Beyond Weight Loss: Reframing Obesity Care Through Science, Support, and Systems 

Obesity care is often framed around weight reduction as the primary endpoint, with success measured in kilograms lost. In practice, as highlighted at the 33rd European Congress on Obesity, effective care is far more complex, representing a continuous, multidimensional process shaped by biology, behavior, environment, and experience.This year’s congress brought together evidence across clinical practice, pharmacology, and digital health, revealing a consistent theme: meaningful outcomes depend on integrating stigma-free care, targeted therapies, and sustained patient engagement.

These findings reinforce that obesity care must evolve from a narrow focus on weight to a broader, system-level approach that supports long-term health, adherence, and quality of life.

From Weight Stigma to Weight-Inclusive Care

Weight stigma remains deeply embedded in healthcare delivery, influencing both patient experience and clinical outcomes. It operates across multiple levels:

• Structural barriers, such as inadequate equipment or facilities

• Interpersonal interactions, including dismissive or judgmental communication

• Intrapersonal effects, where individuals internalize stigma and anticipate bias

Both implicit and explicit biases continue to shape care. While explicit bias may appear as overt negative assumptions, implicit bias often emerges subtly through tone, body language, or rushed clinical decisions. These experiences have measurable consequences: increased anxiety, reduced cognitive processing, avoidance of care, and poorer mental and physical health outcomes.

Weight-inclusive care offers a practical alternative. By prioritizing respectful communication, collaborative goal-setting, and health behaviors rather than weight alone, clinicians can reduce stigma and improve engagement. Simple strategies, such as asking permission to discuss weight or ensuring privacy during assessments, demonstrate how small changes can meaningfully shift patient experience.

Redefining Outcomes: Semaglutide and Beyond

Pharmacological innovation is reshaping expectations of treatment success. In the context of GLP-1 therapies such as semaglutide, weight loss is increasingly understood in terms of body composition, functional outcomes, and cardiometabolic risk.

Data presented at the congress showed that approximately majority of weight lost with 7.2mg semaglutide was attributable to adipose tissue, with muscle function largely preserved. At the same time, patient-reported outcomes including quality of life, appetite regulation, and eating behaviors are becoming central to evaluating treatment benefit.

Treatment success is also influenced by practical considerations. For oral semaglutide, dosing timing and administration conditions affect bioavailability, while patient preference plays a key role in adherence. Some individuals favor daily oral dosing, while others prefer less frequent injections, reinforcing that treatment choice should align with what patients can realistically sustain.

Importantly, speakers positioned pharmacotherapy as long-term tools within a broader framework of behavioral and clinical support.

Liver Health and the Hidden Burden of MASLD

Obesity rarely exists in isolation, and the congress highlighted metabolic dysfunction–associated steatotic liver disease (MASLD) as a common yet under-recognized comorbidity.

Many individuals remain asymptomatic until disease progression is advanced, despite underlying metabolic disruption driven by visceral adiposity and liver fat accumulation. Once hepatic fat exceeds approximately 5%, the risk of progression to inflammatory and fibrotic stages increases significantly.

Early identification is therefore critical. Simple, non-invasive tools such as the Fibrosis-4 (FIB-4) score can help stratify risk in routine care and guide decisions around further investigation or referral. This reflects a broader shift toward recognizing obesity as part of a multisystem disease process requiring proactive, integrated management.

Digital Engagement as a Driver of Outcomes

Digital health solutions are emerging as key enablers of sustained behavior change, particularly when combined with pharmacological treatment.

Across multiple studies, patient engagement, defined by coaching interactions, self-monitoring, and app use, consistently predicted better outcomes. Even in populations considered “difficult to treat,” such as individuals with Polycystic Ovary Syndrome (PCOS), higher digital engagement was associated with greater and faster weight loss.

Engagement also influenced treatment persistence. Patients who were more actively involved in digital programs showed lower discontinuation rates and remained on therapy longer. Notably, clearly defined, personally meaningful goals further supported adherence, suggesting that motivation and structure work together to sustain behavior change.

However, not all digital components contribute equally. Human interaction, particularly early coaching contact, emerged as one of the strongest drivers of ongoing participation, while overly complex or burdensome features could reduce engagement. This highlights the importance of thoughtful design rather than feature volume.

Wearables, Coaching, and Behavioral Precision

Wearable technologies are increasingly used to translate behavioral goals into measurable action. Data such as daily step counts can feed into personalized coaching systems, enabling adaptive goal setting and real-time feedback.

One study reported average increases of over 1,200 steps per day, with greater improvements observed when wearable data were combined with human coaching. This hybrid model, with technology supported by human interaction, appears particularly effective in sustaining engagement and improving outcomes such as BMI.

Researchers are now exploring behavioral clustering approaches to predict which patients will benefit most from specific types of support. This signals a move toward more personalized, data-driven intervention strategies in obesity care.

Biology, Adherence, and the Next Wave of Therapies

Advances in pharmacology continue to expand treatment possibilities. While GLP-1–based therapies have demonstrated strong efficacy, real-world persistence remains a challenge, influenced by cost, side effects, expectations, and treatment burden.

Emerging therapies aim to address these limitations. Reduced-frequency dosing, such as monthly injectables, may improve adherence, while multi-pathway approaches target complementary biological mechanisms. Long-acting peptide-antibody conjugates, such as MariTide, which combines GLP-1 receptor activation with GIP receptor inhibition, amplify metabolic signaling and enabling less frequent dosing schedules.

At a biological level, obesity reflects complex interactions between genetic susceptibility and environmental exposure. While pathways such as leptin–melanocortin signaling play a well-established role, the success of incretin-based therapies highlights how modulating dynamic metabolic systems can yield substantial clinical benefit.

Eating Behavior, Cognition, and Context

Behavioral and psychosocial factors remain central to obesity risk and treatment response. Studies presented at the congress showed how cognitive processes, such as inhibitory control in response to food cues, and environmental influences, such as socioeconomic status, shape eating behaviors.

Hedonic hunger and emotional eating were associated with higher obesity risk, while mindful eating appeared protective. Importantly, rigid dietary restriction was linked to increased emotional and external eating, suggesting that overly restrictive approaches may be counterproductive.

These findings reinforce the importance of flexible, awareness-based nutritional strategies that align with broader behavioral and psychological support.

Integrating Findings: A System-Level Approach to Care

Although each area of research focuses on a different dimension of obesity care, the findings are interconnected:

• Reducing stigma improves engagement and access to care

• Pharmacological advances enhance biological outcomes and risk reduction

• Digital and behavioral strategies sustain adherence and amplify treatment effects

• Early identification of comorbidities enables proactive, integrated management

Together, they describe a comprehensive care model that extends beyond weight loss to address the full complexity of obesity as a chronic disease.

Key Takeaways for Future Obesity Care

• Address stigma directly: Embed weight-inclusive practices into clinical workflows and training

• Broaden outcome measures: Include body composition, function, and quality of life alongside weight

• Integrate care models: Combine pharmacotherapy with behavioral and digital support

• Prioritize engagement: Design interventions that are simple, personalized, and supported by human interaction

• Detect comorbidities early: Use practical tools to identify and manage conditions such as MASLD

These insights reinforce a central shift: obesity care is no longer defined by a single intervention or outcome, but by a coordinated, patient-centered system that evolves over time.

Embedding this approach into clinical practice will be essential to improving long-term outcomes, reducing disease burden, and delivering care that is both scientifically robust and meaningfully experienced by patients. 

Marcela Roy, MA, is Executive Director, Clinical Science & Medicine at Signant Health. She has been with Signant for over 15 years and has over 20 years of clinical and research experience. Her focus is Mood Disorders and Endpoint Reliability quality monitoring. She provides strategic direction in the organization, as well as team leadership and business development support. 

Elias Ketiar, MD, MRCP serves as the Clinical Vice President, Science & Medicine, at Signant Health. Dr. Ketiar draws on his wealth of more than 20 years of academic and clinical experience to advise on clinical trial design, execution, and governance. He has extensive experience in General Internal Medicine and Cardiology and is a Member of Royal College of Physicians (London), UK. Dr Ketiar has been engaged in academic research and was involved in a pioneering project investigating genetic causes of congenital heart disease, which culminated in a Medical Doctorate with St George’s University of London, UK. He also has peer reviewed papers published. He has always been involved in all phases of clinical development and interested in global clinical trial solutions. 

Lauren Crooks, MSc has comprehensive cross-functional experience within the life sciences and information technology sectors. At Signant, she combines this experience to provide scientific consultation and support to clients on the implementation of eCOA to optimize patient care and outcomes in clinical trials. She has supported eCOA projects across multiple therapeutic areas, including dermatology and neurology, with a current focus on respiratory diseases.