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José Antonio Sau
Malaga
Friday, 16 May 2025
María del Mar Malagón is a professor of molecular biology at the University of Cordoba and president of the Spanish obesity society. She hosted the 32nd European Congress on the disease, which brought more than 4,000 international specialists together in Malaga. In this interview, she reviewed the progress made with the disease and declared war on the stigma associated with it.
-Who is considered obese and how much of the population is affected?
-The diagnosis involves the body mass index, which is a ratio between weight and height. There are established ranges that are perhaps targeted towards the caucasian population: up to 25 counts as normal, 25 to 30 overweight and from 30 onwards, it's obesity in varying degrees. With regard to the proportion of people living with obesity, in Spain we are talking about 20 per cent of the population - two out of every ten adults. Between six and seven adults in every ten are classed as either overweight or obese.
-Is this one of Andalucía's major public health problems?
-We are undoubtedly talking about tremendous numbers. We haven't talked about childhood obesity, which is at around 10 per cent, one of the highest in Europe, and it is highly likely that these children will increase BMI over time. Obesity is a disease that increases the risk of other diseases. Imagine a child who starts with obesity, they may develop cardiovascular problems or diabetes and will have to live with disease for most of their life. It's a serious problem.
-And how do you tackle childhood obesity?
-There are more campaigns, more talk about prevention, and yet the rates are still not decreasing. There are many causes: genetic, biological, environmental and socio-economic factors. We have to address all these aspects because obesity calls into question location, education and financial situation (among other factors). Plus the offer of hypercaloric food, which is much more affordable than the food that we understand as healthy.
-What progress has been made?
-We have scientific evidence that body mass index is an indicator, but we need to know more for a diagnosis, such as body composition, because accumulating fat in the abdomen is really harmful, (or losing muscle mass - which is what happens in sarcopenic obesity). If the recommendation is exercise with this type of obesity, the person has to be careful about the type of activity they do - so it's a bit of a vicious circle. There's a lot of research in the development of weight loss drugs, but there is also a lot of research into mental health and new technology.
-Is there any advice that stands out in the new clinical guideline for tackling obesity?
-Overall it's about improving health, but another key aspect is the stigma: it's wrong to consider the sole cause of obesity as eating too much. When weight is gained, all the mechanisms that are perfectly adapted to say 'you have already eaten, stop eating' are disrupted. It is not a lack of willpower, obesity does not choose you, it is not a question of decision. Although it is certainly necessary to introduce healthy lifestyle habits, pharmacological treatments are available for those with serious conditions. Obesity has to be considered a disease and be integrated into health systems - just as diabetes has been.
-Are there other myths that we should discredit?
-I think we have talked about the stigma that society has towards people with obesity, which can also have an impact on employability. Another important factor is self-esteem: many people with obesity feel that it is their fault, so they won't go to the doctor. This is a myth that needs to be debunked.
-Are ozempic type drugs prescribed for other diseases?
-Ozempic is not for obesity. Let's talk about the active ingredients: liraglutide, or semaglutide. The biological principle is the same - they are both incretins. But the dosage changes for the treatment of obesity or diabetes, and for obesity it has a different name. Obviously I think we all know people who have a wedding or event and say: "I want this and the Spanish agency allow it". That is why I put so much emphasis on prescription by specialised health professionals. Because the prescription has to be accompanied by changes in nutrition and exercise. So let's reinforce this shift in lifestyle, but leave it up to the professionals to decide what an individual needs. For example, they could need psychological support, because obesity can be caused by trauma or stressful situations. It's very complex.
-What are the risks associated with obesity?
-There are around 200 associated diseases. It's a major risk factor for the development of cardiovascular disease and diabetes. But it also causes liver disease, kidney disease, osteoarthritis - the whole musculoskeletal system is affected by the inflammation it causes. The weight can cause respiratory problems, depression, anxiety and is associated with several types of cancer. Obesity basically affects everything.
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