2023-11-22 11:12:01
Internists have stressed that considering obesity as a chronic disease will facilitate a care process around and addressing its comorbidities. GLP-1 analogues for obesity present unpublished efficacy and safety data.
The prevalence of obesity in the Spanish adult population is 23%, but it is estimated that by 2030 it will be 30% and by 2035, 37%. And in children and adolescents, the prevalence of obesity increases by 2.5% year-on-year, according to various scientific societies and bodies dedicated to its management.
It is essential in our country to catalog and evaluate obesity as a “chronic disease” – in the EU it has been so since 2021 – and consider that all associated comorbidities are a “consequence.”
Added to this is that people with obesity can develop metabolic diseases, such as diabetes and metabolic liver disease, cardiovascular diseases (ischemic heart disease, heart failure with depressed ejection fraction, HF with preserved ejection fraction, or stroke), sleep apnea. sleep, chronic kidney disease, up to 32 different types of cancer, infertility and sterility, and joint problems – osteoarthritis – and they have a greater risk of needing prostheses and their replacement for some of the damaged joints.
As an example, one of the main items is HF and, especially in the case of preserved ejection fraction, the main problem is excess fat around the heart, which prevents it from expanding and also infiltrates the myocardium. .
Furthermore, another example is the impact on chronic kidney disease: “In a few years, obesity will be the main cause. “The fat is deposited outside the kidney and also causes the organ to filter more.” And what can be done? The experts have reiterated that from Internal Medicine “we are convinced that obesity is the cause of all associated comorbidities.” Therefore, it should be the first point of the decalogue to study and address it completely. Another key aspect is to “draw the patient’s main profile” and assess whether or not they need to lose weight, since “there are very old and fragile patients where losing weight is counterproductive.”
Interaction with other treatments
Another aspect to analyze and study is to see how excess adiposity, which is the correct way to measure obesity, influences “the treatments that internists usually give.” We are used to treating people who have pulmonary thromboembolism with anticoagulants. It is one milligram of heparin per kg of weight, but how much is administered to someone who is overweight?”
Along these lines, it should also be analyzed how obesity interacts with these treatments. Regarding the financing of anti-obesity drugs, the president of the SEMI has pointed out that it is not sustainable for it to be for everything, but rather that “it must be prioritized for those patients who have a disease associated with obesity.” She has also emphasized the study of lifestyles and their influence on the health of these patients, and whether all of them, whether old or young, should receive the same treatment. In this sense, she recalled that older people need a different approach “especially to avoid losing muscle mass.”
There are no “healthy obese”
Along these lines, it is insisted that there are no “healthy” obese people. Until now, it had been postulated that obesity is a risk factor for other diseases and that there is the metabolically healthy obese phenotype (FOMS), according to which there are healthy obese people who are no longer at risk of developing other diseases. Now, it is beginning to be postulated that this phenotype does not exist and that the fat accumulated in the body is always dysfunctional; It is made up of very large molecules and, therefore, the body is inflamed and sick. “We cannot talk about the metabolically healthy obese person. We must consider obesity as a chronic, relapsing and multifactorial disease. Obesity is not a risk factor for diabetes and other heart diseases, but obesity itself is a metabolic disease, from which other metabolic diseases derive.
Therapeutic news
The most notable therapeutic developments for the management of obesity are GLP-1 receptor agonist drugs, a treatment already in use. Semaglutide at a dose of 2.4 mg is pending approval for an obese patient profile. Other drugs under investigation are GLP-1 agonists and GIP agonists (another intestinal hormone), tianeptine, which has been seen in clinical trials to produce weight loss of more than 30% at high doses, but also a lot of weight loss. of muscle mass.
Combination drugs such as glucagon and GLP-1 coagonists or glucagon, GIP and GLP-1 coagonists could be added later. These drugs increase muscle mass and at the same time decrease excessive weight loss. Likewise, the indications for IFSO bariatric surgery have been expanded (American guidelines), which can now also be offered to patients with a BMI > 35, regardless of whether they have another associated comorbidity, BMI > 30 if they have diabetes or other comorbidities. associated (when previously it was for patients with a BMI > 40), also over 65 years of age, and in children and adolescents. Enrique Mezquita.
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