15 April 2025, The Netherlands

Julius Clinical’s Scientific Officer, Associate Professor Manuel Castro Cabezas, interviewed Professor Liesbeth van Rossum, internist-endocrinologist and professor in the field of obesity at the Erasmus MC, University Medical Centre, Rotterdam, Netherlands. Dr Van Rossum is an internationally recognized scientist and author and serves as the European co-leader of the Obesity, Diabetes, Nutrition and Metabolism theme of the European Society for Endocrinology. She is also a member of the working group on Obesity Policy of the European Association of the Study of Obesity.

Dr Manuel Castro Cabezas started off by asking Dr Liesbeth van Rossum what she felt was the primary unmet clinical need in the obesity field?

It is crucial to raise the awareness of policy makers, health care professionals (HCPs) and the wider community.

It must be understood that obesity is neither a cosmetic nor behavioural issue but a multifactorial medical condition. When obesity is not taken seriously as a disease, it is also undertreated.

What would help raise awareness?

Given the disease complexity, HCPs may benefit from additional resources and support. The MC Erasmus resource Check Causes Obesity sets out the seven causes of obesity; lifestyle, social economic, psychological, hormonal, medication related, hypothalamic and rare genetic causes. This resource includes a tool for determining the cause(s) of obesity in a given patient. The simple online questionnaire can be completed by patients at home then reviewed with their general practitioner, who can create a tailored treatment plan including referral to relevant specialists as appropriate.

The first advice in the Dutch guideline is to ask permission to discuss a patient’s weight. When HCPs ignore the topic altogether, or jump into treatment mode, the patient may feel the issue is insignificant or that they do not have control over their treatment journey. The next step is to assess underlying causes and contributing factors – for example, by using the online screening tool www.checkcausesobesity.com (in Dutch: www.checkoorzakenovergewicht.nl) – and to personalize treatment based on the identified causes and comorbidities.

What is current treatment practice?

Current practice is largely focused on lifestyle interventions then if these are unsuccessful, medical treatment (for example pharmacological or bariatric surgery) is implemented. Prevention and lifestyle choices are of course very important, but not always sufficient. Medical treatment options are improving and may benefit patients earlier than currently prescribed.

For high risk patients, treatment is sometimes implemented earlier but reimbursement can be an issue. This differs from other fields where approved medications can be more easily prescribed.

Will pharmacological treatments replace bariatric surgery?

While HCPs generally prefer pharmacological treatments over surgery, as awareness grows about this disease, more patients will also be treated for obesity in general. It is conceivable that all treatment modalities, so lifestyle interventions, pharmacological interventions and also surgery may be applied more often in clinical practice, rather than only treating the obesity-related comorbidities. In addition, also non-responders to pharmacotherapy may benefit from surgery. The two interventions may also work in conjunction for some patients.

What can be done in childhood obesity?

Childhood obesity is both easier to reverse than adulthood obesity, and is devastating. A recent study suggests that severe obesity at four years of age could reduce life expectancy to just 39 years (Severe obesity in childhood can halve life expectancy, global modelling study finds – EASO).

As with adulthood obesity, lifestyle intervention is crucial, but it differs in reliance on parental engagement and the role of the school. Governments must both raise awareness in parents about how everyday choices affect a child’s long-term health, and implement policies that support schools.

One study showed that children who drink one sugary drink per day gain on average 1 extra kg per year, setting them up for early onset obesity – all parents want to know these facts!

Measures are needed to create healthier environments and reduce the risk of obesity, such as promoting healthy eating in schools through for example making water the drink of choice, prohibiting candy distributors (not only in primary school but all the way up to university), and banning fast food restaurants in front of schools.

What will most improve quality of life for patients with obesity in the next 10 years?

This is two-fold and relies upon turning back the tide on rising obesity rates and improving treatment of the disease.

We must recognise and tackle the societal causes of obesity. Governments globally must embrace their role in implementing policy that makes healthy choices the norm.

The other game changer is improved treatment options for the population already affected by obesity. Obesity medications are becoming more effective every year, and there are hundreds more under development. These drugs also play a role in facilitating and improving the effectiveness of critical lifestyle interventions.

Beating this disease is doable but it requires a concerted team effort, relying on governmental measures and all stakeholders, including HCPs and patients.