Obesity is a chronic illness. That is the conclusion of Spanish experts in endocrinology and nutrition, who took part in the first summit on obesity which was held in Spain recently. At the conference, the specialists argued that excessive weight should be considered a chronic disorder and therefore the public health system should pay for a type of medication which enables obese people to lose up to 15 per cent of their excess weight. They believe the health authorities in Spain should classify obesity as the same type of chronic illness as the World Health Organisation and American Medical Society have done.
However, there is still no real awareness that being fat is a dangerous illness and that obese people should be treated as patients and not marginalised because of their weight. Obesity, which has become a public health problem, is responsible in many cases for the onset of Type 2 diabetes, cardiovascular illnesses, hypertension (high blood pressure), obstructive sleep apnea, gall bladder problems and pain in the joints. It is also associated with some types of cancer (breast, colorectal, kidney, pancreas, oesophagus, prostate, thyroid and endometrium, among others). A figure which highlights the magnitude of this question is that obesity shortens lives by between five and ten years.
The experts in endocrinology and nutrition say we need to put an end to the stigmatism suffered by obese people, and they point out that there are some ideas about excess weight which are completely wrong. For example, they confirm that some people become obese even though they do not eat to excess.
One of the specialists at the summit was Francisco Tinahones, the president of the Spanish Society for the Study of Obesity (SEEDO) and director of the endocrinology and nutrition clinical management unit at the Clínico hospital in Malaga. "Obesity is the poor relation of illnesses," he says. "It is not classified as an illness by society or by the political class".
He also points out that there are effective drugs against obesity and claims these should be financed by the public health authorities for certain patients, in exactly the same way as those suffering from high blood pressure or cholesterol. With this type of medication, an obese person can lose up to 15 per cent of their weight.
One such medication is Liraglutide 3 mg, which is injectable. It reduces appetite so the patient doesn't feel hungry and, at the same time, produces a persistent feeling of being full, which helps people to stick to a long-term diet.
The obstacle to public health funding is the cost of this treatment (about 300 euros per patient per month), but Dr Tinahones stresses that if they were to carry out a cost-benefit analysis they would see that there would be a saving, because the weight lost by the patients would improve their health and their lifestyle and they would not have to take medication to combat the problems caused by their excess weight. In Spain, the associated costs amount to seven per cent of total spending on health.
"We have to stop seeing obesity as an attitude, because it presents many factors which are not voluntary, including some biological mechanisms which mean that those who suffer from them do not feel full after eating. Therefore it is essential that they are treated by health professionals," says Javier Salvador, a consultant with the endocrinology and nutrition department at the University of Navarra Clinic.
These sources say that pharmaceutical treatment for obesity is also proving useful as a complement to bariatric surgery, especially before and after the operation. Before having surgery, the patient has to lose weight and this can be achieved more quickly with medication than by diet alone.
Dr Tinahones explains that 20 per cent of obese people are metabolically healthy, but the other 80 per cent have illnesses which affect their quality of life and are dangerous for their health. Being overweight is a warning. Once this occurs, and people put more weight on, they need to change their lifestyle, eat healthily (the Mediterranean diet is highly recommended) and take regular exercise.
In some cases people don't care about their excess weight, and the experts say that is an attitude which needs to change. "The data shows that people don't perceive themselves as obese and that makes it difficult to tackle the problem," says Dr Tinahones.
To achieve weight loss, the first thing is to accept that you are carrying many extra kilos. "There is always a way of losing weight. What you have to do is accept the situation and apply them," says the doctor. He proposes two changes in lifestyle: a healthy diet and regular exercise. By restricting calories and moving more, extra kilos will be lost. Three key factors are sleeping well (a repairing sleep prevents obesity); not snacking between meals and taking exercise (walk, swim or cycle). Obesity can be overcome, but it is essential that the person doesn't see themselves as slim, says Dr Tinahones.
For many people, a sedentary lifestyle has become so deep-rooted that they barely move at all and that has a negative effect on their body. A lack of exercise combined with a diet rich in fats and precooked foods lead inexorably to weight gain. The survey carried out by the Spanish Society for the Study of Obesity showed that more than 30 per cent of obese people spend more than five hours of their free time sitting down. That is associated with extreme sedentarism and is a type of behaviour which causes weight gain because not enough calories are burned off.
To fight against the charms of the sofa or a comfortable armchair, experts recommend walking. The ideal is to walk between 8,000 and 10,000 steps a day, which is a walk of about 70 to 80 minutes. "You have to try to do a million steps in a hundred days," explains Francisco Tinahones.
Other healthy types of exercise are cycling, swimming and musculature exercises, although it is important to choose the type which best suits each person's physical condition. As well as exercise, a low-calorie diet based on cereals, vegetables, pulses and fruits will also help to lose weight.
On the other hand, snacking between meals encourages obesity. It has been shown that more than 60 per cent of obese people do this and they usually snack on foods with a high calorie content. On the contrary, less than 30 per cent of people who are not fat snack between meals. If you feel hungry before a mealtime, the best thing is to eat fruit, carrots or lettuce leaves.