The European Congress on Obesity (ECO) 2026 has historically focused primarily on weight reduction. However, this year, a shift in tone was evident with obesity increasingly being framed not as a condition defined by body mass index (BMI), but as a systemic illness demanding organ-level intervention across multiple comorbidities.
Industry symposia echoed this year’s ECO focus on shifting the obesity management framework, exploring this emerging philosophy. Two companies, Madrigal and Novo Nordisk, with recent approvals in metabolic dysfunction-associated steatohepatitis (MASH), Rezdiffra and Wegovy, respectively, drew physicians’ attention to the risk of patients with obesity developing MASH, where early diagnosis is critical.
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Madrigal’s decision to sponsor a symposium at ECO titled “MASH in People Living with Obesity: Pathophysiology, Risk Stratification and Optimised Management” reflects a deliberate effort to engage prescribers beyond the hepatology community. With obesity and diabetes clinics representing some of the highest-yield environments for undiagnosed MASH, the company is making a push to embed fibrosis risk stratification into metabolic care pathways before patients have progressed in their disease. The clinical case made at the symposium was structured around a stepwise non-invasive testing algorithm anchored by FIB-4 as a first-line screen, with vibration-controlled transient elastography (VCTE) or the enhanced liver fibrosis (ELF) test as second-line confirmatory tools. Critically, a practical limitation that is often overlooked in the obesity clinic setting is that VCTE accuracy degrades meaningfully as BMI rises, which describes the very patients most likely to present in these clinics. Blood-based alternatives such as ELF are validated, guideline-consistent, and unaffected by BMI-related constraints, making them well-suited for routine integration into obesity care workflows. However, despite the strong evidence, a lack of awareness still acts as a barrier to embedding these tools into standard practice.
Novo Nordisk’s symposium opened with a consensus statement from the International Obesity Collaborative declaring that weight loss is merely one outcome of obesity care, not its goal. The central argument was that obesity and its complications have long been managed individually and that this fragmented approach fails patients whose risk is fundamentally systemic. Novo Nordisk continued by reporting evidence across cardiovascular, hepatic, and functional endpoints, including SELECT for major adverse cardiovascular events reduction, STEP-HFpEF for heart failure benefits beyond weight loss, and ESSENCE for liver histology and broader cardiometabolic improvement. This data supports a multidisciplinary and holistic treatment approach to obesity, where hepatologists, cardiologists, endocrinologists, and primary care physicians coordinate a patient-centred care pathway, rather than operating in individual silos.
Together, the two symposia reflect a broader shift in how obesity is being understood and managed, no longer as a condition defined by weight alone, but as a systemic disease with serious consequences across multiple organs. With the number of patients living with MASH projected to rise substantially through 2030, driven by the parallel growth of obesity and type 2 diabetes, the need for earlier identification has become more important than ever. According to GlobalData’s Pharma Intelligence Center, the total number of diagnosed prevalent cases of MASH in all ages is projected to reach about 229 million by 2032.
