A new guideline co-led by Vall d'Hebron proposes a change in the pharmacological approach to obesity based on improving health and reducing complications

Dr. Andreea Ciudin, coordinator of the Comprehensive Obesity Treatment Unit at Vall d'Hebron University Hospital and principal investigator of the Diabetes and Metabolism group at Vall d'Hebron Research Institute (VHIR), has co-led a study with a panel of international experts to create the first European algorithm to guide health professionals in the personalised pharmacological treatment of obesity. The work, the result of collaboration with members of the European Association for the Study of Obesity (EASO), has been published in two articles in the journal Nature Medicine. It was also presented at the 32nd European Congress on Obesity (ECO).

The project, co-led by Dr. Ciudin as co-chair of the EASO Obesity Management Working Group, consisted of a meta-analysis of the clinical trials conducted to date on the approach to obesity. According to the results, the team has created a practical algorithm that proposes a personalised pharmacological treatment, adapted to the clinical context of each patient, overcoming the classical view focused only on weight loss or body mass index (BMI).

The work shows the benefits of approaching obesity as a chronic and multifactorial disease, with multiple manifestations and associated complications. “This algorithm represents a paradigm shift: we don't think about weight loss, but focus on improving the patient's actual health and preventing or remission of associated complications”, says Dr. Ciudin.

The document distinguishes between two major clinical situations, in which the therapeutic target is different. On the one hand, patients with excess fat that generates mechanical complications, such as sleep apnoea or knee osteoarthritis; and on the other, patients with metabolic complications, such as type 2 diabetes, fatty liver or cardiovascular disease. This personalised approach, which is already being applied at the Vall d'Hebron Comprehensive Obesity Treatment Unit, is aimed at improving patients' health and quality of life.

The guide, developed from clinical experience and the most recent scientific evidence, serves as a reference for health professionals and establishes recommendations on the drugs to be used depending on each specific case. It also highlights the importance of this type of algorithm being reviewed and updated periodically to reflect advances in research.

As the authors of the paper explain, this new treatment model, although it requires an investment in some therapies, represents a significant long-term reduction in the healthcare costs associated with the complications of obesity, and helps to prevent its progression towards serious or chronic diseases.

Female leadership for the benefit of patients

The algorithm was coordinated by Dr. Andreea Ciudin at Vall d'Hebron and Dr. Barbara McGowan at Guy's and St Thomas' NHS Foundation Trust in the UK, both co-chairs of the EASO Obesity Management Working Group. The study involved obesity experts from different disciplines and from nine countries.

"We are particularly proud that this project has been led by two young women experts. It will undoubtedly have an impact that will benefit patients”, concludes Dr. Ciudin.