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FLORENCE, ITALY — Obesity must be recognized and treated as a disease. This was the central message of the 23rd European Congress of Internal Medicine (ECIM) 2025, held from March 5 to 8.
With the rapid rise of new anti-obesity medications, internists explored the economic and health burdens of obesity, recent advancements in pharmacological and surgical treatments, effective lifestyle strategies, and the persistent stigma associated with the condition.
Lifestyle Interventions
During a workshop titled Adult Obesity Treatment Course for Internists, organized by the European Association for the Study of Obesity, discussions focused on patient experiences and the significant roles of physical exercise and nutrition in managing obesity.
Despite strong evidence supporting these benefits, a gap remains between theory and practice.
“Today, there are few specialists focused on prescribing exercise, but I am confident that their numbers will continue to grow. It is a step-by-step process that has just begun, but I believe it will take hold,” Francesca Battista, a researcher from the Department of Medicine, University of Padua in Padua, Italy, told Univadis Italy, a Medscape Network platform, during the workshop.
“One of our missions is also educating and empowering our colleagues so that they can increase their knowledge and ability to prescribe exercise,” she added.
“Obesity is a genuine medical condition, a complex disorder that requires comprehensive management across all facets, free of stigma and bias. Specialized centers must be approached for treatment,” emphasized Valerie Tikhonoff, MD, PhD, professor of food science and clinical nutrition at the University of Padua’s Department of Medicine and a speaker at the workshop.
Tikhonoff highlighted the crucial role of patient associations, which are deeply engaged with the realities of obesity care and can help guide patients toward appropriate resources. “It is important for the general population, healthcare professionals, and patients to understand that obesity is not just about aesthetics and recognize the significant health risks associated with obesity,” she stressed.
Pharmacological Advances
Ania Jastreboff, MD, PhD, associate professor of internal medicine and pediatrics at Yale University School of Medicine, New Haven, Connecticut, spoke remotely about the current pharmacological treatments for obesity during a session. She detailed a variety of drugs used in treatment, from long-established ones such as orlistat, metformin, and liraglutide to newer hormone-based therapies such as tirzepatide and semaglutide, many of which are still in development.
These newer drugs are proving to be more effective in weight loss than older ones. However, despite these advancements, obesity is often not considered a disease. For example, in patients who are obese and also suffer from hypertension, diabetes, and hypertriglyceridemia, treatments typically focus on these other conditions rather than on obesity.
Jastreboff suggested several reasons why obesity drugs are not commonly prescribed for patients with obesity. The primary reason for this is the perception that obesity is not a medical condition but rather a personal choice. This view is further reinforced by concerns about side effects, doubts about the effectiveness of these drugs, cost and availability issues, and challenges in adjusting dosages.
“It’s true, these treatments have side effects, but which medication doesn’t?” she pointed out. It is important to discuss potential side effects with patients before beginning treatment and to adopt strategies to manage them, such as starting with the lowest possible dose, monitoring for adverse effects, and adjusting the dosage according to the patient’s tolerance.
Recent studies have highlighted the effectiveness of new medications in reducing weight and mitigating other significant risk factors, such as cardiovascular, renal, and metabolic issues. Thus, treating obesity involves enhancing overall health outcomes.
“Obesity is a diverse, complex, and chronic disease for which there is currently no cure, necessitating lifelong management,” she said.
Surgical Insights
In this evolving therapeutic landscape, is there still a role for bariatric surgery? Absolutely, according to Gerhard Prager, MD, a specialist in minimally invasive metabolic and bariatric surgery and professor of bariatric surgery at the Medical University of Vienna, Vienna, Austria.
During his presentation, Prager outlined the primary surgical methods for treating obesity, with sleeve gastrectomy leading, followed by Roux-en-Y gastric bypass and single-loop gastric bypass. Unlike drug treatment, surgical treatment requires tailored approaches and meticulous patient selection to avoid excessive intervention. The significant weight loss achieved through these surgeries can lead to severe nutritional deficiencies if not managed properly.
Prager emphasized that advancements in metabolic/bariatric surgery continue to evolve. Unlike the past decades, today’s procedures not only focus on weight loss but also on managing metabolic syndrome through less invasive techniques, incorporating endoscopy, robotic surgery, and artificial intelligence to determine the most effective surgical strategies.
“We are currently seeing a reduction in the number of metabolic/bariatric surgery procedures, but I believe that will soon change,” Prager told Univadis Italy.
While new medications are highly effective, data indicate that 70% of patients discontinue their use within two years. “These patients experience the benefits of weight loss and need to maintain these benefits to be considered successful.”
He noted that this is something that surgery can offer them and that he believes the future lies in the integration of novel endoscopic techniques with pharmacological treatments.
“The collaboration between surgeons and clinicians is already robust, and I am sure that it will continue to grow,” he concluded.
Disclaimer:
This article is intended for informational purposes only and should not be considered medical advice. The information provided is based on expert discussions at the 23rd European Congress of Internal Medicine (ECIM) 2025. Readers should consult healthcare professionals for personalized medical guidance. The experts interviewed declared no conflicts of interest regarding the topics discussed.
