Professor Lena Carlsson Ekander recounts the origins and evolution of the Swedish Obese Subjects (SOS) Study – the world’s longest prospective investigation into the effects of intentional weight loss on survival and metabolic health. She reflects on the vision of the study’s founder, Prof. Lars Sjöström, and how the team built a nationwide cohort across 25 hospitals and 480 primary-care centres. The discussion covers the scientific rationale, ethics of non-randomisation, landmark outcomes (increased life expectancy, cancer and diabetes reduction), and important safety insights such as fracture risk and alcohol-related mortality. The conversation closes with the public-health implications of early, proactive treatment of obesity and diabetes prevention.

This episode features Francesco Rubino (King’s College London) and  Dr. Riccardo Cohen (President of IFSO) discussing their leadership of the Lancet Commission on Obesity Diagnosis. They explain why obesity has historically been treated as a risk factor rather than a disease, and how their work has established the first formal diagnostic framework. The Commission, comprising 56 global experts, distinguished between preclinical obesity (excess adiposity without organ impairment) and clinical obesity (with signs, symptoms, or organ dysfunction). They describe the long, sometimes contentious process of reaching consensus, the importance of separating diagnosis from treatment guidelines, and the implications for clinicians, patients, and policymakers. The framework is presented as a turning point in obesity medicine, enabling clear diagnosis, guiding treatment intensity, and shaping future management strategies worldwide.

Joined by Professor David Cummings (University of Washington, Seattle), Paulina and Marco explore the revolutionary impact of new incretin-based medications such as semaglutide and tirzepatide. Cummings explains their origins in metabolic surgery research, how GLP-1 and GIP mechanisms work, and why the field has shifted dramatically after decades of weak pharmacological options. He addresses surgeons’ fears that drugs might replace operations, reframing them as complementary tools that can expand patient access and even drive more people into treatment pathways (the “gateway effect”). The discussion highlights unanswered questions-timing of drug use around surgery, long-term cost-effectiveness, and tailoring medications to individuals-but concludes that surgery and medications together form a stronger, multidisciplinary strategy against obesity.

Hosts Professor Paulina Salminen (Finland) and Professor Marco Bueter (Switzerland) introduce the new Obesity Podcast, setting the stage for open, stigma-free discussions around obesity as a chronic disease. They share personal backgrounds as bariatric surgeons and researchers, reflecting on their work in metabolic surgery, clinical trials, and eating-behavior research. Both emphasize that the podcast is not about promoting surgery but about offering an evidence-driven platform to discuss all treatment options, highlight current projects, and fight stigma around patients and therapies. The episode outlines their vision: data-driven dialogue, expert guests, and contributing to global understanding of obesity care.