The day of the fight against Obesitywhich this year is celebrated this Tuesday, different scientific societies have once again denounced the “double burden” of this chronic diseasewhich “increasingly and worse affects people with fewer resources”, during a press conference in which the president of the Spanish Society of Obesity (SEEDO), Dr. Diego Bellido, urged the Ministry of Health to “assess the cost-benefit ratio of the introduction” of semaglutide (the antidiabetic drug sold under well-known brands such as Ozempic or Wegovy), in patients suffering from cardiovascular pathologies or sleep apnea derived from obesity.
At a conference for journalists organized this Tuesday in Madrid, Dr Bellido spoke about the economic cost of obesity. “This treatment probably cannot be financed for everyone, it is a complex issue, but the public administration must tackle it and, at least, in the context of obesity as a disease”, establish criteria for use in certain comorbidities associated with obesity with an effectiveness componentas for a cardiovascular pathology or sleep apnea”, he defended as part of the strategies for a disease which also asked the authorities to be recognized as chronic.
The president of SEEDO asked Minister Mónica García’s team to use criteria to provide equitable access to these medicines, while recognizing that “probably not universal due to costs involved”. According to him, the administration is “sensitive” to this request, but “fearful” of the high cost it could cause to the National Health System. In Spain, according to the latest available data, 19% of the adult population suffers from obesity. If we add overweight people, this figure rises to 55%.
Bellido clarified that at the secondary prevention level, semaglutide “has already been shown to reduce all-cause mortality and cardiovascular mortality.” There are clinical studies that support this use is beneficial as a determinant of health. Another pathology which, thanks to these medications, is considerably reduced, or even practically cured, is sleep apnea, which is increasingly common in obesity. ” In this context, he asked the administration “to evaluate the cost-benefit ratio of the introduction of these drugs under these conditions”, in order to be able to “demonstrate whether it is really profitable in real life”. We are talking about a question of profitability.“.
Earlier this month, the World Health Organization (WHO) published its first clinical guideline on the use of type 1 glucagonoid peptide analogs (GLP-1), previously included in its List of Essential Medicines for the treatment of type 2 diabetes in high-risk groups, to treat obesity. In the guidelines, the WHO emphasizes “the importance of Ensuring equitable access to GLP-1 analogues and preparing health systems to use them. If policies specifically aimed at this are not adopted, access to these treatments could worsen existing inequalities. The WHO also called for “urgent action to support production, affordability and systems readiness to meet global needs.”
“The drug It is not a magic pill, but an additional element of a comprehensive and multifactorial treatment. this facilitates the patient’s adherence to the treatment, in addition to the fact that they are not affordable for life”, highlighted the president of the National Association of People Living with Obesity (ANPO), Federico Luis Moya, who advised taking advantage of the time that pharmacological treatment lasts to acquire changes in habits in order to achieve a stable healthy weight.
For her part, the coordinator of the obesity sector of the Spanish Society of Endocrinology and Nutrition (SEEN), Irene Bretón, highlighted that a recent study by her organization revealed that out of 14 million hospital discharge reports, “not even 6%” coded obesity as a patient’s illness, while the real prevalence is much higher among those admitted. At this point, Bellido emphasized that scientific societies need data to be able to “sound the alarm” to the administration, so that it sees the need to finance these drugs, but also to clinicians. The expert regretted that “Many patients are discharged without us knowing that they suffer from obesity” and “they come in with a diagnosis of a heart attack but not with a diagnosis of the underlying problem.”
The “double burden” of obesity
The specialists, who strongly advised against the use of these medications without a medical prescription, began the discussion by denouncing that Social inequalities largely influence various aspects of the approach to obesity such as the quality of food, the possibility of practicing physical activity and access to information and rigorous medical care.
Bretón wanted to make visible “the double inequality of obesity, which increasingly affects people with fewer resources, and it is these people who suffer from more difficult access to health services to prevent and treat it, which constitutes a vicious circle from which it is difficult to escape”. To treat this metabolic disease that specialists ask to be recognized as “chronic, complex and multifactorial”, Bretón defended the need to carry out public health policies such as make healthy foods affordable, promote environments that facilitate physical activity and guarantee health care that guarantees early detection, as well as “orientation to multidisciplinary teams and access to effective treatments that take into account the social and cultural perspective, so that the measures really reach those who need them most.”
Likewise, Dr. Bellido added that “inequality is not a consequence, but part of the origin of the problemtherefore if the social determinants are not addressed, the prevalence will not decrease. »
Specialists point out that obesity increases the risk of contracting more than 200 diseases. According to SEEDO data, in Spain the cost of inaction to end obesity exceeds 130 billion euros per year and could reach 161 billion euros in 2030. Likewise, SEEDO argued that “when clinically relevant weight reductions are achieved, the benefit for the health system and for society is substantial, reaching an estimated social value of 84 billion.”
Internationally, obesity is estimated to increase from 16% today to 39% in 2040, with a particularly rapid increase in low-income regions. “It is no longer a disease concentrated in rich countries, but it is spreading to those who have fewer resources to deal with it. Currently, 6% of the global burden falls on the poorest countries and by 2040 it will reach 26%,” Bellido said.
In its recent guidelines, the WHO stated that “even with a rapid increase in production, it is estimated that by 2030, GLP-1 analogue treatments will only be available to less than 10% of people who could benefit from them.” The WHO has urged the international community to “study strategies to expand access to these treatmentssuch as bulk purchasing, tiered pricing, and voluntary permits, among other options.
Recognition and stigmatization
For his part, the president of ANPO said that the main difficulty for obese people is obtaining a diagnosis, “since obesity is not recognized as a chronic and multifactorial disease.” For the president of ANPO, “this recognition is essential to work to improve accessibility to any therapeutic treatment likely to improve their quality of life.”
Additionally, Moya emphasized the importance of treatment compliance: “Obese people are often unaware of the complexity of this disease, making it difficult for them to understand the need to change their habits. of life and its nutrition.
Likewise, ANPO emphasizes the importance of raising awareness in society of the importance of this pathology in order to put an end to the stigmatization suffered by people who suffer from it. “This stigmatization is mainly induced by erroneous belief that obese people choose to live with this disease“, he remarked.
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