BY UE STUDIO

Updated Thursday,21December2023-12:40

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Obesity is one of the great epidemics of the 70st century. Since the 30s, its prevalence has continued to grow. In fact, it has doubled or tripled, depending on the country, in the last <> years. The increase in caloric intake together with current inadequate lifestyles, such as a sedentary lifestyle, enhance the effects of the genetic alterations that characterize obesity. A chronic disease that is caused by an alteration in the appetite regulation system and fat functioning.

Today, a person with obesity still lives surrounded by stigmas and prejudices that end up undermining their quality of life. "The barriers start with the day and dressing is already a problem. Clothing stores offer clothes for people with normal weight, but finding large sizes – especially for young people – that fit well and make us feel comfortable is very complicated," explains Victoria Buiza, a patient and president of the Híspalis National Bariatric Association, which works to raise awareness of the problems of obesity and overweight. He continues: "People with obesity have a harder time finding (and keeping) work and even traveling by plane or sitting on the bus."

In addition to sedentary lifestyles and genetic predisposition, Dr. Javier Salvador, professor emeritus of Endocrinology at the University of Navarra, also adds to the list the obesogenic environment, socioeconomic aspects, such as inequality, psychological factors, such as mental stress, and some diseases and treatments that contribute significantly to the increase in the prevalence of obesity.

In reality, obesity, the doctor says, is "a complex disease in which genetic, environmental, biological and behavioral causes interact with each other." All of them facilitate the excessive accumulation and functional alteration of adipose tissue. This generates an inflammatory response. The expert assures that this inflammation constitutes one of the most important bases for the development of complications in the form of metabolic and cardiovascular diseases and cancer, among others.

More than 200 associated diseases

Obesity remains, for example, the leading cause of type 2 diabetes and is a direct cause of 11 different types of cancer. In addition, "more than 200 complications attributable to obesity have been described, which constitute their own diseases. These include cardiovascular problems such as hypertension, heart failure, atrial fibrillation, myocardial infarction and stroke or metabolic-based diseases such as type 2 diabetes, fatty liver and various types of cancer. Obesity can also lead to endocrinological diseases such as polycystic ovary, infertility and hypogonadism," says Dr. Salvador.

"Patients are very discouraged by going from office to office. It is difficult to be clearly told that we suffer from a chronic multifactorial disease that carries the associated risk of having many other associated pathologies," says Victoria Buiza.

For her, the consequences and psychological impact of this disease on the mental health of patients is very serious. "In many cases, patients do not know the reason for obesity. This, together with society's external prejudices that make them feel guilty for their pathology, causes depressive symptoms," he argues.

Buiza also stresses that these mental problems are even more aggravated in childhood and youth, because "children and young people still do not have enough resources to cope with this disease at a mental level."

Is diet and exercise enough?

Until not so long ago, it was believed that obesity was due to a lack of will on the part of the patient, so there is a tendency to place the blame on the person himself. Today, science has shown that it is a chronic disease, where there is an energy imbalance, produced by an alteration in the system of appetite regulation and the functioning of adipose tissue, which is conditioned by biological, genetic and environmental factors, among others, and not by the patient's lack of will.

As a result, explains Javier Salvador, "the old treatment proposal based on 'less plate and more shoe' is not effective in treating obesity and maintaining the long-term result." It is true that, in general, diet and exercise can achieve a maximum weight loss of 5-8%. But, in reality, the most serious complications of obesity require weight losses greater than 15-20%.

Therefore, the doctor explains that diet and exercise, although beneficial and necessary, do not resolve the genetic alterations or alterations in the regulation of the energy balance that they induce, "so you can lose weight in the short term, but then recover, reversing the benefits achieved".

The Medical Role in Obesity Management

In this context, the medical community needs to individualize treatment in order to improve adherence. This is what Dr. Salvador believes, adding another key factor: the education of people living with obesity, health professionals and society in general.

According to the expert, this knowledge would facilitate "the understanding of obesity as a chronic, progressive, relapsing and multifactorial disease, which in turn would improve therapeutic performance and help avoid the harmful stigmatization."

These are prejudices that need to be destroyed. The president of the National Bariatric Association calls for people with obesity to be treated the same as all patients with other types of chronic diseases. "It is seldom stated as a clear clinical judgment that we suffer from obesity. We are treated for other causes such as hypertension or diabetes or we are given photocopied diets, but without personalized treatment and without a multidisciplinary unit behind it."

The treatment of obesity, which is different in each person, therefore requires a multidisciplinary approach to address the different causal factors and complications derived from obesity in each individual. For this reason, the specialist in Endocrinology, Dr. Salvador, considers that it is necessary to "improve access to therapeutic resources – including a greater availability of nutritionists, specialists in the prescription of individualized physical exercise, psychologists in the use of pharmacological and surgical treatment when indicated and the facilitation of adequate long-term chronic follow-up.

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