In 2016, three out of ten people on the planet, which equates to more than 2.2 billion people, were overweight, and more than 796 million were obesity, according to World Health Organization (WHO) data. Such a scope turns excess accumulated fat into something much more serious than a local problem - let alone aesthetic - and the UN's own public health policy body calls it a "global epidemic of the 21st century." Obesity is the letter for many dangerous health problems, such as type 2 diabetes, metabolic syndrome, heart disease, stroke, various types of cancer, and respiratory disorders. There is no doubt about its impact as a risk factor, but should it be treated as a disease? Would that drive a medical solution to the problem?
These questions have on the medical community in an intense debate. No one doubts that behind the discussion, which has recently aired in an article published in the journal British Medical Journal, there is a powerful gentleman, health spending, But it's not the only factor in the debate,
A controversial investment
For Clotilde Vázquez, head of the Endocrinology and Nutrition Department of the Jiménez Díaz Foundation and researcher at CIBER Obesity at the Carlos III Institute of Health, the controversy of considering obesity as a disease is due to economic factors Health. "As in diabetes, having the person play their part is as important as considering obesity as a disease and the need to treat it. Obesity is an anomalous form of interaction with the environment, and this depends on the complex ibrication of various mechanisms. If treated as a disease, we are obliged to provide care and subsidize drugs and techniques for its treatment," explains
According to a study published in Spanish Journal of Cardiology, by researchers from the Hospital del Mar Institute for Medical Research and hospital del Mar, in Barcelona, care for people who are overweight, obese and morbid obesity generates an overcost to the National Health System of around 2 billion euros. "Although in Spain it is considered as a disease, and as a risk factor for many other diseases, the response of the health system is poor, and despite having had good epidemiological studies on the prevalence of obesity, lack all-time prevention measures at the community and state level," emphasizes the endocrinologist.
In terms of the goal of health spending, a key point is to market drugs that benefit body weight, says Camilo Silva Froján, member of the Center for Biomedical Research in Network Obesity and Nutrition And specialist in Endocrinology and Nutrition of the University of Navarra Clinic. For Silva, considering obesity as a disease would mean improving patients' access to treatments: "The arrival of new safer and more effective drugs could generate a lot of frustration if the patient does not access them. The expectation is very positive in the results of preliminary studies with developing drugs, but the economic crisis forces control of health spending. In Spain, patients' access to dietary - quality nutritional education - surgical and pharmacological treatments should be greatly improved. There are treatments that significantly improve the weight and health of obese patients, but they are not funded."
The dietitian-nutritionist at the Vallcarca-Sant Gervasi Primary Care Centre in Barcelona, Alex Pérez, remembers that a person is obese when his body mass index (his weight in kilograms divided by the square of his height, in meters) is about over 30. "Years ago the perimeter of the waist (if it is greater than 88 centimeters in women and 102 in men) is also taken into account in its diagnosis. But the body composition (fat, muscle, bones, viscera...) is not taken care of, since in the usual clinical practice does not have precise and reliable devices, nor many times of time", regrets Pérez, for whom it is a mistake that in pathologizing the pathology obesity seal political or economic interests over health and social,
Less social stigma, but also responsibility
A positive effect of considering obesity as a disease, according to its supporters, would be to alleviate the prejudices and stigmas that weigh on the obese person. "Like any disease, it has causes, complications, epidemiology and treatment. It can be treated by changes in lifestyle habits, endoscopic procedures, drugs, or surgery. It can have a mild, moderate or severe impact on health, and can vary throughout life, even sometimes unpredictably. To hear that weight loss depends only on willpower is unfortunate. Normalizing disease status for obesity would make things better, as long as the patient doesn't stop considering himself the administrator of his health," Silva thinks,
For the critical voices of the debate, obesity represents the body expression of excessive eating and, in general, an unactive lifestyle. "It is not due to an organic failure, nor an accident, nor is it the result of a bacterial, fungal or viral infection, but to living in a hyper-fed environment where a primary instinct is continually led to being satisfied," says nutritionist Alex Perez. And warns of the counterproductive effects of considering obesity as a disease: "Over-medicalizing a health problem that needs corrective action in lifestyle makes it tend to think that diseases are entities that act as externally, which leads us not to take responsibility beyond taking a pill," he adds,
Although excess accumulated fat may be the sign of some diseases such as Cushing Syndrome, physician Juan Gervás, author of the Sano and Salvo blog (and free from unnecessary medical interventions), believes that in most cases the obesity is not a disease. "Neither is famine. which is considered disease depends on a social consensus, Expanding the field of disease is medical abuse, and moderation is appropriate when defining disease, risk factor and health. The debate responds to spurious interests of physicians, obesity clinics, academics, researchers and scientific nutrition communicators, who are all overtheless and dogmatize. Many people will suffer when they become sick and no such exclusion will be compensated for any benefit, and would legitimize aggressive treatments that are often unfounded. This is a repeat story in obesity, with dozens of drugs removed from serious problems of side effects," warns the doctor.
There's another way to look at it. Claiming obesity as a disease is framed, according to the psychotherapist Xavier Sanmartín, in visibility of problems that until now have not been exposed and that generate a great mobilization to raise social awareness, such as functional diversity, carnism or the use of plastics. "Visibility of a problem is intended to hold us accountable for taking action in the line of change. Obese people have suffered social stigma and are very sensitive to criticism from those who feel entitled to tell them what is right for them. The danger they may intuit is that if obesity is considered an illness other people may feel entitled to invade their privacy by telling them how to live and what they have to do. Here an identitarian reaction would reject aid in an attempt to restore the self-determination of the election itself. The debate should revolve around patient responsibility for their illnesses, There are social movements that seek to empower the patient towards greater awareness of their disease and towards greater involvement in treatment," says Sanmartín."h3 lang"zxx" xml:lang"zxx">A Consequence of Inequality
The debate about whether obesity should get disease is complex, and fraught with nuance. For example, those that emerge by the fact that different types of obesity can be distinguished; for Sanmartín, placing all obesity at the same level, both by grade and etiology, would be a mistake. "Obesity due to biological cause (by hypothyroidism, for example), is not the same because of social factors (a consequence of poverty, education...) or by behavior (the cross on the back of the emotional dining room). Intervention has to consider biological, cultural, psychological factors... it is therefore a multifactorial problem that requires a multidisciplinary approach. Social action to address risk factors for obesity such as poverty are also medical competence, as prevention," argues the psychotherapist,
And obesity is not an exclusively health problem or that it should be solved only by medical interventions, as the endocrinologist Camilo Silva acknowledges. The environment plays a decisive role, and its influence is very difficult to deactivate (when it is possible to do so). "Obesity is a medical problem that is increasing morbidity in our society. Being such a widespread problem, it has a strong social dimension, which has its peculiar characteristics. One of them is the association of obesity with a lower purchasing capacity due, among other things, to the abundance of cheap but very caloric foods".
People living in medium-low socioeconomic strata take care less of their overall health, which, in the medium-high strata, especially in large population concentrations, points out nutritionist Pérez. "There has been talk of 'food deserts', urban or peri-urban areas where getting fresh and healthy food without the need to travel and do many kilometers by car is almost impossible. In these cases, the majority use of ultra-processed foods is almost the only option. It is necessary for economic and productive actors, health workers and urban planners to reconsider so that their decisions transcend their partisan interests," he stresses.
In developed countries, the most important thing is to see obesity as a political and non-medical problem, the doctor Gérvas points out. "The atlas of obesity is the atlas of poverty. Poverty, and the inequity that causes it, is associated with obesity and type 2 diabetes. Clinical interventions are intended for failure. Over the years patients generally regain lost weight. The practical it is to go to social determinants, to public health, to the conditions in which people live. WHO should say that obesity is the symptom of inequality, and develop policies against inequity and inequality. It should also promote public health approach. In addition, there is a clear 'anti-obesity' stigma in the health sector with serious impacts on women's health. Obesity, rather than a health-threatening problem, is a problem that puts dignity and human rights at risk," concludes Gérvas.