Making an Impact in the Field of Obesity (ECN eLearning Hub Launch)

• Professor Liesbeth van Rossum’s book is called Fat: the Secret Organ: The surprising science behind the most misunderstood part of the body

Transcripts are auto generated, if you spot an error, please email enquiries@easo.org

Good evening, my name is Brittan Jensen, and on behalf of the EASO Early Career Network Board, I would like to welcome you all to this very first e-learning hub. We are delighted to see that so many have signed up to participate today. And participating today from the EASO board are also Lisa Hedje, who will be chairing the session, Niamh Arthur, Bram Berndsen, and Silas Frønby, who will chair the chat function and technique, as well as Bidja Kallikoglu.

Before we start, we would like to say a few words about the Early Career Network. The aim of the network is to create opportunities for early career researchers and health professionals to meet and learn from each other. And this e-learning hub is the first of a series of online seminars.

If you're not already doing so, please follow the EASO Early Career Network on Twitter and Facebook, and join our group at LinkedIn, where we'll share information on upcoming seminars and events. We also hope that many of you have applied to participate in the winter school that will be held in Seville in December. And we hope that you plan to participate in the European Congress on Obesity in Dublin in May next year.

The call for abstracts is now open. So Lisa, over to you. Okay, thanks, Britt.

Hi, everyone. I just wanted to start by saying a huge thank you to our guest speaker, Professor Lisa Van Rossum, for your time and for your willingness to share your expertise with EASO's Early Career Network members. I also wanted to thank all of you as the audience and hopefully active participants of the question and answer session for your enthusiasm and for your interest in the launch session of the EASO's eLearning Hub.

So it's my pleasure to be chairing the session today. And just to quickly introduce myself, my name is Lisa Heggy and I'm a PhD student based at University College London. So I will be briefly introducing our guest speaker before handing over the floor for around 45 minutes, after which we will move on to a question and answer discussion session.

If you have a question for our speaker throughout this webinar, please enter it into the chat and we will ask it at the end. Or in Q&A session, you are really encouraged to raise your virtual hand and turn on your camera if you haven't already and use your microphone to ask a question. Or again, you can just ask within the chat.

So I want to quickly introduce our guest speaker. So we have Professor Lisa Van Rossum, who is an internist endocrinologist and professor in the field of obesity and biological stress research at the Erasmus University Medical Centre, Rotterdam in the Netherlands. Professor Van Rossum is a co-founder of the Obesity Centre CGG, which is a centre for diagnostics of underlying causes of obesity and personalised treatments.

This centre is also one of EASO's collaborating centres for obesity management. Professor Van Rossum obtained an MD and PhD and performed an obesity research fellowship in Baltimore, USA. She has received many international awards and grants for scientific research and is frequently an invited speaker to scientific congresses, international media, TEDx, and has also published with colleague Mariette Boone in an international best-selling and award-winning book named Fat, the Secret Organ.

The surprising science behind the most misunderstood part of the body. In 2020 and 2021, Professor Van Rossum is appointed as a top 10 most influential woman in healthcare in the Netherlands. Her mission as a doctor, scientist, and administrator is to diminish the international epidemic of overweight and thereby contributing to physically and mentally healthier societies.

So just a final note for me before I hand over to our speaker we will be circulating a feedback form at the end of today's session. And so I'm really looking forward to hearing your thoughts on the launch webinar. I'll now hand over to Professor Lisa Van Rossum and thank you again for your time.

And we're really looking forward to learning from you. Well, thank you so much for this very kind introduction and also thank you all the organisation of the ECN of the EASO and the EASO itself by this really great invitation. It's really for me a great honour to be here the first speaker at the e-learning hub and especially about this topic of how to make impact as a researcher.

And I maybe want to start off with first a question to the audience, to the participants right now. Because I'm really curious because some are researchers, some are clinician, maybe some are both. I would like to know, are you either researcher then raise your hand.

It can be digitally I think. Yeah, oh yeah, you can do very simple like this. Yes, and who's clinician and who's both.

So mainly researchers if I had it right, yes. Okay, thank you so much. Well, let's start off, I will start off with sharing my presentation.

Let's see. I know we'd love to hear whether it's visible like this. Yeah, perfect.

Thank you so much. So how to make impact? Well, I took some examples in the field of obesity because as for example, as a researcher, many people know how to be successful in general. These are the common parameters, we have to publish, obtain grants, invitation for presentations, for boards, professorships, we all know.

But that doesn't necessarily make you make really an impact. So how can you make impact as a researcher or as a clinician? Well, to start off, first a disclaimer, I don't have any manual like for a washing machine, how to make an impact. The only thing I can do is to share my own story with you to see what I experienced, what didn't work and what did work to make any impact.

And the story of my life actually started in 1975 and I will not start there and bore you with this, but I will take this period in life when, and I'm about somewhere here now, she's looking a bit older already, maybe I'm 47. So I'm sort of midlife and in this part of my life, I will share my story with you. And it started actually back in the 90s, 98, when I was a student, a medical student and I was doing research at the lab.

I was actually looking for leptin receptors and at that time was really exciting because well, it was just discovered that leptin was existing. And so there was a huge interest in leptin and of course as obesity researchers, you know leptin is essential and it's a fat hormone. And if you have a lack of leptin or you have a resistant receptor like this little girl here in the screen as one of our patients, then you are developing obesity at a very young age or have increased appetite.

So looking at this leptin receptors, I was doing experiments. However, at this specific cells I was looking at, I couldn't find them. Day in, day out, I did a lot of research and experiments and every time they failed.

But somehow I felt research should be more fun than only filled experiment. Somehow I got interested in research and I obtained a fellowship, actually scholarships to go to the US and do some research there. And there I found out actually that research can be really fun.

So I went to Baltimore and thereafter I obtained my medical doctorate and I did after the research fellowship and I did a PhD back in the Netherlands and I started my internal medicine residency. Then I had another very important malpoint and I got mother of my first child. I became internist endocrinologist in the Rasmus Medical Center and then I started to do my dream.

And my dream was actually to co-found the Obesity Center. I really have to introduce you my small friend here because she opened the door herself. So maybe you can ask my, Tim, can you say Mihaela? Okay, maybe she will introduce herself anyway, but I started to actually do my dream because I saw, well in Baltimore, really I found that obesity research was exciting and that obesity was way more complex than I thought it would be.

So I started, my dream was to start my own obesity center in the Netherlands. Then a couple of years later, I became professor in the field of obesity and biological stress research. And I became leader of the obesity diabetes fields of the European Society of Endocrinology, which is a great honor being an endocrinologist.

Well, in the way there, I started obtaining grants and at the same time, yeah, oh, my son is already saving me from my cat. Thank you so much. So we obtained funding, but I want to stress that obtaining funding is a lot of work.

And for every 10 proposals writing, you maybe receive one or two. So sometimes it looks really successful, but people don't realize that a lot of field grants are also in the same years. I also had some board functions and also an advisory role.

So the minister, I come back to that later, became a member of our Royal Dutch Academy of Sciences. And indeed, we wrote a book together with a colleague of mine. I come back to that later.

So if we would say there are some ingredients to how you can have an impact as a researcher or as a clinician. And it's basically a combination of these factors, planning, personality, networking, visibility, and maybe also luck. So I will go with you through all these things.

Well, when we talk about planning, you can choose your research topic. For example, you focus on one or two topics. And what is a good topic? Well, maybe if the field you're working in is about a rare disease or anything, for example, but then the disadvantage can also be to get cases, for example, in that field.

The advantage is that you are rapidly, you can be an expert in that field. So maybe the ideal topic will be a topic that's quite frequent for obesity, for example, but has a small research field. But important to choose a topic where you're deeply interested in.

So let me give you one example. For example, we did a couple of years ago, started doing a cortisol measurements in scalp hair. What that was a new biomarker for chronic stress.

So your chronic stress hormone level, you could measure actually in hair. I took it from the forensic medicine. They already did steroid hormones in hair, but you actually could do it also in humans.

And the field of interest is large. I mean, stress hormone can be related to obesity, metabolic syndrome, psychiatric disease, whatever. But at the time, there were only four laboratories in the world who were able to do this hair stress hormone measurements.

And that was a chance because we had lots of collaboration all over the world and people could just send us hair and we could renew the technique, we could give feedback on the levels. So that was easy. Then personality can be a factor also in how to have an impact.

And well, I think this is important that you will have, but it's needed to have a real interest in and enjoyment of research because research is demanding. It costs a lot of time, money and sometimes also private life, but you need to be proactive. And important, research is not only about success.

Actually, in every research project, there are always failures and there are many challenges and hurdles. And I always loved this expression of Winston Churchill stating that success consists of going from failure to failure without a loss of enthusiasm. I think that that's a really good topic.

Also have attention for your working and private life because your loved ones, they are so important in life. So also keep eye on them, have attention for them. This is my family actually.

So then networking, that's also something we can do actively, something about it. And I was a person who was used to, I think a couple of years ago, I was more of a person maybe a bit shy standing when there's an important researcher standing at a party or anything, at a Congress. Always there are people around and when to start networking is hard.

And sometimes you need to be proactive, but also to know how to talk about your research. If you start talking about details half an hour, everybody get bored. So what we helped was actually create an elevator pitch also for networking.

If someone asks you, well, what are you doing research about? What's your field? Well, have some nice words. Then you can have an easy topic to discuss and to exchange ideas. I learned doing an elevator pitch, which also helped dealing with the press and the media training.

And this was the basics. And there are many, just Google elevator pitch and there's so many good advices out there. But it's basically that you frame your research and you start and end with your main message.

Using a metaphor is also crucial in there. And maybe there should be something in there like a wow factor. Should be very short, not containing any professional lingo and practice it and be convincing.

That's all the ingredients I learned about an elevator pitch. And around that time, I actually had this media training. We had a couple of publications and then one of that was about hair cortisol as a long-term stress measurement.

And it was associated with increased risk of cardiovascular disease. And actually the risk on cardiovascular disease when we had high cortisol levels in our hair was almost the same like having diabetes or smoking. Actually my PhD student here, Laura Mannesheim in the right, she was really talented at PhD working on that.

And we gained press attention. A lot, several things, but one of them was around Christmas time. And you know, Christmas time, there is no news.

And it was second Christmas day. A lot of people watched the national news and because there was no news, our paper became news. And they didn't even take our major breakthroughs that we thought, well, there are some research findings noted to give us a breakthrough that stress can be measured in hair.

Okay, that's how they translated. And at the same time, also the Endocrine Society in the US did a press release about our work that indeed stress was tied to heart disease and diabetes. And that yielded press attention.

And then it's sort of starting to roll. And sometimes when it starts with a written press, it also starts to go to television, for example. And there was one day, it was one of my very first television performances.

And I remember exactly that specific day. There was being called by national television program and they asked me, would you like to be our guest in studio tonight at a live show being viewed by millions of people, which has a lot in our small country of the Netherlands. And well, they said, well, but maybe we also will invite a secretary of state tonight.

And we need actually seven researchers for our topic. But if the secretary of state is coming, we only need three researchers. And I was on my way to my outpatient clinic, not prepared for any TV program.

So I went to my outpatient clinic thinking, well, probably they will not need me because out of seven, only three will exist when the secretary of state is coming. So I didn't really take it too seriously. So I went to my outpatient clinic and I saw my patients, but then at around three to four o'clock or so, they called again.

Well, we would like definitely to invite you as one of the researchers and the secretary of state is coming. And then at once I was scared because I figured so many things could go wrong. I actually had a bad hair day that day.

I was not wearing any clothes what I could wear on television. And I find so many hurdles and so many reasons not to go. Also, I had to hurry because I mean, I was still running my outpatient clinic and it was a live show and it could be a traffic jam and I will be probably too late and how to handle.

Well, they solved everything. They sent a car with a driver and whatever. So sometimes you just have to step out out of your comfort zone and I actually did.

So I went there and in the car, I remember very well back in the seat, I started to write an elevator pitch. I picked up a piece of paper and I wrote my elevator pitch because I had only a few minutes. And I wrote it down on some words and I memorized it so that I could do it spontaneously.

And that worked, it actually worked. And what I learned that the benefit was very unexpected for me because not the lay audience is watching television, but also researchers. And the very next day, I had lots of new research collaboration among which also colleagues from another university medical center in the Netherlands.

And they had really great studies using the immune system and looking at the effects of cortisol in the Iceman, which is a famous person can stand in cold and his immune system is improved by the cold. And they asked for collaboration to investigate cortisol levels. So for the first time I realized that not only lay audience, but also researchers are looking the television and it's very easy to network on that.

And well, of course you also sometimes need luck and favorable circumstances. And if the circumstances are favorable, just grab them. But also what can help is visibility.

And that's maybe also in line of the networking thing because visibility will help you also to have new collaborations. And one of the examples to create visibility in our experience was when we opened our Obesity Center C2G in Rotterdam, which was my dream when I came back at United States and how to open a center. Well, we first figured we should ask maybe the mayor of Rotterdam, because we live in Rotterdam and ask him to open it.

And he was a famous man, but he was way too busy to come to our Congress. Okay, to our opening Congress. Okay, so he sent his representative of the municipality.

Then we asked the Minister of Health to come. Well, of course too busy. And she sent a representative of the Ministry of Health.

Then we figured, okay, well, maybe we should just ask the queen, the queen of our country, Queen Maxima. And we wrote a letter and to our surprise, she came. And what we didn't realize is when the queen is coming, that the mayor of Rotterdam was obligated to come as well and to open the door of the car of the queen.

So at once we had the queen there, we had all kinds of important people, but also the board of our university hospital was coming. And actually the important thing is we were able to tell our story about the complexity of obesity and the treatments to an audience, which was important because many other people came because of these people. And that helped because also journalists, of course, when the queen is there, journalists come and we were able to tell our story to newspapers, national newspapers, and years later, this extended because you sort of become an expert nationally of obesity.

So I did together with my colleague, Iroka van den Acker. She's a pediatric endocrinologist and she's doing the childhood obesity and I'm doing the adult obesity in the country. But then the next point is how, and that was a really important thing.

How can you make knowledge accessible to society to a large extent? And I think this is one of the main drivers for me in the field of obesity that we know, and you will recognize that being also expert in the field of obesity, that we have a lack of knowledge in society about obesity and a lot of judgment there. Now, to go back to some content, and I realized that as obesity experts, you already know about that, but let me take you to some content. I think there was a lack of this knowledge in lay public, but also in policy makers.

And that is, for example, that fat mass is an endocrine and hormonal organ producing about 600 hormones and substances, which are really important for the immune system. And as you all know, when you have too much fat, which is the case in obesity, your fat hormones become disturbed, and your body and your fat becomes in a pro-inflammatory state. And that is leading to more than 200 diseases.

You'll know diabetes, cardiovascular disease, 13 forms of cancer, depression, joint problems, you name it, so many diseases. And often people think that this is one of the major causes unhealthy lifestyle, but there's also sort of a judgment. So if you just eat less, move more, then the problem is solved, which we know it's not as simple as that.

And why is it not as simple as that? There are many reasons, but one of the reasons is that there are many other causes than only unhealthy lifestyle. And as you know, 40 to 60% of your weights are already determined in your DNA. And one of the things which is determined to your DNA is for example, how is your homeostatic system working, your appetite being regulated? And as you probably know, when we start eating or thinking of eating a food, then our body starts to make ghrelin, hunger hormone.

And after about 20 minutes, our homeostatic system will start producing cytokine hormones, PYY, CCK, GLP-1. And still, sometimes you feel really full, but you can still eat, but only when you really like it. And that's because you have an hedonic system.

And both systems are also important targets for treatment. Now you can importantly disturb your hunger hormones by crash dieting, ultra processed foods, by mental status, but also many other factors like social culture, microbiome disturbance by antibiotics, for example, sleep deprivation, stress, medication use. And of the latter one, I will show you one example, which sometimes storytelling helps also to tell the complexity of obesity to others.

And medication is really a big thing. And maybe one short story, I had a patient, this is John, and he was gaining weight all the time. And he was actually living really healthy, a healthy eating pattern.

He was exercising every day. He was actually walking with his wife every day. And his wife confirmed that he was really living healthy, but he was still gaining weight.

And actually in the last year, he gained 30 kilograms of weight in one year. He turned out to use corticosteroids and all over his body in a high dose. And after talking to his dermatologist and we replaced this corticosteroids with the same healthy lifestyle, he lost 35 kilograms.

So this is one of the examples you can see, there's a lot of influence of medication in some patients, not in all. So basically this is a list of underlying causes and factors which can potentially contribute to weight gain or impair weight loss. And so it's not as simple as only lifestyle.

Of course, unhealthy lifestyle is for many people an important cause, but also mental factors can play a role. Medication, hormonal factors, like a third function problems or an amino pulse, but also sometimes rare medical disease. So first proper diagnostics.

So I would like to illustrate some society impact by some examples and society issue I was willing to, I was eager to solve. I thought, well, we need proper diagnostics of underlying causes of obesity, because it's often lacking. People are just, when they come to a doctor, a doctor is saying, well, just go on a diet.

Often it's not, because I mean, going on a diet is not an obesity treatment as you probably know, but also in advance we need to do, what type of obesity is there? Well, there was also one of the aims of our obesity center. Here you see my colleague, Erica van der Acker, one of our main points. Why? Because then you can target your treatment on the person who's in front of you.

And also be innovative with the treatments. So looking at this schedule, how could we gain attention for it? How can we implement it in society? Well, one was through National Guideline of Obesity, and we managed to, with a scientific force, first, of course, a scientific publication, you see it here in Obesity Refuse, and it is now part of the new Obesity National Guideline. Next, we introduced it in our National Network Approach of Overweight.

We are developing a whole network approach, maybe one slide to show you, to tell you about that. We have in the Netherlands, we often have the medical domain, so the GPs in the hospitals, and we are treating all the comorbidities of obesity, but not obesity by itself. Why? Because we can't find in the social, where in the social domain can I find any help for depth counseling or social teams? I just don't know how to find them, or a lifestyle coach.

Or sometimes you have a limited list and it helps, but in the network approach, we have a central care coordinator there, and instead of treating a person with antihypertensive drugs because people are very stressed or having obesity, now we can actually prescribe, go to the central care coordinator, and you will get a warm referral to the help you need, whether it's lifestyle, whether it's a social domain, or back forward from the social domain to the medical domain because you are using medication which is impairing weight loss. So this coordinator is important, and actually they are also now using our schedule with all these factors and screening for what type of obesity are we dealing with. Other things how to implement it in clinical care is education, making e-learnings, talking to the GPs, the internists, all obesity specialists in your country, but also internationally.

We need to spread the word about the complexity of obesity. And last but not least, I wrote a book about it with Maria Bone. I'll come to that next.

Because the next society issue for me, which was really important, is that there's still a stigma and people just don't know about the complexity of obesity. And I noticed that for years, when I went back in the nineties in the research in Baltimore, and I found out it is so complex. People think just eat less, move more, and solved.

And in every journal or magazine, people read how to handle obesity, just go on a diet, and the one popular diet is this and that, and it's so much more than just going on a diet. And we felt that we are responsible to translate the research into a book. And I did together with Maria Bone.

In English, it's FAT, the secret organ. And in September of this year, we have already 16 editions. We updated all the time.

So new, for example, pharmacotherapy options are there, less interventions. It's published in several countries in Europe, but also now getting outside Europe. I'm really excited about that.

And also in the Arabic countries and China, for example, and even got awarded some literature prizes. And this is Maria Bone. She's also an obesity specialist.

I wrote it together with her. So it's made like a major review, but then in accessible way with case reports, that people will recognize themselves. But it's not only for, we noticed that not only the lay audience is reading it, but when it starts also in other languages, that also healthcare professionals read it.

Because for the first time, it's the scientific knowledge and the clinical practice-based knowledge with references in the back. But it's really for the daily practice, people recognize themselves. And what happened is that when we launched the book and it was published, that also the media in other countries started to pay attention to it.

And that was really a way for us to implement the science of obesity in society. Not only healthcare professionals, but also we had impact on policy and policymakers. Very lately, this book was a reference in the European Society of Endocrinology, which is white paper to European Commission.

It was a base for speech in the European Parliament. And last week, actually, it was also mentioned reference number one in a letter to the House of Representatives in my own country by the Secretary of State. So also politicians need knowledge in an accessible language.

And most important, actually, it was also for patients. The patients started to themselves because we thought monogenic obesity would be very rare, but we did the research also in the Netherlands in 1,200 patients who were seeking help in a specialized obesity center. And actually almost 99% was having a definitive diagnosis or a potential diagnosis of a monogenetic or syndromal obesity.

So yeah, it's still relatively rare, but it's not as rare as you thought. Actually, there are very often missed. And when people read the book and they will recognize themselves, oh, I have early age onset obesity, I've increased appetite, so really hyperphagia, and I'm the only one in my family, for example, three alarm symptoms of monogenic obesity.

Well, go to specialized obesity center and there are targeted therapies for some of the genetic obesity, for example. And spreading all these words and this knowledge is teamwork. And here I put them in a slide and the majority of my PhDs and the postdocs in our team have been on television to tell the story, to show the complexity, to explain the things.

And we actually train also the PhDs to do that, to also be able in lay language, how to translate scientific knowledge to large audience. So what I learned is that in TV programs, radio and newspapers, that's a really good way for large scale knowledge transfer to broad public, for individuals, healthcare professionals, but also politicians. Feasibility is good for new collaborations, but also for investors because investors can also watch television.

And we had a really good, great donation by an investor who read about the complexity of obesity. The downside of all these things is, yeah, it's time consuming. And sometimes you get a lot of useless requests.

Well, me help was actually reading this book of Carmine Gallo, Talk Like Ted. And there are really splendid ways how to do, if you do, for example, a small presentation or anything, how to make your point clean. So that's a really great book.

Another society issue is that sometimes treatments are not always available or accessible for a patient with obesity. And in the Netherlands, we had these treatments for obesity, like in the European guideline, are actually also, whilst interventions, pharmacotherapy and baroque surgery. And of these three categories of treatments, only baroque surgery is reimbursed, was reimbursed until 2019.

So basically, that's stunning. And I know this is the case in many other countries that until 2019, lifestyle interventions, pharmacotherapy were not reimbursed. And what happened is that I noticed this, I mentioned this in several television programs, and this television programs here, the Monitor, there was a valuable one, because this one was on a Sunday evening and it's watched by politicians.

And what I told here was basically that I said, well, if a person has, for example, BMI 39, then we can basically recommend only to eat a lot of, or make sure you gain a lot of extra kilograms because then the BMI will be above 40 and you will be eligible for reimbursed obesity treatment, baroque surgery. And actually, that was what I truly sometimes heard from my patients in my own patient clinic, that doctors actually told them, you can better gain a little bit of weight because there's a treatment then. And just telling this on television on Sunday evening, the next morning, on Monday, our Ministry of Health, right persons and our natural healthcare authorities, they contacted me and said, well, we need an appointment in the same week.

We had a really good appointment because I, to say I have been negotiating for years already to get licensed interventions in the basic insurance, but somehow I failed, I didn't get through, you know, it was already in the guideline. I was always surprised, why can I get it through? But the people who I was talking to, they were not at the level of decision-making, but now it was in the news, it was important for them. And what happened is within two years after this contact, we managed to get the licensed interventions, the programs being reimbursed since 2019.

We have new specialized combined licensed intervention reimbursed coming year. And that also paved the way for pharmacotherapy because if you fill on a licensed intervention after one year of treatment, for example, in a program, then you're eligible for pharmacotherapy as an add-on on a healthy lifestyle. So at once you still did still not all, all the treatments are still some lacking, so there's still work to do, but using the media and the visitability and the trust as a researcher or as a clinician or both, you can use it for politicians and also for policymakers in the field of care to realize better health care.

Another society issue is that we know better prevention is urgently needed. And always, well, there's a criticism. Yeah, you should not treat obesity because well, there is the lifestyle or less, not the environment is still obesogenic, which is actually true, but to explain that you need not only treatment, but also primary prevention, I sort of use a metaphor to explain that both are needed because I often see that people say, there's only you need treatment or you need primary prevention.

And with primary prevention, I mean making healthier products in the supermarket, have a sugar tax, make sure the marketing on healthy foods is promoted and not the marketing on unhealthy food. And these all are things which are basically should be done by politicians and by the industry, the retail. So yeah, of course the tap should be closed.

And that's actually a task of politicians or the industry, but actually the bath is already full. In Europe, more than half of the individuals in Europe is already living with overweight or obesity. And there's a task for the healthcare professional, we should empty the bath.

And only when you empty the bath and you close the tap, so primary prevention and treatment, then you can counteract and combat the obesity epidemic. So you need both. In the Netherlands, we have the National Prevention Agreement.

So closing the tap, well, that's part of it. It's really not good enough, but we are working on it to get it better. And as a researcher, as a doctor, we always have to say it also environment needs also improvement because now it's stimulating everybody to develop obesity and we should need an environment stimulating health.

So yeah, using a metaphor helped me to introduce the message. So the last society issue I would like to address, and then we go to the questions, is that of course, when there was a pandemic of COVID or is actually, we know obesity was a great, this was a very important factor. For example, at the Dutch ICU, we know almost 80% was living with overweight or had obesity.

And as you perfectly know, obesity is related to a serious cause of COVID-19 through comorbidities or adipose tissue as a viral reservoir but also through immune system. And at that time, around the first wave, we had a publication of people with obesity. We knew that when they participated in a combined lifestyle intervention, already after 10 weeks, they majorly and significantly improved their immune system, the regulation of their T-cells, for example, and it further improved after, at the end of the program, after one and a half year.

So we thought, well, we have a really nice publication and they were awarded for a specific publication prize. And Elina van der Zalm and Isabelle van der Zalm and Elina van der Valk, PhDs on this, they were awarded with a publication prize, really nice. But no politician will read these papers.

And the same was true for another paper. At the same time, during COVID, we found that, like many others, that all factors which are beneficial in green for obesity, they are also beneficial for immune system and all the factors considering lifestyle, which are in red, are negative influencing weight, are also negatively influencing the immune system. So we thought it's important to have a message out there that politicians say not only hand-washing, social distancing, all these things, which are of course necessary, and vaccines, vaccinations, but this is also a healthy lifestyle, even if you're living with obesity, it's important.

So there we were, sitting there with our nice publications, being very proud as a scientist, but we had no single impact because no single politician would read it, but we felt it's important. So what I actually did, as a Monday evening, I wrote an email and I summarized in lay text what I thought was important about their findings and what the politicians should know. I wrote an email, which became a letter, and the next day, I sort of had an elevator pitch.

So a short pitch about my advices based on our recent research and other research. And I was in a meeting with some people in a whole network and they were influencers, the CEOs of interest industry or former politicians. And it was a small meeting, but they said, hey, this elevator pitch is actually interesting.

Just send us also the letter we would like to sign. And then it started, a lot of important people in the Netherlands started to sign this letter. And at the time I sent it to the Minister of Health, there were so many important names that it really took it seriously.

And actually, a person built a whole website around it. And at the day I sent it to the Ministry of Health, it was so picked up by the media. Probably, I mean, it was for me, never been met for the media.

I even didn't think about it. It was a letter to the Minister of Health, but probably the Ministry of Health had a leakage to the press. I don't know how these things go, but it went to the press.

But that was actually good because it forced politicians to do something with it. And indeed, the very next press conference, our Minister of Health, you see the Prime Minister and our Minister of Health, they for the first time, they said not only social distancing, washing hands, get a vaccination, but they also said, well, important to live healthy, to eat healthy, to move, to exercise, to reduce stress. And also it happened that there was an urgent need for more preventive measures and public campaign on healthy lifestyle.

And after these actions, somehow at once, I was in a top 10 most influencing woman in healthcare and was a LinkedIn top voice next to the Minister of Health and also one of them women of the year, you know, that automatically happened. And not because it was my aim. I never was planning on becoming random woman of the year.

This happened because I have an internal driver and was proactive and also of course lucky, but also was proactive with the content. So my take home messages would be that you can generate impact by combination of all these factors, planning, personality, visibility, networking, and of course luck. But the most important thing is that I think to take home is choose a topic that you're really passionate about and become an expert in a field.

And don't be hesitant, but be proactive to use your knowledge also outside of the academia. I think that's my most important message. And last but not least, realize that making impact is not an individual's effort.

It's a group effort. And I'm happy to show you, you're my very enthusiastic team. I'm so proud of them because a lot of the research we do together to communicate together, together we have to impact.

It's not an individual thing. So thank you very much for your attention. I will stop my screen sharing.

And I realized that I had no opportunity to look at the questions yet. So I see there are some questions in the chat or I should maybe hand over to the moderator right now. Thank you very much, Lisbeth.

Thank you. We have had a few questions in the chat. I just want to thank you very much for such an inspiring presentation and for sharing all of your experiences and your career milestones in the area of obesity.

I'll certainly be off to create my elevator pitch after the session. But first, we will be starting off with the question and answer session. So I do want to just be mindful of the time.

This session was for around an hour, but we are okay to overrun. So if you do have any burning questions, feel free please to stay past the hour and we will get to all of the discussions. So I'm going to open up the floor.

I will just grab the questions that have been asked in the chat. But maybe I'll start off with my own question just to use my chair privileges while I organize the questions here. So I was listening, obviously, and you spoke about your experiences of speaking on the television and speaking about your research when you were on the television and then being contacted by the Minister of Health and how this then went on to support the lives of people living with obesity.

So I just wanted to ask whether you had any specific advice for people who are at their early career stage who might not yet have the standing to be invited onto the TV to speak about their research, but specifically to use the media to maximize their research impact. Are my early career professionals be able to do so with the aims of hopefully when they develop their career being invited onto the TV to speak? Yes, I think that's a good thing because some of the things also happened early in my career, but it was also sometimes there is a snowball effect and how to start snowball, of course, is your question. I think there are great opportunities right now by using, for example, social media.

Because I was not so active on social media at that time, but I think there are great opportunities right now. And I sometimes see other people right now also people who are early in their career, they have a really great post on statement. And then if someone, you can tag people you think they could be a voice of your post.

And if you have a strong message, it can be picked up actually. And I sometimes see early career persons and they start with a LinkedIn post or a Twitter post, which is being picked up by the media. And at once it can explode.

So, and that's an important thing that if it starts to snowball, don't be afraid. I mean, sometimes step out of your comfort zone. I was so afraid my first time on television.

If you start realizing that how many people are watching and what could go wrong. And I see also a lot of people say, no, I don't have time. And there's so many reasons not to go.

But if you start just going and you get also used to it a bit and it really helps the visibility because if you do well and then a media training helps, then the next time they will ask you again. So make use of the first opportunity, try to do well and then the snowball will start rolling. And in this time, I think social media is really helpful for that to have a good post.

And I see also a question here. Did you have any specific media communication training or did you learn anything from this experience which you can offer as tips or advice? Yeah, I think for me, the media training I received when I had one of our national grants, you automatically were off to media training. And at that time I had hardly any contact with media.

So I thought, well, why to do? But I was so glad I actually did it because that whole media training because just right after the things started to happen with the research and then I was less hesitant to do it. And I see that, so media training really helps. And also, or reading the book, what I said, How to Talk Like Ted, it's also really helpful, how to bring a message or anything.

So to be prepared because, and of course, I mean, it's also practicing doing it more often. So for example, with the PhDs, the first times you can do it on, to start on television, regional television, radio, newspapers and help and train, what was your main message? You know, you get so many tricks there. And then when you're more convinced and you know how to tell your story, it can grow in it.

So it's a process, I think, it's really a process. That's great. Thanks very much for such an in-depth answer.

It's great. So we have another question, one from Angelo Di Vincenzo. I hope I pronounced that correctly, one of the audience members.

And the question is, what do you think will be the most interesting research topic in obesity in the future? Yeah, I think for what's a very big topic right now is of course, all this new pharmacotherapy because there's a lot of, the landscape of obesity is changing very rapidly, new techniques in bariatric surgery, there are new types of obesity treatments in lifestyle, but also in pharmacotherapy. And the major steps are now, I think, in pharmacotherapy, but at the same time, there's a very delicate ethical discussion going on in countries because you see a lot of people saying, why using medication against obesity? You should just eat less or we should do the supermarket. You know, and that's exactly the discussion where you sometimes can use a metaphor, okay, we should close the tap and empty the bath or any other metaphor to say, yeah, okay, but we do need treatments.

Next, in addition to all the primary prevention measures, you should do both. And you see a lot of politicians there. And I think knowing that it's a delicate topic and also as an obesity researcher, I think it's so important to explain about obesity, the complexity of obesity, but because people know so little and even a lot of medical doctors don't know what they don't know.

And we have to be really careful in our message and make it accessible. And so in that field, also in the pharmacotherapy, there's a lot of people who are against it, especially MDs. I don't know whether you recognize in your countries.

I see in my country, there's also people saying, well, of course, patients are extremely happy with it, but a lot of MDs have to get used to the idea that obesity is a disease, and it's a chronic disease and relapsing disease, and they don't know. So I think that that's a point also where in the future, the obesity field is moving and we have a lot to communicate there. And we can make an impact there if we make sure and convince them it's a disease to get it accepted as a disease, which is the case in the Netherlands.

And therefore, I realize it's easier in the Netherlands to get reimbursement for all these treatments. Thank you. Thank you.

And we have another question which can be linked, certainly in the UK, there's urgent research in this area. So it's from Marilyn Galeana. And the question is, when you have obesity and depression together, how can you approach the patient to start treatment, especially when the patient is in denial? So that's obviously a clinical question.

Yeah, I think also that is important to communicate with the individual patient, but also onto a larger audience, because we know that depression is a very common comorbidity of obesity. We actually also wrote a whole review on intercombination because we know the pro-inflammatory state of the fat mass, these cytokines, but also the leptin disturbances, the insulin disturbances, they also have negatively affect the amygdala and in the amygdala, the mood is being regulated. So depression and obesity, they often go together.

And if the depression is obesity related, which is not always, but often the case, then we know that actually, we showed it also in our research that if you do a combined life-saving intervention and people lose weight, that depression scores are improving. An interesting thing, it's not correlated to the weight loss, but it is correlated to the loss of fat mass. So the pro-inflammatory fat mass is probably responsible also for this depression, but it helps to communicate about it.

And also when a patient is denial, also then communication, not judgment, because the first thing to discuss obesity in the office actually is ask permission. Okay, you come here for depression, is it okay to also discuss your weight? And if they 90% think, oh, that's okay, 10% not okay, wait till another time. But the ones who say, okay, I would love to, it's okay to discuss your weight.

And then you can explain about the relation between obesity and depression and how you can improve your depression also by working on your weight at the same time. The same is true for pharmacotherapy. We have some pharmacotherapy who is also related to one of the pharmacotherapy medications that's also an antidepressant in there.

So there are more solutions there and to be open to the patient and explain it can be really helpful. That's great, thank you, really, really insightful. We have another question, this time one from Niamh Arthouse, who is one of the EASO ECN board members.

So the question is, have you experienced much kickback from society when trying to communicate such sound science and evidence-based messages? And how have you managed to triumph so successfully with such challenges? Yeah, I think, yes, I think you have to be, you have to be aware that on every post on socials or television performance, people will, some are very positive, but some are also negative and they will say simple, oh, you just kick their asses, eat less, move more, whatever, what are you telling for complex things? So to keep it easy, to have nuance in there, it's important and we should, if we don't tell the message, who will do it? And I think for us as a scientist, or if you're a clinician or both, we are the trusted person, so we are independent and we can tell society about it. So it's really important that we tell it. And yes, people sometimes negatively react, but what they always do is actually, okay, keep calm, never offensive back, but being very calm in the response on socials, explaining again.

And just very, because every post on that, other people will think the same. So they need more explanation and to be easy and very comprehensive, but also accessible in your answers, that helps. And a funny thing is that I sometimes also have when I do, for example, education on medical doctors who have a surgical background, I often tell about lifestyle and pharmacotherapy and the value of it.

And they think I'm a lifestyle guru, for example. And for lifestyle experts, I tell about pharmacotherapy, aberrant surgery. And they think I'm one to try to make all obesity patients into the medical field.

Or it's so funny to choose the other part of, I think it's important to bring into new perspectives. And yes, it can backfire sometimes, but still, if you, I think the important thing is that if you're not aggressive, but stay calm and communicate in a relaxed way and having facts, if you base it on the science, you will never harm, I think. Great, thank you.

So we do have a couple more questions. As I said, we have overrun on time. So I will read out the remaining questions and then perhaps we can just round off the session in the next 10 minutes or so.

So a question linked to pharmacotherapy from Rock Herman, who thanks you for such an inspirational presentation and says, since we are also talking about the potential of pharmacotherapy and we now have potent medications, do you see any possibility of improving the personalization of obesity pharmacotherapy since a significant variation in treatment response is noted in clinical practice? For example, gender, diagnosis, presence. Absolutely, absolutely. And I think in between now and 10 years, obesity treatments will be way more personalized and that will be true for lots of interventions.

Also nutrition will be more personalized, medication will be more personalized, but also better surgery. And that all starts with proper diagnostics. What are the characteristics of this patient? And I see here gender and comorbidities, but also the causes, the schedule I showed.

What is the cause? Is it lifestyle? Is it hormonal? Is it mental? And offer help based on the disorder. Is it a binge eating disorder? They need psychological help. Is it lifestyle problem? They need lifestyle help.

If it's a hormonal problem, they need hormonal. And if it's a mixture, they need a mixture of treatment. And that's where we are actually developing now an obesity care tool, obesity e-care tool, and that people can fill out all these questions.

And then you have an algorithm and you can already categorize the red flags. Is there any sign of obesity, of a genetic obesity disorder or lifestyle problem or whatever? So yeah, we and others will probably try to contribute to personalized treatments. And that's really the aim also of our obesity center.

So yeah, I hope for it. And I think we all together in an app work will work on it because that's how we can treat our patients the best. That's great, thank you.

So Fiona Curran has a question and they ask, can you speak about the use of liposuction, particularly in relation to reducing fat cells and inflammation? Yeah, the funny thing is in the body that the number of fat cells is already being programmed during childhood until your age of 20 or so. And if you, after the age of 20, the fat cells can get larger and get smaller, but the number of fat cell will always be constant. And if you are living with obesity, your fat cells are obviously more hypertrophic.

But when you do liposuction, you remove fat cells, but your body is programmed. They know exactly from stem cells, they will reproduce fat cells that the number becomes stable again. So liposuction is not an obesity treatment.

The number of fat cells you will regain. And then depending on the cost, they will be again, hypertrophic or not. So that's not an obesity treatment.

It's in treatment for sometimes some obesity like features, like lipomatosis, for example, very localized fat accumulations. But this is rare. Great, thank you.

And I've deliberately saved this question for the end as you could probably speak about it for much longer than the next five minutes, but it's from Dimitri Feynman. And the question is, do you think obesity is a disease? Yes, well, what I explained in the beginning, I think it's really important message. Yes, it is a disease because it's a disease of your fat mass.

Your fat is inflamed, it's an organ and all the hormonal function is being disturbed. So yes, when you have too much fat, it's got inflamed and it's sick, just like a liver and a heart can get sick. And actually it's not about my opinion, but it's actually also that HWO and also the European Commission also defined obesity as a disease.

And that may help also your country, if in your country it's not recognized as a disease to get it recognized as a disease because there it starts with the treatments. So when in your country, it's not recognized as a disease, start to work on them, communicate about it, that it is a disease, why it is a disease, but also that it's already recognized as a disease by the HWO. And that makes it easier to get treatments reimbursed like Lassa interventions, pharmacotherapy, surgery.

Because like in diabetes, we all think it's normal or when a patient has a heart disease, we all think it's normal that it's a disease and you have treatment and obesity is stigmatized. People don't know that it's a disease and it is. Great, thank you very much.

So I will close the question and answer discussion session. Thank you again, Lisbeth, for such an inspiring presentation and for such a great discussion section at the end. And thank you to all the participants who have watched the webinar and contributed questions.

I'm going to hand over just to Britt just to close the session. So thanks again. And thank you all for watching and for your attention.

Thank you so much. Thank you, Lisa. And thank you, Lisbeth, for this very nice presentation and for all of these interesting questions.

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