30 years ago, when I was a young PhD student, we didn't talk about obesity, we didn't talk about overweight, for many reasons, of course. There were not as much overweight and obesity back then, but we also didn't really have tools to help our patients with this issue. The game has changed, because we now have these new tools. My name is Tina Vilsbøll. I'm a medical doctor. I’m a professor at Steno Diabetes Center Copenhagen, Denmark, where I'm a clinician but also a scientist. And I'm also the Honorary Secretary of the EASD. And I was asked, actually, to share my thoughts about where we come from and where I see that we are going in respect to the impact of overweight and obesity itself but also related to diabetes. And honestly, I remember 30 years ago, when I was a young PhD student, we didn't talk about obesity, we didn't talk about overweight, for many reasons, of course. There were not as much overweight and obesity back then, There were not as much overweight and obesity back then, but we also didn't really have tools to help our patients with this issue. Many things have happened. The surgeons have been better in doing bariatric surgery, different types of bariatric surgery, but also within the last ten years, indeed, and mainly the last two years, we've actually had tools in our toolbox to help our patients with diabetes and obesity to improve their body weight. But one of the major things that I'm actually worried about is the development in obesity and overweight, because what we can actually see that it's not only old males late in their life that are overweight or obese. It starts early, even in a country like Denmark, where I'm from, one out of five kids, when they start school, actually, are struggling with overweight. And if you become or have overweight at an early point in life, you're more prone to have type 2 diabetes. And we talk about a certain threshold of coronary heart disease. And if you're overweight and obese early, you reach this coronary heart disease threshold earlier. You are at a high risk of developing cardiovascular disease, cancer and many other things. So, what has actually happened in the recent years? Mainly the treatment has changed due to drugs that actually do not only improve glycaemic control but also improve body weight in individuals with type 2 diabetes. Added on to that, it also saves lives. We've had a lot of patients participating in cardiovascular outcome trials. So the game has changed, because we now have these new tools. And when we’re talking about treatment of overweight and obesity, it is of course GLP-1 based therapies that are the backbone, not only the monoagonists, which have now been on the market for a long time, very beautiful effect on HbA1c but also a dose-dependent effect on weight reduction. Last year we had the first trial, the SELECT trial, demonstrating that in 17,000 individuals with overweight, high risk of cardiovascular disease, GLP-1 was actually able of saving lives. But that was just the first trial, because a lot of other compounds are in development. Right now, it's actually more than 70 peptides that are in human development, so from phase one to phase three. It's difficult to keep an overview, and, of course, we should focus on those that are in phase two and three or are already on the market. And we're talking about monoagonists, we're talking about dual agonists, we're talking about triagonists. And then at the EASD this year, we actually also have seen a lot of data where amylin has been added on. And what we have seen so far is really interesting. It's a two-digit decrease in body weight, improved glycaemic control, and in the future will see more trials in respect to change in cardiovascular disease. So right now, a lot of really exciting things have happened, more to come. And right now, guidelines are almost being rewritten per conference we go to. But there's much more to be seen in the future. We have now for a very long time had bariatric surgery as a backbone for obesity treatment. There are still a lot of people seeking treatment for obesity with respect to getting a bariatric surgery. But what we also see now is that with the new drugs that we have in the pipeline, more and more people have realised that having overweight or obesity, with and without diabetes, is dangerous. But one of the big challenges out there is that in many countries, bariatric surgery is part of the things that you actually offer for free, whereas in general, there's no reimbursement on the GLP-1 based therapy. And that's a challenge. My dream as a diabetologist interested in overweight is that we skip the short-term costs. We need to consider what's the benefit for the patient, but also the long-term effect, because by giving a good treatment you avoid cardiovascular disease, cancer, give a better quality of life and so on. So, we look at the individual and consider what's actually best from an evidence-based therapy. Should this patient have a bariatric surgery? Should he have medication? In many cases, medication could be an added benefit if you have patients on antidepressive or antipsychotic medication, they might not need it for life, but for a period where life has struggled. But it's actually one of the things that we discuss a lot: Who should get the medication? And as a clinician, you should discuss it with the patient. You should consider what tools do you have in the toolbox and what is actually possible for the individual to afford. Talk to the patient. Consider how far are you from target, what tools should we use. Is it bariatric surgery? Is it medication? Is it diet or exercise? Do not forget diet and exercise. It should still be a backbone for the treatment of individuals with overweight and obesity. We need to keep the patient in the centre and really keep a holistic treatment. So, it's not only the giving a prescription, it's also cost, it's implementation. It's keeping the patient on the drug and acceptance without stigmatising the patient.