Incretin-based therapies have transformed obesity treatment, producing substantial weight loss and benefits across cardiometabolic outcomes. However, translating therapeutic efficacy into sustainable population-level benefit remains challenging across European healthcare systems that vary in workforce capability, multidisciplinary care, reimbursement, access, and monitoring infrastructure. We describe this mismatch as the EASO Integration Paradox: therapeutic innovation has advanced more rapidly than the health-system structures required for its optimal, equitable, and sustainable implementation. In this EASO Position Statement, we propose the EASO Integration Framework, a model for integrating incretin-based therapies into comprehensive obesity care. The framework is organized around five interdependent pillars: Right Patient, Right Care, Right Workforce, Right Data, and Right Access. We also outline a European research and implementation agenda focused on real-world evidence, harmonised monitoring, workforce development, pharmacovigilance, and equitable access. The challenge is no longer whether incretin-based therapies should be used, but how they should be implemented responsibly within comprehensive obesity care pathways.

Diabetic foot ulcers (DFUs) remain a major complication of diabetes mellitus, with significant human and economic costs. Plantar pressure (PP) is the most widely used surrogate to assess DFU risk. Existing PP measurement insoles are primarily designed for in-clinic assessments using external instrumentation to guide passive offloading strategies. However, reliance on brief clinical measurements limits their ability to capture real-world loading patterns, motivating the development of sensing systems capable of continuous monitoring and integration within pressure-management footwear. Such systems require spatially discretized sensing elements fully embedded within the shoe architecture. This work presents the design and characterization of plantar-monitoring Au-plated pressure system (P-MAPS), a custom-topology pressure-sensing insole codesigned for precise spatial alignment with offloading elements. The sensor uses the piezoresistive response of Velostat combined with gold-plated electrodes to improve uniformity and repeatability. The device exhibits a measurement range of 45-350 kPa, a coefficient of variation below 2.5%, normalized hysteresis of 25.8%, and 6% drift after 5 min. Dynamic gait validation against a commercial reference (Pedar, Novel) demonstrated accurate peak pressure estimation with 2.6% error under full spatial overlap while enabling localized pressure measurement over actuated regions and revealing that sensing areas not colocated with actuator regions can misrepresent local pressures due to spatial averaging effects. These results establish P-MAPS as a robust and practical sensing solution for continuous, footwear-integrated plantar-pressure monitoring and adaptive offloading applications.

BackgroundBipolar disorder (BD) is a chronic psychiatric illness associated with high rates of medical comorbidities, among which metabolic syndrome (MetS) is particularly prevalent and consequential. Affecting nearly half of individuals with BD, MetS compounds the risk of cardiovascular disease, type 2 diabetes, and premature mortality, while also undermining psychiatric stability and cognitive functioning. Despite these outcomes, metabolic health remains underrecognized and undertreated in psychiatric care.ObjectiveThis narrative review aims to examine the bidirectional relationship between BD and metabolic syndrome and to highlight multidisciplinary strategies for metabolic monitoring and clinical management in this population.MethodsA targeted literature search was conducted using PubMed (2000–2025), covering studies on the epidemiology, behavioral and biological mechanisms, pharmacologic and lifestyle interventions, and clinical care integration related to BD and MetS. The review followed established quality guidance for narrative synthesis and was structured using the Population–Concept–Context framework to improve transparency in the selection and synthesis of the literature.ResultsThe comorbidity between BD and MetS is shaped by multiple interacting factors, including shared behavioral risk factors, inflammatory pathways, hypothalamic–pituitary–adrenal (HPA) axis dysregulation, and the metabolic effects of psychotropic medications. While pharmacological treatment remains essential for mood stabilization, systematic metabolic monitoring is crucial to mitigate treatment-related risks. Evidence supports the central role of lifestyle interventions, including nutritional strategies and physical activity in reducing cardiometabolic risk. Emerging therapeutic approaches such as GLP-1 receptor agonists and ketogenic metabolic therapy show potential benefits but require careful clinical integration. In selected individuals with severe or refractory obesity, bariatric surgery may be considered. Therapeutic patient education (TPE) represents the cornerstone of care by supporting self-management, treatment adherence, and shared decision-making.ConclusionAddressing the dual burden of BD and MetS requires a multidisciplinary and patient-centered approach integrating metabolic monitoring, lifestyle interventions, pharmacological strategies, and therapeutic patient education. Strengthening collaboration between psychiatry, primary care, and metabolic specialists is essential to reduce cardiometabolic risk and improve long-term health outcomes in this vulnerable population.

Aims Diabetes prevalence in the Eastern Mediterranean Region (EMR) is among the highest globally, yet structured therapeutic patient education (TPE) is inconsistently implemented. This study aimed to describe the multi-phase development, structure, and implementation planning of a WHO-led, diabetes-specific TPE curriculum tailored to the EMR. Methods A multi-phase, formative approach was used to inform curriculum development. This included a synthesis of existing evidence, a regional situation analysis combining desk review, stakeholder surveys, and semi-structured interviews, and stakeholder consultations. Qualitative data were analysed using a thematic approach, and findings were integrated through an expert-driven, iterative consensus process. Reporting was guided by relevant principles for complex intervention description. Results The different phases identified key gaps in the organization, content, and delivery of diabetes education across the region, as well as priorities for culturally adapted and competency-based training. These findings directly informed the development of a structured curriculum composed of eight modules, covering core aspects of diabetes management, self-care, and context-specific considerations. The curriculum incorporates defined learning objectives, core content areas, and participatory teaching methods, and is supported by an implementation guide informed by implementation science frameworks. Conclusions This work provides a transparent description of the development of an evidence-informed, theory-driven TPE curriculum adapted to the EMR. The curriculum offers a structured framework to support the delivery of diabetes education and may be adaptable to other contexts, subject to local contextualization and future evaluation..

Obesity in older adults is a growing public health concern. Age-related changes in body composition, including loss of muscle mass, fat redistribution, and reduced basal metabolism, promote sarcopenia and sarcopenic obesity, thereby limiting the relevance of body mass index as a sole risk indicator. While weight loss can improve certain cardiometabolic and functional outcomes, it poses specific risks in older adults, particularly worsening sarcopenia, malnutrition, frailty, and loss of independence. Obesity management should therefore be individualized and focused on preserving physical function and quality of life, with adapted nutritional strategies, physical activity, and behavioral interventions as the cornerstone of care.

Significant weight loss, achieved through bariatric surgery, anti-obesity pharmacological treatments, or intensive lifestyle modifications, is frequently associated with cutaneous and morphological sequelae leading to dermatological complications, functional limitations, and a significant psychosocial impact. Reconstructive plastic surgery (abdominoplasty/body lift, limb contouring, breast or cervicofacial procedures) improves comfort, body image, and quality of life, but it carries a risk of complications that requires careful patient selection, weight stabilization, and nutritional optimization. Access to care depends on medico-administrative criteria and documentation of functional limitations. Integration into multidisciplinary care pathways aims to ensure efficient and equitable management.

Migrant and allophone people often face linguistic, cultural and structural barriers, with limited access to healthcare. To address this issue, the Therapeutic Patient Education Unit has created at the University Hospitals of Geneva a new therapeutic programme specifically for these people living with obesity. It includes educational workshops tailored to their language skills, health literacy and migratory background. An interdisciplinary team, with the support of interpreters, works together to provide inclusive and personalized care, promoting persons' autonomy. The aim of this innovative scheme is to reduce health inequalities, improve access to care and enhance persons' ability to manage their illness in an environment that respects their cultural diversity.

Obesity is a chronic, multifactorial, and relapsing disease. This condition is the result of a complex interplay of biological, psychological, social, environmental, and genetic factors. Management in primary care requires a comprehensive, individualized, and interdisciplinary approach centered on the lived experiences of people living with obesity. Therapeutic patient education, early screening for complications, and addressing weight stigma are essential pillars. Pharmacological and surgical options can be valuable, but only as part of a structured, long-term care plan. The primary care physician plays a key role in rebuilding trust, supporting motivation for long-term behavioral changes, and coordinating care within an interdisciplinary network.

Therapeutic patient education (TPE) is a structured, person-centered educational process designed to empower individuals living with non-communicable diseases, such as diabetes mellitus. Educational interventions addressing diabetes in the Eastern Mediterranean Region (EMR) are isolated , and their effectiveness is not well reported. Therefore, this systematic review evaluates the impact of TPE interventions on diabetes self-management outcomes in the EMR. We searched six databases (MEDLINE OVID, PubMed, Web of Science, Scopus, CINAHL, and ScienceDirect) for relevant articles. Articles were included if they reflected on TPE initiatives addressing diabetes, conducted in the EMR, delivered by healthcare professionals or multidisciplinary healthcare teams, and utilized TPE components and/or constructs. Data extraction included self-management outcomes of diabetes mellitus and the country of intervention. Effect sizes were computed for all outcomes. 24 articles, including TPE constructs (knowledge, skills, and confidence) or components (goal setting, action planning, shared decision-making), were included in the analysis. Most articles were randomized controlled trials (n = 14). Workshops and educational sessions in group settings were the most common modality of TPE interventions (n = 18). Results were reported based on self-management outcomes: [1] self-care [2], anthropometric and lifestyle, and [3] biological outcomes. The combination of knowledge and confidence (n = 8), and goal setting (n = 8) were the most reported combinations of the patient competency profile and TPE components, respectively. Most studies (n = 18) reported on self-care outcomes, such as general or specific diet adherence, blood glucose monitoring, foot care, and medication adherence, with effect sizes ranging from small to large. 16 articles also reported on biological measures (glycemic, lipid profile, and blood pressure measurements), 11 on anthropometric outcomes (body mass index-BMI, weight, and waist circumference), 4 on dietary outcomes, and 4 on physical activity outcomes. Mixed effect sizes were observed for anthropometric and biological outcomes, with most studies revealing small effect sizes for changes in BMI, weight, and blood lipids. In contrast, large and significant effect sizes for waist circumference, HbA1c, and fasting blood glucose were noted. Despite varying effect sizes for most outcomes, TPE interventions in the EMR showed significant improvements in several diabetes self-management outcomes, including waist circumference, HbA1c, and fasting blood glucose. TPE components and constructs were more prevalent with significant improvements and considerable effect in self-care and biological outcomes, particularly when the TPE constructs were utilized in combinations of two or more. PROSPERO, registration number CRD42024601438.

OBJECTIVE:To highlight the unique challenges faced by individuals with co-occurring Type 1 Diabetes (T1D) and Attention Deficit Hyperactivity Disorder (ADHD), and to advocate for the adaptation of Therapeutic Patient Education (TPE) through tailored strategies and interdisciplinary care models. METHODS:Using the COM-B model (Capability, Opportunity, Motivation - Behavior) as an analytical framework, we explore how executive dysfunction in ADHD impacts diabetes self-management. Drawing on current literature, clinical insights, and behavioral theory, the article identifies barriers to effective care and proposes adaptations to TPE that better address cognitive and behavioral needs. RESULTS:Executive function deficits in ADHD impair psychological capability to perform essential diabetes management tasks, while limited access to mental health integration and inadequate caregiver involvement reduce environmental opportunity. Motivational challenges are compounded by repeated experiences of perceived "non-compliance." Tailored education strategies, including simplified routines, technological supports, structured environments, and affirming communication can enhance engagement and outcomes. Interdisciplinary collaboration is critical to implementing these adaptations. CONCLUSION:Current TPE models are not fully equipped to serve patients with both T1D and ADHD. Integrating cognitive screening, personalized education techniques, and cross-disciplinary expertise can close this gap. By embracing neurodiversity in chronic disease education, health systems can move toward more equitable and effective care for all.

Against the backdrop of the obesity pandemic, treating obesity and reducing its complications is a major health challenge. The revolution in the new treatments of obesity represents a powerful tool to meet this challenge with less risk. As a result, the demand for overinvested medications has exploded. The impatience of concerned people to receive such treatments jeopardizes the therapeutic relationship. To find a way out of this predicament, the interdisciplinary team of the Therapeutic Patient Education Unit at the University Hospitals of Geneva has implemented a new therapeutic program for obesity management. It is based on peer sharing, a motivational approach, reflection on the skills to develop to initiate medication, and key learnings, and aims for sustained commitment to behavior change to achieve long-term weight loss.

Recent pharmacological advances, illustrated by molecules such as semaglutide 2,4 mg and tirzepatide, have transformed the management of obesity. New innovative molecules, based in particular on key entero-pancreatic hormones such as glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, and amylin, are currently being studied as monotherapies or in various combinations. Other therapies targeting other pathways, such as the leptin-melanocortin pathway, are also in development. Initial results regarding weight loss are promising, but long-term studies are needed to assess their safety and lasting efficacy. These medications must be part of an overall management approach in which lifestyle changes remain essential to ensure lasting, optimal results.

The treatment of obesity is complex and relies on interdisciplinary follow-up. The new medications promote weight loss without addressing the underlying causes of overweight or obesity. Medication alone, without an interdisciplinary approach, can be detrimental to the patient due to the significant risk of therapeutic failure. These medications do not meet the reimbursement criteria, and the prescribing physician must submit a request for reimbursement authorization and periodically report to the health insurance. The initiation, follow-up, and discontinuation of pharmacological treatment of obesity must be undertaken in partnership between the person living with obesity and the obesity specialist.

Smith-Magenis syndrome (SMS) is a rare genetic disorder characterized by intellectual disability, behavioral challenges, sleep disturbances, and obesity. Managing obesity in SMS is complex due to the behavioral dysregulation. This case involves a patient with SMS who experienced significant weight gain from early in childhood, developing complications such as type 2 diabetes, dyslipidemia, and steatotic liver disease. Initial management with lifestyle changes was insufficient, leading to progressive weight gain. At age 18 years, subcutaneous semaglutide was introduced, resulting in marked improvements in impulsivity, food cravings, and weight control. However, because of a global shortage of this medication, at age 21 years, she was switched to the oral formulation of semaglutide, which led to a relapse in violent behavior, increased food intake, and weight regain. When subcutaneous semaglutide became available again, it was reinstated, stabilizing her weight and behavior. This case underscores the potential of glucagon-like peptide 1 receptor agonists (GLP-1 RAs) in managing both obesity and behavioral symptoms in SMS. While injectable GLP-1 RAs show promise, further research is needed to determine why they may be more effective than oral formulations. Further studies are needed to confirm the effectiveness of GLP-1 RAs and the dosage and explore alternative treatments for long-term obesity management in genetic syndromes.

Recent pharmacological advances, illustrated by molecules such as semaglutide 2,4 mg and tirzepatide, have transformed the management of obesity. New innovative molecules, based in particular on key entero-pancreatic hormones such as glucagon-like peptide-1, glucose-dependent insulinotropic polypeptide, glucagon, and amylin, are currently being studied as monotherapies or in various combinations. Other therapies targeting other pathways, such as the leptin-melanocortin pathway, are also in development. Initial results regarding weight loss are promising, but long-term studies are needed to assess their safety and lasting efficacy. These medications must be part of an overall management approach in which lifestyle changes remain essential to ensure lasting, optimal results.

Glucagon-like peptide-1 receptor agonists have revolutionized the management of obesity. However, when they are discontinued, often due to reimbursement limitations, there is a high risk of weight regain. This is linked to complex biological mechanisms, including hormonal disruption, a drop in basal metabolism, and dysregulation of central reward circuits. Lasting weight loss is best achieved through a gradual transition, accompanied by professional and interdisciplinary follow-up that includes nutritional, psychological, and behavioral interventions, as well as adapted physical activity. A comprehensive approach based on therapeutic patient education is essential for maintaining long-term therapeutic benefits and preventing rebound effects.

Migrant and allophone people often face linguistic, cultural and structural barriers, with limited access to healthcare. To address this issue, the Therapeutic Patient Education Unit has created at the University Hospitals of Geneva a new therapeutic programme specifically for these people living with obesity. It includes educational workshops tailored to their language skills, health literacy and migratory background. An interdisciplinary team, with the support of interpreters, works together to provide inclusive and personalized care, promoting persons' autonomy. The aim of this innovative scheme is to reduce health inequalities, improve access to care and enhance persons' ability to manage their illness in an environment that respects their cultural diversity.