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Obesity is a disease, not a personal choice

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According to the 2021 Regional Panorama of Food and Nutrition Security prepared by the Food and Agriculture Organization of the United Nations (FAO), one in four adults, some 106 million people, suffer from obesity in Latin America and the Caribbean. Not only that, but this is a growing problem. Between 2000 and 2016 there was an increase of 9.5 percentage points in the Caribbean, 8.2 in Mesoamerica and 7.2 in South America. Childhood overweight has also been increasing for 20 years in the region and in 2020, 7.5% of children under five years of age, 3.9 million, were overweight, almost 2% more than the world average.

This is not a problem isolated to America. In Europe, significant figures are also being reached that continue to increase and during the celebration of the XVII National Congress of the Spanish Obesity Society (SEEDO) they wanted to send a warning message. “Obesity is one of the most prevalent chronic and multifactorial diseases that exist today. And it is a disease that goes beyond weight and body mass index. There are genetic, epigenetic and molecular factors that affect it,” says Dr. Mar Malagón, coordinator of the Nutrition, Endocrine and Metabolic Diseases Area at the Maimónides Institute for Biomedical Research of Córdoba (IMIBIC), in Spain.

"We must change the perspective that has been had until now on obesity and we have to make it very clear that it is a disease, it is not a condition derived from free personal choice, a message that has been repeated many times and that has created an important stigma for people living with obesity,” highlights Dr. Andreea Ciudin, specialist in Endocrinology and Nutrition at the Vall d'Hebron University Hospital in Barcelona, ​​Spain. We must not forget that right now obesity is the fifth cause of mortality worldwide and can help to develop other serious diseases such as diabetes, cardiovascular problems or cancer, among others.

Beyond nutrition and exercise

For many years, the focus in addressing obesity, both in terms of its prevention and its treatment when it has already developed, has been placed on nutrition and exercise. These two are undoubtedly important pillars of this disease, but research in recent years has served to bring to light other factors that are also of capital importance in its genesis. “We know more and more about the role played by the microbiota, the set of microorganisms that live in our intestine, both in the generation of obesity and in the development of other diseases associated with it. The gender perspective is also of great importance. And there are many predictive factors of response to treatment and the approach to obesity that are also being studied right now,” highlights Dr. Albert Lecube, head of the Endocrinology and Nutrition service at the Arnau de Vilanova hospital, in Spain.

All this new knowledge about this disease makes a completely individualized treatment more necessary than ever, as indicated by Dr. Cristóbal Morales, specialist in Endocrinology and Nutrition at the Diabetes Day Hospital of the Andalusian Health Service in Spain. “There is no obesity that is the same as another, because numerous factors influence it, such as genetics, biology, cultural education, gender differences… knowing them helps establish prevention and treatment strategies,” he explains. A prevention that, according to the specialist, should start from the moment of birth. "We are talking about a pathology in capital letters that, in addition, directly impacts the quality of life of the patient who is blamed for his own illness."

Pharmacological treatments for obesity

Until now, in those cases in which obesity has reached a point where diet and exercise no longer work and serious health problems have arisen, the only truly effective alternative is bariatric surgery, a set of procedures surgical procedures that seek to reduce body weight by reducing energy intake through changes in the gastrointestinal tract. However, different pharmacological treatments that can radically change this are becoming increasingly more relevant.

“We are investigating new molecules that can transform the way we address obesity. It is a revolutionary moment and thanks to these new pharmacological approaches it is possible to help people with obesity gain quality of life with results never seen before. For example, much progress has been made in drugs that reduce appetite," says Dr. Morales, who points out that for good use of these new alternatives it is very important to design personalized treatments that take into account the characteristics of each person with obesity and that it is important to understand that general diets do not work in all cases.

Clinical trials carried out with some of these new drugs have achieved a weight reduction of between 15 and 22%, but it is also important to understand that other factors such as the amount of fat mass or quality of life are also improved. notably. "It has been seen that these new drugs are effective in preventing up to 90% of the development of diabetes, which is one of the main diseases derived from obesity and would justify the use of these medications to avoid all complications and expenses." derived from the development of this other pathology,” added Dr. Andreea Ciudin.

Fight the stigma of obesity

Experts never tire of repeating the importance of also fighting against the stigma that people with obesity currently suffer. For many years they have been blamed for this condition, accusing them of bad habits. The latest research is demonstrating how diet and exercise are just two more factors in a complex multifactorial disease. “It is very important not to blame people with obesity and to help them. There are more than two hundred complications that are related to it and it is not a question of aesthetics, but of health,” recalled Dr. Cristóbal Morales.

For this reason, experts emphasize the need to prepare national health plans that address this public health problem from a global perspective and take into account the multiple factors that affect it. “People's economy has a very important impact on the development of obesity. It is known from many studies that people with lower incomes have a higher rate of obesity. People's zip code ends up being a determining factor in the development of this disease,” concluded Dr. Mar Malagón.


"Because prevention is better than cure"

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