, Romania, and I represent an association called Together Against Obesity.

For World Obesity Day, we are planning a few activities such as sending a press release to media outlets with key messages of ECPO for World Obesity Day together with two different patient organizations from Romania.

We will also have an online webinar hosted by me with a doctor specializing in diabetes, metabolic diseases and nutrition.

We’ll have a newsletter sent to over 70,000 email addresses of people interested in health as well as medical professionals.

And of course, a social media campaign as well in line with every other friend from ECBO.

Thank you very much and have a great World Obesity Day everyone. – Hello, ECBO.

We’re busy recording our share your story documentary for World Obesity Day.

And we are visiting Adele in De Meurne in the Netherlands.

Here’s our cameraman.

Hi.

And we are sharing different stories from different patients’ perspectives to show the healthcare professionals their biases about obesity.

So I hope we will see you very soon on World Obesity Day. – Hello.

I am Hanna Vrabcová and I greet you from Slovakia.

I want to introduce you to our project for World Obesity Day, ROC 2025.

We will present the translation of the WHO recommendation on physical activity 2020.

We will make three podcasts about educating patients with obesity.

On the website CS Dravia there will be conversation about the impact of obesity on health.

We will do training for older adults on nutrition and physical activity.

We will talk about the stigma and the terminology people face.

There will be even more activities.

See you all on World Obesity Day Europe 2025.

Addressing obesity together.

Hello, it’s Yure Bezita from Switzerland.

I will present our action for the World 2025.

First of all, we will present the book “Ma’am, what is obesity?”

It will be presented for the schools, but also the pediatrician and the general public.

Secondly, we will also have a round table with the specialists and also committee from your visitors and members to speak about the obesity management, GLP-1, and a new video of Uribesitas on traumatic experiences of stigmatization and discrimination.

And we will have also a symposium for specially physicians on obesity management and stigmatization.

So there you have it.

And thank you to our tremendous colleagues.

We could not feature every country across Europe because obviously that would just take all of this patient lounge.

But thank you to those who actually shared what is taking place in their own country today or even yesterday like in Ireland or in the coming days or the coming months.

Because World Obesity Day is just not advocating for one day.

It’s advocating for a change in lives as we go on, as we continue throughout the year.

So many of the programs taking place, like in Germany with our colleagues over there, that will take place for a number of months.

So keep sharing across social media.

I cannot encourage you more.

It is now getting a little bit later and I do need to change.

It is getting a bit grey outside.

I was promised some sunshine here, but apparently that’s not looking likely.

However, I want to leave you with some final words from our beautiful new president, Deanna Castillo, who is just a tremendous person and human being who lives with obesity and other chronic diseases and is also just so passionate about driving change and continuing this journey.

So she is here with us, she is going to be in the Parliament today, but she did do a recording for Royal OBC Day.

So thank you to my amazing team, who you all know, but you will see in the credits all of their names.

Also to our partners, who we could not produce and do these events without.

We simply couldn’t.

So thank you to you all.

Thank you for listening and watching.

And we will see you on the next Patient Lounge.

And please, please, please continue to support your advocates in your own country as we continue to address obesity together on Well-Obesity Day 2025.

Adios, bye. – Hi, I’m Diana Castillo, the new president of ECPO.

I’m excited to see the contribution of patient organization that have joined our initiative and to see how every year on World Obesity Day, our work continues to convey a strong and clear message about information, management, and the importance of addressing obesity together.

Thank you very much, and I wish you a good World Obesity Day 2025.