Obesity remains one of the most pressing public health challenges in Europe, with substantial health, social, and economic consequences. Despite extensive research and numerous national strategies, obesity prevention efforts remain fragmented across countries, limiting comparability, scalability, and policy impact. The present description introduces the collaborative effort of "OBEClust," a pan-European initiative designed to harmonize obesity prevention research and policy, fostering collaboration across disciplines, sectors, and countries. OBEClust aims to create a coordinated framework that integrates research methodologies, shared data infrastructures, and knowledge translation approaches to strengthen the evidence base and support the development and implementation of effective and equitable obesity prevention strategies. The initiative brings together researchers, policymakers, and public health stakeholders to standardize core indicators, align evaluation frameworks, and promote evidence-informed policy development. By facilitating cross-country collaboration and reducing duplication of efforts, OBEClust seeks to strengthen capacity for prevention research and accelerate the implementation of effective interventions. Through harmonization and structured knowledge exchange, OBEClust addresses existing gaps between scientific evidence and policy action. This initiative provides a collaborative framework for European obesity research coordination that provides a transferable model for cross-project cooperation through methodological harmonization, structured knowledge exchange, stakeholder engagement, and evidence translation.

Bariatric surgery (BS) has short- and medium-term benefits in improving metabolic syndrome (MetS) components, but its long-term impact remains incompletely characterized. This systematic review and meta-analysis aimed to quantify the long-term effects of BS (≥ 5 years) on fasting blood glucose (FBG), HDL cholesterol, triglycerides (TG), waist circumference (WC), and systolic and diastolic blood pressure (SBP and DBP). A comprehensive literature search was conducted across relevant databases. Eligible studies included randomized controlled trials and observational cohorts reporting pre- and postsurgical metabolic outcomes after at least 5 years of follow-up. Random-effects meta-analyses and meta-regressions were performed. Fifty-four articles (49 cohorts and five RCTs), including 37,840 baseline participants, were analyzed. BS was associated with significant improvements across all outcomes, with effect sizes varying by study design. Pooled estimates ranged from -22.97 to -44.68 mg/dL for FBG, +10.25 to +11.94 mg/dL for HDL, -54.11 to -59.59 mg/dL for TG, -20.55 cm for WC, -7.82 to -9.76 mmHg for SBP, and -4.80 to -6.48 mmHg for DBP. Meta-regression showed stronger effects in patients with higher baseline values. BS provides sustained, long-term improvements in all major MetS components. However, these findings are primarily driven by studies on Roux-en-Y gastric bypass, whereas long-term data on sleeve gastrectomy remain limited. High-quality longitudinal evidence on sleeve gastrectomy is needed to improve the generalizability of these results to contemporary surgical practice.

Psychiatric disorders are highly prevalent among individuals living with obesity and contribute to treatment resistance, poor adherence, and adverse health outcomes. Yet, obesity management often remains fragmented, with limited integration between endocrinology, psychiatry, and behavioral health. This Perspective advocates for a mental health framework for obesity care. We emphasize the need for future investigations to test the clinical relevance of behavioral phenotyping as a complementary approach to pharmacotherapy, including GLP-1 receptor agonists, to enhance treatment personalization. By reframing obesity as a disease deeply intertwined with mental health, we emphasize the need for multidisciplinary care models that incorporate psychological assessment, stigma reduction, and patient-centered nutrition counseling. Advancing this framework will require closer collaboration between medical and mental health disciplines and greater investment in neurobehavioral research to improve long-term outcomes in obesity care.

Recent studies suggest that health literacy (HL) may play an important role in management of individuals living with severe obesity (BMI ≥ 40 kg/m[2]), but to date, there has been no attempt to synthesize characteristics and outcomes of these studies. To explore the prevalence of low HL in people with severe obesity, and how HL may impact on health outcomes and management of severe obesity, six databases and two independent journals were searched. Seventeen studies were included in this review, mostly undertaken in high income countries, among females and candidates of bariatric surgery. Low HL ranged from 3.7% to 57.9% in cohorts studied, possibly explained by the heterogeneity of HL tools (i.e., seven different validated tools). Eight studies found higher HL to lead to better treatment outcomes (e.g., weight loss, attending appointments). Thematic synthesis of qualitative studies identified a lack of access to health information and support from healthcare providers (domains of HL) as barriers in improving health in patients with severe obesity. There is notable gap in interventional studies on improving HL in people with severe obesity. Overall, HL seems to be an important predictor of health outcomes in management of severe obesity. Further research is needed to assess the impact of HL on a broader range of health outcomes in nonsurgical patients with severe obesity.

Despite all efforts, obesity remains a major health concern worldwide, with continuously increasing rates, affecting approx. 14% of the total world population, being as high as 43% in some countries. As obesity is related to numerous comorbidities, including type 2 diabetes, cardiovascular diseases, and some types of cancer, the consequences for the individual and society at large are drastic. Therefore, it is crucial to understand and predict who is at risk of developing obesity in order to implement early prevention strategies. Many individual risk factors have been emphasized. However, as obesity is a rather multifactorial complication, single markers/biomarkers have thus far not allowed for an efficient prediction of obesity. In addition to less modifiable parameters, such as environment and socio-demographics, studies have revealed that obesity is related to several interacting aspects, including host factors such as genetics/epigenetics or gut microbiota, and more readily modifiable factors, including nutrition and physical activity, as well as sleep patterns and psychological well-being. It is likely that combining markers from across different domains, that is, multimodal markers, allows for better predictability for the risk of developing obesity. However, it must be considered that not all markers are fully predictive; many are rather reactive or even both. In this review and position paper, we emphasize the state-of-the-art regarding (bio)markers that have successfully been employed for predicting obesity risk. An emphasis will rest on novel, emerging biomarkers, and the need for a more integrative, multimodal assessment of obesity risk for a combined assessment aimed at improving risk prediction.