In a joint session at the 33rd European Congress on Obesity in Istanbul, EASO and EASD discussed metabolic health across the lifespan. Prof. Matthias Blüher, EASD Honorary Secretary, explains why obesity and diabetes research are increasingly inseparable; from PMOS and menopause to sarcopenic obesity and future joint guidelines.
“Obesity is not only a major risk factor for type 2 diabetes. It can also worsen outcomes in people living with type 1 diabetes and contribute to so-called double diabetes. Treatment strategies therefore need to consider weight, glycaemic control, cardiovascular risk, renal health, and quality of life together”, explains Prof. Matthias Blüher, clinician scientist at the University of Leipzig and Head of the Institute of Metabolism, Adiposity and Vascular Research at Helmholtz Munich.
In the joint EASO/EASD symposium at ECO 2026, experts addressed central questions for contemporary metabolic medicine. They focused on critical phases in life, in which metabolic health may deteriorate: puberty, early adulthood, menopause, and older age. This lifespan perspective is important because risk does not suddenly appear at the moment of diagnosis. Changes in body composition, hormones, fat distribution and insulin sensitivity may begin much earlier, and prevention is most effective when clinicians recognise these transitions in time.
We recognise that obesity may be the driver of many cases with type 2 diabetes. It may worsen the outcomes in patients living with type 1 diabetes. It may require a specific treatment approach. My name is Matthias Blüher. I’m a clinician scientist from the University of Leipzig, focusing on diabetes and obesity treatment. I’m also responsible for the Institute of Metabolism, Adiposity and Vasculature Research at the Helmholtz Centre in Munich. I’m the Honorary Secretary of the EASD, being responsible for the next two EASD congresses in Milan and Budapest next year. So first of all, EASO and EASD grow together because of the topic overlap. Obesity is a risk factor for the development of type 2 diabetes and most likely the most important risk factor. But there are also a couple of other overlaps between obesity research and diabetes research, thinking about double diabetes in people living with type 1 diabetes, for instance, or how do we treat patients which have type 2 diabetes but also obesity in the right way? The topics covered for this conference reflected metabolic health across the lifespan and critical phases of deterioration of metabolism, namely puberty, early adulthood, but also menopause, the elderly patients. And we covered also aspects of men’s health. So we are really up to date here. Just 24 hours ago, PCOS has been proposed to be renamed into PMOS, which is Polyendocrine Metabolic Ovarian Syndrome, because the cysts are not anymore the hallmark of the pathophysiology, but rather the endocrine dysfunction. Metabolism alterations in metabolic function, that includes hyperglycaemia, that includes fat distribution disturbances, also adipose tissue dysfunction, they are all contributing factors in addition to insulin resistance for this PMOS. There are therapeutic implications, not by the name of course, but by the pathophysiology. Again, obesity, insulin resistance play an important role, affecting fertility, quality of life, but also the metabolic outcomes for women living with this condition. Menopause is a critical age for women with a lot of transitions. There are psychological changes and factors, there are metabolic factors. The talk from Alexandra Kautzky-Willer focused on the metabolic aspects. And we learned – that is not novel, but reinforced – that the changes in the perimenopause are very much similar to the changes in obesity development. And the topic was that women at this age, at this phase of their life, are still not treated well in the context of awareness of the disease. Visiting people for regular check-ups for cardiometabolic risk, for instance. So I think this is new, that we have to learn that with modern pharmacotherapies and other therapies, we frequently come too late. And here prevention of the diseases would be key. A frequently forgotten group when we talk about metabolic health across lifespan are elderly people. The definition of elderly is somewhat arbitrary, of course. But if we take people who are 75 years and older, we have not many study data suggesting which treatment may be the best. We don’t really rely on the biological age. We do not really know which medications work better or worse in elderly people. Professor Patel introduced studies on men’s health across the lifespan. There is something similar to the menopause period in men. Their testosterone production goes down. A lot of symptoms such as fatigue, decreased libido, erectile dysfunction, metabolic impairments go along with this phase. So men’s health is a topic that is sometimes underrecognised because we do not have an equivalent of the menopause time in men. It’s more gradually deteriorating over time and that may be overlooked. So here awareness is also a big issue. So coming from the EASD perspective and this perspective as a diabetes clinician scientist, we recognise that obesity may be the driver of many cases with type 2 diabetes. It may worsen the outcomes in patients living with type 1 diabetes. It may require a specific treatment approach. So I think in the future EASO and EASD will even further grow together. We will look into joint statements, we will design symposia, but beyond that we also need to think about guideline development together with the ultimate goal to improve health and the lives of people living with obesity and diabetes. And here I think we can only take advantage of joining forces.
Video transcript
One of the most topical issues discussed was the recent renaming of Polycystic Ovary Syndrome (PCOS) to Polyendocrine Metabolic Ovarian Syndrome (PMOS).
“The new terminology reflects a broader understanding of the condition: Ovarian cysts are no longer regarded as the defining feature. Instead, endocrine dysfunction, insulin resistance, hyperglycaemia, altered fat distribution and adipose tissue dysfunction are increasingly seen as central components,” says Blüher. He noted that obesity and insulin resistance influence fertility, quality of life and long-term metabolic outcomes in women affected by the condition. Therapeutic approaches currently include behavioural strategies, nutrition and physical activity. But incretin-based pharmacotherapies have proven very effective and well tolerated in this particular subset of people at risk for type 2 diabetes and further obesity progression.”
Prof. Alexandra Kautzky-Willer from the Medical University of Vienna presented menopause as another phase in which metabolic risk can accelerate rapidly. The decline in oestrogen is associated with changes in fat distribution, including a shift towards central obesity, which is linked to higher cardiovascular risk.
“In a relatively short period, women may catch up with men in terms of cardiometabolic risk, yet the awareness and monitoring of this transition remain insufficient,” stresses Blüher.
The session therefore highlighted prevention and timely diagnosis. Regular cardiometabolic check-ups around the menopause, earlier attention to weight gain and fat distribution, and appropriate use of modern therapies may help prevent clinicians from intervening too late.
Older people were described as a frequently forgotten group in metabolic medicine. For adults aged 75 years and above, clinical trial evidence remains limited, and treatment decisions cannot rely on chronological age alone, as Dr. Claudia Coelho, Guy’s and St Thomas, London, elucidated in her talk at the joint meeting.
Assumptions about older patients have changed, Blüher summarises: “Metabolic and bariatric surgery was once often restricted by age, partly because benefits were expected to occur too late. Newer evidence and clinical experience suggest that older adults may still benefit from effective obesity and diabetes treatments such as bariatric surgery. Another example is incretin-based therapies such as semaglutide and tirzepatide that showed the same beneficial effects when it comes to weight loss, weight stabilisation and glycaemic benefits even at higher ages, although individual tolerability and comorbidities must be assessed carefully.”
Sarcopenic obesity adds another layer of complexity. In older adults, weight loss without muscle preservation can undermine mobility and independence.
“Therefore, we strongly recommend an exercise strategy that combines strength training, endurance and coordination!” emphasises Blüher. Modern pharmacotherapies like semaglutide and tirzepatide have already proven that between 20 % and 30 % of lost weight is lost muscle or connective tissue weight. Future research may also explore treatments that preserve muscle mass or mimic some of the metabolic effects of exercise.
The symposium also addressed men's health across the lifespan. Unlike menopause, age-related hormonal changes in men often occur gradually, making them easier to overlook.
“Professor Dipesh Patel from the Cleveland Clinic London explained that declining testosterone may be associated with fatigue, reduced libido, erectile dysfunction and metabolic impairment. Treatments such as incretin-based therapies, metformin, SGLT2 inhibitors and testosterone replacement may be relevant in selected patients, but safety signals – including possible cardiovascular side effects such as arrhythmia or atrial fibrillation – require careful consideration”, summarised Blüher.
For Blüher, the future lies in closer cooperation: “Obesity may be the driver of many cases of type 2 diabetes and may worsen the outcomes in patients living with type 1 diabetes. Management of obesity and diabetes grow together at all levels. And I think it is about time to use the joint resources for funding but also for research efforts to go together and consider obesity not only as a risk factor, but also as an important medical health problem that may affect any of the health issues and diseases we are talking about, but particularly type 2 diabetes and double diabetes.”
The joint session in Istanbul is therefore likely to be part of a broader development. EASO and EASD may collaborate further on symposia, joint statements and guideline development. The ultimate goal, Blüher stresses, is to improve the health and lives of people living with obesity and diabetes by combining expertise, research resources and clinical perspectives.