As part of the EU-funded BETTER4U project, a major clinical trial is currently underway across Europe, offering a new perspective on preventing and managing obesity. The BETTER4ALL trial is designed to explore how personalised, data-driven interventions – supported by artificial intelligence – can help people live healthier lives by addressing the complex and individual factors that contribute to obesity.
We spoke with Dr. Eva Karaglani, Postdoctoral Researcher at the Nutrition and Dietetics Laboratory of Harokopio University in Athens, Greece, and co-leader of BETTER4U’s clinical trial activities, to better understand the trial’s scope, its scientific foundations, and how it is paving the way for more tailored and sustainable health interventions for people living with obesity.
A Pan-European Trial with a Personal Touch
The BETTER4ALL trial includes 1,022 adults living with overweight or obesity, equally distributed across seven European countries: Greece, Cyprus, Spain, Portugal, France, Poland, and Sweden. These countries were chosen for their diversity in culture, geography, and healthcare systems, as well as for their relatively higher prevalence of obesity.
Led by Harokopio University in Athens, the trial is coordinated by a team of experienced researchers, including Dr. Eva Karaglani, who has worked in the field of nutrition and chronic disease prevention for over a decade. Alongside Professor Yannis Manios, her long-time mentor and Professor at the School of Health Science & Education at the Harokopio University of Athens, she is overseeing the design, implementation and evaluation of this complex and ambitious trial.
Combining AI and Human Insight
Obesity is a complex, chronic disease, influenced by a combination of genetic, metabolic, environmental, and behavioural factors, making it a challenging topic to study. What sets the BETTER4ALL trial apart from others is its deep level of personalisation. Participants are randomly assigned to one of two groups: one receives standard care lifestyle advice, and the other receives personalised recommendations based on an AI causal model. These recommendations are tailored using polygenic risk scores (PRS) – which combine information from many different genes to estimate a person’s inherited risk for weight gain – along with data on physical activity, sedentary behaviour, sleep, diet, movement, and their environment.
The AI causal model integrates information from wearable devices, mobile apps, and health assessments, but it does not make autonomous decisions. Instead, it acts as a decision-support tool for health professionals, helping them refine personalised lifestyle interventions while ensuring that clinical judgement remains central.
Minimising Burden, Maximising Engagement
A key feature of the trial is its commitment to reducing the burden on participants. Many indicators – such as physical activity, sleep patterns, and environmental exposure – are collected automatically via GPS-enabled smartwatches, requiring minimal manual input. This streamlined approach supports both participant engagement and feasibility for healthcare professionals.
Participants benefit not only from continuous digital monitoring but also from behavioural coaching delivered through the app and face-to-face sessions with trained dietitians. Free counselling, lab assessments, and personalised feedback offer additional incentives for individuals to stay engaged and motivated throughout the six-month intervention and equivalent follow-up period.
Towards Scalable, Sustainable Solutions
The trial is designed with long-term impact in mind. By testing a real-world application of AI-supported personalisation across diverse European settings, BETTER4ALL seeks to lay the groundwork for future implementation in clinical and public health settings. The results will inform evidence-based policies and guidelines, and will be made publicly accessible through scientific publications.
“Obesity is not simply about personal choices or willpower – it’s a chronic disease with genetic, behavioural, and environmental roots. BETTER4ALL recognises this complexity and helps shift the focus to personalised support, science-based interventions, and sustainable change.”
Eva Karaglani, MSc, PhD
Dietitian-Nutritionist, Sr Research Associate at the Department of Nutrition and Dietetics, School of Health Science and Education – Harokopio University, Athens
