Obesity is a public health problem that not only does not stop, but continues to rise, with figures more typical of a pandemic. In fact, it is estimated that More than half of adults and a third of children in our country are overweightaccording to data from the Carlos III Health Institute and Aesan. And the forecasts are that these figures will go up.
Specifically, 21.6% of the Spanish population lives with obesity according to the Nutritional Study of the Spanish Population (ENPE), a chronic, complex, multifactorial and relapsing disease. To understand how this disease is addressed in the National Health System, the Obequidad studywhich describes the management of obesity in Spain from the perspective of Primary Care, Endocrinology and Internal Medicine doctors. The data, presented at the 46th National Congress of the Spanish Society of Primary Care Physicians (Semergen), correspond to the results of the survey of 131 family doctors from the different Autonomous Communities.
Obequity, promoted by the medical company Lilly, reflects that 40.1% of patients with a body mass index (BMI) ≥30 kg/m2 do not have a diagnosis of obesity recorded in their medical history. “We try to see the importance of coding obesity, as happens with a stroke, diabetes or a heart attack,” explains the Dr. José Manuel Fernández-Garcíaone of the authors of the study, a specialist in Family and Community Medicine and coordinator of the SEMERGEN Nutrition Working Group.
According to the respondents, More than 95% of people who receive medical care for obesity in Primary Care present some associated complication. Among them are the dyslipidemiawhich is detected in 54% of people with obesity, the type 2 diabetes (52%), the high blood pressure (49%), the osteoarthritis (45%), cardiovascular diseases (37%), the sleep apnea (34%), the fatty liver disease associated with metabolic dysfunction by 34% and psychiatric illnesses (31%).
A chronic pathology
Recognizing obesity as a chronic disease based on adiposity and that is at the origin of multiple diseases is essential to recognize the importance of prevention and a comprehensive approach with effective long-term health care, based on evidence. “People with obesity deserve access to comprehensive health care, which includes, depending on the needs of each patient, lifestyle measures, such as nutrition, exercise and behavioral therapy, medications or bariatric surgery, says the Dr. Miriam Rubio de SantosMedical Director in the Diabetes and Obesity area at Lilly. “And the performance of Primary Care specialist is essential in the management of a chronic disease like thisfrom prevention, diagnosis, treatment and follow-up.”
Improving the functional capacity and quality of life of people with obesity and reducing the risk of cardiovascular complications were the main reasons for starting treatment in Primary Care, according to the Obequidad study. The level of BMI, psychological complications, pain and aesthetic reasons were also included among the reasons for starting treatment, although less relevant.
Diagnosis of obesity
In Spain, there are specific guides for the comprehensive approach to obesity. 18.3% of respondents indicated that they did not use any clinical practice guidelines. “It is good that the management of obesity is standardized, there are centers that do not have specific units for this disease. The multidisciplinary intervention and have standardized guidelines on how to address obesitylike the GIRO guide, is necessary for a more efficient approach. It is a very complex disease that has many aspects. A single group of professionals is not going to achieve it, several have to achieve it. It is a challenge for the entire society,” says the author of the study.
Obequidad also points out that the use of complementary methods to evaluate body composition is low. The most used complementary method to BMI for diagnosis is the measurement of waist circumference (79% of respondents), while Techniques such as bioimpedance are still not widespread among Health Centers (8%). On the other hand, the study also indicates that there are 9% of specialists who indicate that they do not use any complementary method.
The development of obesity involves multiple factors: genetics, age, gender, ethnicity, education, economic level, sedentary lifestyle, stress, sleep disturbances, urban and sociopolitical environment, etc The study shows that the majority of patients receive medical attention for obesity as a result of an opportunistic diagnosis (44%) or at their own request (41%). The most common patient profile in Primary Care includes women aged 40-64 years with grade I obesity.
Therapeutic interventions
The comprehensive management of obesity requires a coordinated multidisciplinary intervention. In the case of grade III obesity, the study demonstrates a more frequent use of pharmacological and surgical treatmentsaccording to 78% of the participants, compared to grade I and II obesity.
Dietary and nutritional changes, as well as increased physical activity, were the most recommended interventions for people with the highest degree of obesity, according to the majority of participants.