Highlights and reflections from the European Congress on Obesity 2024: Beyond BMI and the importance of a multi-organ perspective

Contributing authors: Edvin Johansson, Senior Imaging Director @ Antaros Medical and Akvilė Lukošė, Director, Business Development @ Antaros Medical

Earlier this month, almost 3000 delegates attended the 31st European Congress on Obesity (ECO 2024), which was hosted by the European Association for the Study of Obesity (EASO) and held in Venice, Italy from May 12-15.

We were eager to learn about the most recent developments in the field of obesity, a disease area that is growing rapidly and where there is a lot of research activity. In this blog post we describe some of our highlights and reflections from the congress.

The complexity of obesity: Beyond BMI

A common theme throughout the congress was the need to go ‘beyond BMI’ when identifying, monitoring, and treating overweight and obesity. Body Mass Index (BMI) is calculated with a simple formula using only an individual’s height and weight. There are many other factors relevant for weight gain, such as sex, age, ethnicity, and muscle mass. Yet despite its limitations and variability at the individual level, BMI is the most commonly used measure for identifying individuals considered to have overweight or obesity. This has implications also within drug development in obesity and other metabolic diseases, as BMI is often used in the inclusion criteria for clinical trials.

In essence, obesity is an adipose tissue-related disease, so BMI can be considered at best a surrogate measure of adiposity. There are other methods for directly, or at least more accurately, assessing adiposity, and importantly in obesity drug development, changes in adiposity. Research has shown that the type of adipose tissue (i.e. visceral, subcutaneous) and its location (i.e. around and within organs) can have different effects. Looking more closely at adiposity and the source of the weight loss is important in the treatment of obesity, and to this end there was research presented on the preservation of lean tissue mass during weight loss as well as other functional assessments.

Overweight and obesity are multifactorial diseases and are therefore difficult to classify or phenotype. This was illustrated through the number of different approaches that were presented throughout the congress, ranging from clinical tools or staging systems, behavioural patterns, and genetic profiling, to detailed body composition. This is also important when considering the observed proportion of non-responders across obesity clinical trials, and may help to provide some understanding as to how we identify responders and non-responders and ensure efficacious treatment is available for people with overweight and obesity. It will be very interesting to see how this evolves in the future and what more we can understand about obesity by looking at it from different perspectives.

The multi-organ perspective: Treating obesity beyond weight loss

Another reoccurring idea throughout the congress was the idea that treating obesity involves treating beyond weight loss alone. Newly available and approved pharmacotherapies for obesity, particularly the incretin-based therapies, have numerous effects throughout different organs of the body. It was great to hear about new research looking into treatment effects in the heart, liver, and kidney, related to the concurrent weight loss and also independent from it. There were also presentations describing research that has investigated effects in the bones and joints, such as osteoarthritis and bone density.

A highlight for us was the plenary lecture given by Daniel Drucker (University of Toronto) titled ‘The expanding impact of central nervous system GLP-1 receptor signalling‘. The potential effects that incretin-based therapies are having in the brain are something we have discussed in our latest webinar, so we were very interested in hearing thoughts and hypotheses regarding the mechanisms by which GLP-1 can be neuroprotective, or how these treatments are changing behaviours, just to name a few. This lecture gave a very comprehensive overview and also emphasised the importance of understanding what these treatments are doing in the brain.

Defining clinical obesity

Lastly, we wanted to reflect on the update from the Lancet Commission on clinical obesity. This commission was formed as a partnership between The Lancet Diabetes and Endocrinology and the Institute of Diabetes, Endocrinology, and Obesity at Kings Health Partners, and engages roughly 60 experts across a variety of disciplines and geographies, with the aim of defining obesity clinically.

While obesity has been recognised as a disease by several medical and health societies, there is still some debate as to whether it should be considered a disease in and of itself rather than a risk factor for other diseases and illnesses.

This has implications for public health and access to treatment for patients, but also for how pharmacotherapies are being developed to treat obesity. It was very interesting to learn more about this initiative and we are looking forward to learning about the outcome of this very important work.

In summary

In summary, it was great to see and hear about all the scientific research that was presented at the European Congress on Obesity. We chose just a few highlights and reflections to discuss in this blog post:

  • Beyond BMI: the common theme throughout the congress was the need to look beyond BMI when considering obesity due to its complexity and the multitude of factors that are at play.
  • Treating beyond weight loss: there was also a lot of discussion about the effects of obesity treatments throughout the body in addition to weight loss, and the need to understand these better.
  • The update from the Lancet Commission on clinical obesity: it was great to hear more about this initiative as well as the topics and issues that are being considered and discussed when it comes to defining clinical obesity as a standalone disease.

We are already looking forward to attending the European Congress on Obesity 2025 next year in Malaga, Spain.

Blog disclaimer:
The views and opinions expressed in this article are solely those of the contributing author/s. These views and opinions do not necessarily represent those of Antaros Medical.

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