Primary care approach to obesity and MAFLD

  Andreea Cuidin
  Specialist in Endocrinology and Nutrition

Dr. Andreea Ciudin, female, born in 1979, PhD, is a specialist in Endocrinology and Nutrition at the Hospital Vall d'Hebron, Barcelona, Spain and Associated Professor of Physiology at Universitat Autónoma de Barcelona, focusing the clinical activity in obesity and its complications. Dr. Ciudin coordinates the Obesity Unit of the Vall Hebron University Hospital, since 2013 which is a EASO- COM. She is the treasurer of the Spanish Society for the Study of Obesity (SEEDO), the coordinator of the working group of obesity and its complications of the same society and co-chair of the Obesity Management Task Force and member of the executive board of the European Association for the Study of Obesity -EASO. Dr. Ciudin is a senior researcher of the Diabetes and Metabolism Research Group (Vall Hebron Institut de Recerca-VHIR) as PI of the research line in Obesity and its complications, mainly focused on MAFLD, cognitive impairment, medical aspects of bariaric surgery and sarcopenic obesity, as well as clinical trials in obesity.

Metabolic dysfunction-associated steatotic liver disease (MASLD), formerly known as non-alcoholic fatty liver disease (NAFLD), is a chronic, progressive condition affecting about 38% of the global population. MASLD has become the most common chronic liver disease worldwide, associated with high risk of progression to steatohepatitis (MASH), liver cirrhosis and hepatocarcinoma. Its prevalence is closely related to obesity, defined not by body mass index (BMI), but as adipose-based disease (excess and dysfunction of adipose tissue, associated with insulin resistance). In this context, currently MASLD can be considered a metabolic dysfunction hallmark, regardless the BMI. Despite being such a prevalent condition, with such severe consequences, at present there are no reliable biomarkers for its diagnosis, or specific treatment. Significant and sustained weight loss, as well as some treatments for obesity and/or type 2 diabetes, have shown promising results for MASLD. However, these data need confirmation is larger clinical trials and longer follow-up. Efforts should be made for a better and personalized approach for patients with obesity and MASLD. In this regard, health care providers in Primary Care play a crucial role. Furthermore, the collaboration between Primary Care and specialized clinics is fundamental during the life span of the patient. Efforts should be made to provide and accurate screening in Primary Care, followed by proper phenotyping and identification of patients at higher risk for progression to MASH (including genetics) in specialized clinics, as well as adequate treatment in both settings.

Learning outcomes:

  1. Biology of Obesity as chronic, relapsing disease based on excess and dysfunction of the adipose tissue
  2. Physiopathological relation between obesity and MASLD: how MASLD is the hallmark of obesity
  3. Therapeutic approach of MASLD in the context of Obesity


Learning objectives:

  1. Screening approach of MASLD in Primary Care in the context of Obesity
  2. Therapeutic approach and chronic management of MASLD in Primary Care in the context of Obesity


State of the art on the pharmacotherapy for obesity

  Volkan Demirhan Yumuk
  Reviewer for the Obesity Reviews, Obesity Facts, Hormones and Turkish Archives of Cardiology.

Professor Yumuk graduated from Hacettepe University Medical School in Ankara. After completing his internal medicine residency, he became a reaserach fellow at University of Michigan School of Medicine division of endocrinology in 1993. In 1997 he completed clinical endocrinology fellowship program at University of Alabama School of Medicine. Currently he is working at Cerrahpasa Medical Faculty Endocrinology, Metabolism & Diabetes Division as a full professor.

He is a founding member and current president of Turkish Association for the Study of Obesity; is currently serving as president elect for the European Association for the Study of Obesity (EASO). He is a SCOPE Fellow, EASO-European Fellow in obesity management, and a member of the editorial board for Obesity Facts.

Dr. Yumuk is an active fellow of American College of Endocrinology and American College of Physicians. He is a member of the Focus Area Expert Panel on Diabetes, Obesity, Metabolism and Nutrition and a member of the Research Roadmap Steering Group of European Society of Endocrinology, a member of Obesity Canada CALIBRE scientific planning committee, a member of AACE Obesity Algorithm Task Force, a member of the MENA Working Group for World Obesity Federation and a member of the Policy Working Group of EASO. Dr. Yumuk’s research area is management of obesity and type 2 diabetes.

He has published numerous papers in national and international journals, and authored chapters in books in the field of endocrinology. He is also a reviewer for several journals including Obesity, Obesity Facts, Obesity Reviews, Clinical Obesity, International Journal of Obesity, Obesity Research and Clinical Practice, European Journal of Internal Medicine, and Journal of Endocrinology.

Obesity is multifactorial progressive, relapsing chronic disease. Pharmacotherapy as an adjunct to lifestyle intervention is recommended by current treatment guidelines in people with BMI ≥ 30 kg/m2 or BMI ≥ 27 kg/m2 with at least one obesity-related complication. Biological and behavioural phenotype-guided pharmacotherapy may optimize obesity therapy in a precision medicine context.  Bupropion-naltrexone for hedonic eating, phentermine-topiramate extended release for abnormal satiation and GLP-1R analogues can be prescribed for people with abnormal satiety. Obesity management is not only weight loss but maintaining the lost weight by preventing weight regain in order to result in sustainable health gains, through longterm multidisciplinary follow-up.

Learning outcomes:

- Obesity management is no different from handling of other non-communicable diseases

- Obesity pharmacotherapy, especially second-generation anti-obesity medications, are expected to fill the gap in between lifestyle interventions and bariatric surgery


Learning objectives:

- Awareness of obesity pharmacotherapy and its outcomes

- Position current paradigm shifts in multidisciplinary obesity treatment algorithms