Translated by AIVersione italiana
Key points
3′ min read
Translated by AIVersione italiana
The real challenge begins now. Italian Law 149/2025 – the first in the world to officially recognise obesity as a chronic, progressive and relapsing disease – has marked a historic milestone, but its value will not be measured by its symbolic significance. It will be judged by its ability to transform a legal principle into real change. Because this pioneering achievement is merely the first step. The success of this reform will depend on how effectively we can translate it into a reduction in the risk of heart attacks, strokes, heart failure and all the complications that still accompany this condition today.
The study
This is precisely the conclusion that emerges from our paper “Italy passes obesity law: an opportunity to prevent cardiovascular disease across Europe”, which has just been published in the European Heart Journal – Quality of Care and Clinical Outcomes. The study by the IRCCS Policlinico San Donato does not merely describe an unprecedented legislative development, but analyses how this decision could serve as a model for the evolution of European health policies, finally placing cardiovascular prevention and the treatment of obesity within the same public health strategy.
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Italia is the first country in the world to have taken this path. This leadership role represents both an opportunity and a responsibility. An opportunity, because we now have the scientific knowledge needed to tackle obesity as a genuine medical condition; a responsibility, because legislative recognition would risk remaining incomplete if it were not accompanied by a profound paradigm shift
The outlook
The law, in fact, provides the tools to bring about this change. It lays the foundations for the gradual inclusion of obesity-specific services within the Essential Levels of Care, for the integration of the condition into the National Chronic Disease Plan, for the implementation of multidisciplinary diagnostic, therapeutic and care pathways, and for the development of a national epidemiological monitoring system. These are not merely administrative formalities, but necessary conditions to ensure that every patient can access a continuous and appropriate care pathway.
The burden of disease
The reasons why this transformation is necessary are now clear even to our legislators. Cardiovascular diseases continue to be the leading cause of death on our continent and account for around 282 billion euros annually in the European Union, of which 42 billion is borne by the Italian healthcare system. A significant proportion of this healthcare, economic and social burden is linked to obesity, one of the main modifiable risk factors for cardiovascular disease. Taking early action therefore means safeguarding the future sustainability of healthcare systems. And, even more importantly, people’s health.
For many years, we regarded obesity as merely a cardiovascular risk factor, dismissing it as the result of an unhealthy lifestyle. Today, we have a much better understanding of the role of visceral adiposity in inflammatory processes, vascular damage and cardiac remodelling; we have more accurate diagnostic tools to identify cardiometabolic risk and, above all, we have access to drug therapies that have been shown to alter the natural history of the disease. The results of the SELECT study (The Lancet 2025) – for example – cited in our paper, showed a 20 per cent reduction in major cardiovascular events in patients with obesity or overweight and cardiovascular disease, but without diabetes, treated with semaglutide. This finding confirms that treating obesity means directly improving heart health.
Science and the law in harmony
In short, Law 149/2025 comes at a time of great clinical and scientific maturity. Science and the law are moving in the same direction. The task now is to develop a care model that implements the law and is consistent with the available evidence, definitively moving beyond the piecemeal and fragmented approach that has all too often characterised the management of this condition
It will be necessary to establish transparent criteria for reimbursement, strengthen the network of specialist centres, invest in the training of doctors and healthcare professionals, develop truly effective multidisciplinary models, and closely monitor any regional inequalities in access to care. These are all prerequisites for ensuring that the new paradigm translates into tangible benefits for citizens
If we can turn this legislative recognition into early, multidisciplinary care tailored to patients’ needs, the Italian experience could become a benchmark for European health policy, where science and law come together for the benefit of patients. And for the health of future generations
* Head of the Endocrinology Unit, Head of Clinical Nutrition and Cardiometabolic Prevention at IRCCS Policlinico San Donato; Associate Professor of Clinical Nutrition (MEDS-08/C); Department of Biomedical, Surgical and Dental Sciences – University of Milan
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