Where policy meets communication: the Global Think-tank on Steatotic Liver Disease at the Global Obesity Forum and the WHO Global Obesity Summit

Where policy meets communication: the Global Think-tank on SLD at the Global Obesity Forum and the WHO Global Obesity Summit

In late October, the Global Think-tank on Steatotic Liver Disease joined two of the year’s key obesity meetings in Madrid. Delfina Boudou and Anthony Armenta attended the World Obesity Federation’s Global Obesity Forum, and Armenta continued on to the second day of the invitation-only Global Obesity Summit, co-hosted by the World Health Organization and the Government of Spain, in collaboration with UNICEF and the World Bank.

The summit’s third day, which was to include a high-level political segment, was cancelled following the train crash in Spain. Our thoughts are with everyone affected.

The policies are known. Moving them is the challenge.

Magdalena Wetzel (Head of Policy & Advocacy, World Obesity Federation) presents stocktake during a media session held before the kick-off of the Global Obesity Forum in Madrid, Spain.

One message carried across both meetings: the policy menu for obesity already exists. What holds it back is getting it adopted, funded and sustained.

At the Forum, Magdalena Wetzel, Head of Policy and Advocacy at the World Obesity Federation, described how policies stall: calls for “more evidence” in place of regulation, watered-down designs, and debates framed around personal choice. Only eight countries have mandatory national rules on digital food marketing to children, and obesity rarely features in UHC discussions. Speakers also set out what real accountability requires: who answers, for what, who judges, and what happens if commitments are missed.

Each of these is a policy problem. Each is also a communication problem.

What the stocktake showed

On the second day, WHO presented a stocktake of its Acceleration Plan to Stop Obesity across 28 frontrunner countries. Progress is real: 26 of 28 countries moved at least one policy forward in four years. In the four countries where adult or child obesity is now falling, prevention and care moved together, though WHO stressed that this is an association based on small numbers.

Anthony Armenta (Communications lead, Global Think-tank on Steatotic Liver Disease) alongside Vanessa Garcia-Larsen (Chief, Risk Factors and Nutrition Unit, Pan American Health Organization), Magdalena Wetzel (Head of Policy & Advocacy, World Obesity Federation) and Beatriz Yáñez Jiménez (Senior Manager, Advocacy and Community Engagement, International Diabetes Federation) during Working Group session at Global Obesity Summit, Day 2.

Countries reported stakeholder engagement and industry resistance among the blockers in the early stages of policymaking, and clear roles across sectors as a leading enabler. Strategic communication now has its own working group shaping Phase 4 (2026 to 2030), and one breakout warned that technical language can shut down the cross-sector conversations that policy depends on.

Awareness needs credible champions

At the Forum, Armenta led a breakout session on behaviour change communication. Participants named complex academic language and information that isn’t always actionable as barriers, and kept returning to one answer: relevant, credible and well-informed champions who can carry the message to communities and policymakers.

Anthony Armenta (Communications lead, Global Think-tank on Steatotic Liver Disease) moderates breakout group on “Behaviour change communications” alongside representatives from International Diabetes Federation (IDF), UNICEF Fix My Food, AstraZeneca, European Coalition for People living with Obesity, Uruguayan Society for the Study of Obesity, Heart & Stroke Foundation of Barbados, and IDF Blue Circle Voices.

For liver health, this goes to the heart of a long-recognised gap. In a global Delphi study led by Prof. Jeffrey V. Lazarus, director of the Global Think-tank, hundreds of experts identified education and awareness as one of six priority domains for tackling the public health threat of fatty liver disease. The 2026 World Health Assembly resolution on SLD calls for greater public awareness, and at our World Health Summit session, participants named unawareness and misconceptions among the biggest barriers to integrating liver health into metabolic care. Awareness grows when trusted voices make an issue relevant, not when information simply increases.

Summary report recording of the breakout session on “Behaviour change communications” by Francine Charles (Programme Manager – Childhood Obesity Prevention Campaign, Heart & Stroke Foundation of Barbados, Inc.).

What it means for the Think-tank

Liver health was present in Madrid. MASLD was named among obesity-related conditions in the media workshop, with journalists who have followed the Think-tank’s work. Primary care, food environments and cities are where both responses meet.

Wetzel argued that obesity must be a political priority, not only a health priority. We agree, and the same must hold for liver health. In the lead-up to the UN High-Level Meeting on UHC, the task is not to rank metabolic conditions against each other. It is to ensure governments and all ministries–from health to financing to commerce–see obesity, SLD and related NCDs as connected, and as core to people’s health and wellbeing everywhere.

Delfina Boudou represents the Global Think-tank on Steatotic Liver Disease during the breakout session on “Early food environments for infants and young children”, alongside members from Ligue nationale Contre l’Obésité Université Paris-Saclay, Gasol Foundation, NCD Alliance, Zambia Heart and Stroke Foundation and Roche.

The Think-tank, together with its partners, will take these insights forward:

strengthening stakeholder engagement,
building broader coalitions across the metabolic health community,
and shaping policy that brings liver health into the wider response.

Our explainer on the relationship between obesity and MASLD, developed with the support of our Scientific Committee, is one step in that direction.

U53R_4N7H0NY2026-11-13T16:23:30+00:00

Registration fees

Category	Early Bird (before 1 April)	On-site
Private Sector/Industry	495	695
Start-up*	150	200
Healthcare Professional, Academic, Public Health/Professional Association, NGO	100	150
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	50	50
Patient or Patient Representative *	50	50

* Registration fee scholarship offered on application, please email: lisa.rice@isglobal.org

Criteria for start-ups:

Early-stage start-up (e.g., pre-seed, seed, or Series A) / Incorporated for under 5 years

Raised under $5 million in funding / Annual revenue less than $1 million

Fewer than 50 employees

What’s included in your ticket?

Entry to all main agenda sessions starting 2pm on 5 June

5 June: Lunch and afternoon networking coffee, and networking buffet reception

6 June: Morning and afternoon networking coffee, and networking lunch

1. Launch a Ministry of Health-led whole-of-government strategy

The growing prevalence of MASLD and MASH in Spain, projected to affect over 27% and 5.9% of the population, respectively, by 2030, necessitates an integrated, cross-sectoral policy response,³ led by an intersectoral working group under the leadership of the Ministry of Health. This whole-of-government initiative could facilitate the mainstreaming of MASLD/MASH into key national strategies addressing chronic diseases in general, and obesity, diabetes, and cardiovascular health specifically through a “health in all policies” approach. These strategies include the Strategy for Addressing Chronic Diseases (2012),³⁰ the Diabetes Strategy (2006)³¹ and its 2012 update³², and the Cardiovascular Health Strategy (2022),³³ where MASLD/MASH remain largely underrepresented despite their metabolic underpinnings. This omission contributes to fragmented care and missed opportunities for early intervention. Systematic integration of MASLD across these strategies, identifying common policy-actionable targets such as commercial determinants of health, would allow Spain to align with recommendations from the European Association for the Study of the Liver (EASL)–Lancet Liver Commission, which urges countries to address liver diseases through upstream, equity-based, and multisectoral policies.³⁵

Crucially, national leadership must be paired with urban action. Cities are where obesogenic environments, food insecurity, and social inequalities converge with high diabetes and obesity prevalence.^36,37 An initiative to address this, “MASH Cities,” calls on municipalities to integrate MASLD/MASH into local health promotion, food policy, urban mobility, and primary care services to mitigate disease progression.³⁸ Major cities in Spain should consider joining this growing platform for sharing learned lessons and best practices. Empowering cities with the mandate and resources to act on liver health can serve as a scalable, equitable response to this growing challenge, as was proposed for Barcelona in May 2025.³⁹

Additionally, inclusion of MASLD/MASH in Spain’s Public Health Surveillance Strategy (2022)⁴⁰ could strengthen early detection and monitoring by enabling systematic data collection and risk assessment in both health and non-health sectors, such as urban planning and food policy. Primary care would be central to this approach, serving as the frontline for MASLD active case finding, fibrosis risk stratification, and referral, with a focus on shared-care pathways between primary care and specialist care. Integration can help standardise primary care practices, including routine FIB-4 risk stratification of individuals with obesity, T2D, metabolic syndrome, or hepatic steatosis, which are often undetected until advanced stages.⁴¹ Primary care should be adequately funded and equipped to screen, stratify, manage cardiometabolic risks, and refer high-risk patients, forming the backbone of MASLD/MASH prevention and control at the national, autonomous community, and city levels.^42,43

Spain’s commitments as a World Health Organization (WHO) Member State provide immediate momentum for national action. The landmark World Health Assembly (WHA) resolution on steatotic liver disease outlines 12 core action item, including incorporating liver health into national NCD strategies and strengthening primary care pathways to tracking liver health indicators, and which now mandates a clear shift toward national action.⁴⁴

2. Create a national MASLD registry, cohort, or observatory

Establishing a national MASLD registry, cohort or observatory is a critical step toward advancing clinical management, research, and policy evaluation. A national registry would enable the systematic collection of epidemiological, clinical, and sociodemographic data, essential for monitoring disease prevalence and progression, identifying high-risk subgroups, and assessing territorial disparities in access to care. While the Epidemiological sTudy of Hepatic infectiONs (ETHON) cohort estimated that 1.33%% of the Spanish population from 2015-2020 had MASH with fibrosis (stage F2-F3), these findings are limited to participants from primary care centers in Madrid, Santander and Valencia.^13,45 Additionally, while national clinical registries like HEPAmet and REGHNA (focused on hospital settings) provide important data, they are not population-based, nor are they consistently linked with public health surveillance systems.⁴⁶ A standardised and centralised MASLD registry would enable longitudinal tracking of this more prevalent disease, facilitate research on progression and treatment outcomes, and help evaluate the impact of interventions over time. Furthermore, registry data could support regional health planning and inform clinical practice guidelines aligned with Spain’s digital health transformation efforts.

3. Add MASLD/MASH as an indicator to the list of Key Health System Indicators

Despite the rising clinical, social, and economic burden of MASLD, the condition is not currently included in Spain’s list of Mandatory Reporting Diseases. This may not be unusual, given that no noncommunicable disease (NCD) is currently included on this list; however, as a Member State of the United Nations (UN), Spain is committed to the Political Declaration of the Fourth High-level Meeting of the General Assembly on the Prevention and Control of Noncommunicable Diseases and the Promotion of Mental Health and Well-being, adopted in 2025.⁴⁷ However, nor is it included among Spain’s Key Health System Indicators, which guide monitoring, evaluation, and resource distribution across the National Health System, including NCDs.¹⁶

Integrating MASLD/MASH as a formal indicator would recognise the disease as a strategic health priority by integrating it into the national health information system, guiding decision-making on screening, diagnosis, and care pathways. Failure to track this disease risks underestimating its long-term economic and public health impacts. Incorporation into the indicator framework aligns with Spain’s commitment to data-driven governance and would support benchmarking across autonomous communities. To support targeted local action on MASLD, tools at the autonomous community level should be developed to guide policy and programme implementation. A MASLD risk index, combining aggregated clinical data, social determinants of health, and population-level metrics, can help identify high-need areas and inform municipal-level screening strategies.

In parallel, a MASLD Impact Score should be created to assess the effectiveness of local policies related to metabolic health, food regulation, healthy environments, early detection practices, and workforce training. This metric could be implemented through municipal initiatives such as “Santander se mueve,” an annual health promotion program.

4. Increase awareness and education of MASLD/MASH among the general public, at-risk groups and healthcare professionals

Enhancing awareness of MASLD/MASH among both at-risk populations, such as those living with obesity, diabetes, and metabolic syndrome, and frontline healthcare workers is critical for early identification, appropriate risk stratification and timely intervention. Given its silent clinical course, MASLD is often underdiagnosed until advanced stages, particularly in primary care settings where patients with obesity, diabetes, or metabolic syndrome are commonly managed.⁴⁸

Spain’s Strategic Framework for Primary and Community Care (2019) already emphasises chronic disease prevention, making it an ideal entry point for MASLD/MASH education.²⁹ Yet, existing knowledge gaps among primary care providers regarding liver disease etiology, progression, and appropriate screening necessitate awareness or education campaigns and professional training modules that build the knowledge and clinical skills needed to manage MASLD in frontline settings.^27,49 A cohesive and comprehensive educational strategy is essential and could begin with the integration of MASLD/MASH-specific content into undergraduate, specialty, and continuing medical education curricula to foster competency in metabolic hepatology across the care continuum. A national interdisciplinary training strategy could bring together professionals from family medicine, endocrinology, cardiology, nephrology, internal medicine, endoscopy, clinical nutrition, and hepatology to address MASLD/MASH as a complex, multisystemic disorder.

A comprehensive communication and engagement health literacy strategy should position MASLD/MASH as serious, progressive, and multisystemic conditions. This involves dismantling the minimising narrative of “fatty liver” and clearly linking MASLD to major outcomes such as cardiovascular, renal and metabolic disease. Such a campaign should incorporate Metabolic Dysfunction and Alcohol-Associated Liver Disease (MetALD), which captures the under-recognised harm of moderate alcohol use in people with MASLD. Establishing a national MASLD/MASH patient platform would also enable the co-design of care pathways, educational materials, public campaigns, and research priorities, ensuring patient-centered policy and practice. Generating local data is vital for municipal- or community-led strategies; notably, an in-progress study by the MASH Cities³⁸ network is currently evaluating awareness of MASLD and its underlying risk factors among representative population samples across major Spanish cities including Barcelona, Bilbao, Málaga, Madrid, and Valencia as well as the autonomous community of Cantabria, to directly inform tailored local interventions and public health campaigns.

Finally, it is critical to explicitly position MASLD within the so-called cardio-renal-metabolic axis, evolving toward a CHRM (cardiovascular-hepatic-renal-metabolic) model that is rooted in the dysfunction and accumulation of visceral fat, regardless of the body mass index (BMI).⁵⁰ A revised, more accurate paradigm further recognises the liver as a pivotal organ in systemic metabolic dysfunction. The CHRM paradigm reflects the shared pathophysiology and clinical trajectories of MASLD, T2DM, chronic kidney disease, and cardiovascular disease. Scientific societies and patient organisations in Spain must collectively support and disseminate this integrative model, aligning MASLD policy with broader strategies for non-communicable diseases.

5. Leverage electronic health records (EHR) through integrated automated diagnostic tools

Integrating MASLD/MASH screening algorithms into existing EHR systems can substantially enhance early detection and risk stratification in primary and secondary care. Automated tools such as intelligent liver function testing (iLFT), which systematically interprets routine liver function tests, performs reflex testing, and identifies likely liver diseases for physicians to consider, and automated calculation of simple non-invasive fibrosis scores such as FIB-4 have shown promise in improving early diagnosis and care pathways, particularly in underdiagnosed conditions like MASLD and MASH.⁵¹ In the Spanish context, where nearly 10 million individuals may be living with MASLD by 2030,³ embedding such tools in the primary care EHR systems used across autonomous communities could standardise assessment, reduce diagnostic delays, and promote timely secondary referrals. Moreover, this approach complements digital transformation priorities already outlined in Spain’s National Health System and aligns with the objectives of the Strategic Framework for Primary and Community Care (2019).^29,52

6. Strengthen the capacity of community health services to prevent and treat MASLD through social prescribing and equitable access to approved pharmacological treatment for MASH

Primary care has a well-established network of health centres across Spain. In the last years, there has been an increase in the number of community-based activities promoting well-being and reducing the metabolic risk profile through social prescribing. These activities usually integrate exercise through increasing physical activity.⁵³ Strengthened primary care systems can reinforce the role of community health services by incorporating social prescribing models to address lifestyle drivers of MASLD in vulnerable populations, such as physical activity, which is a recommended first-line therapy of people with MASLD, and can improve psychosocial health,⁵⁴ which is often reported as poor by people living with MASLD.⁵⁵ By facilitating participation in community-based activities like group exercise, arts, or wellness programs, social prescribing addresses both physical inactivity and the isolation or low mood commonly seen in this population.⁵⁶ In Catalonia, the Programa de Prescripció Social i Salut exemplifies this approach by linking patients to local community assets via an integrated system in primary care, particularly targeting conditions such as anxiety, depression, and social isolation,⁵³ and which may be beneficial for people living with MASLD/MASH. Elsewhere, social prescribing has demonstrated benefit for people living with diabetes.⁵⁷ Evaluation data from Catalonia show that over 70% of participants report improvements in emotional well-being and social support after engaging in prescribed community activities frequently related to physical activity.⁵³

Registration fees

All applications for registration will be reviewed, and you will be notified of your invitation status and fee via email within one week.

Category	Early Bird (before 1 April)	After / onsite
Private Sector/Industry	295	350
Start-up*	95	150
Healthcare Professional, Academic, Public Health/Professional Association, NGO	75	100
Young Researcher / Trainee / PostDoc / Student / Young Person (under 25) *	45	60
Patient with lived experience *	free	free
Patient or Patient Representative *	45	50