It is said to be the epidemic of the 21st century in the Western world: obesity affects almost 1/3 of the adult population and is one of the leading preventable causes of death in Western countries. We have been hearing about this problem for decades, but the prevalence of obesity and overweight in our population continues to increase. The numbers of this disease are impressive, both when talking about its incidence in adults, and especially when referring to obesity in children. Obesity is passed down from parents to children and the 21st century epidemic continues to wreak havoc. And the main problem is the long-term effects: reduced life expectancy, increased diabetes, cancer, cardiovascular diseases, among others. Is obesity a disease? Yes, obesity is a disease. Portugal was, in fact, one of the first countries to classify obesity as a chronic disease – it did so in 2004. Even though this did not lead the population and health professionals to see it as such, which is curious. As it has aesthetic consequences, it is often not seen as a disease, but more as a physical characteristic as a consequence of bad behavior, which does not help in its treatment and contributes to its stigmatization. We end up looking at the obese person as someone who eats too much, who doesn’t exercise, who, deep down, ‘behaves badly’. And that's not necessarily true in most cases. When we talk to these people and realize that, in fact, their behavior is not very different from that of people with weights considered “normal”, we realize that this stigmatization is unfair and harms the approach and treatment. When a doctor says, ‘I know you have an illness, I know it’s not your fault,’ many people feel that someone finally understands them and they become more receptive to treatment. These are used to everyone around them thinking they are overweight because they don't do what they should. The difference between overweight and obesity Overweight is having a body mass index (BMI) greater than or equal to 25kg/m2. This is a risk factor for developing obesity, and in the case of obesity the BMI is greater than or equal to 30 kg/m2. This is probably not the best parameter for assessing obesity and cardiovascular risk, but it is the best studied and the one we use in everyday practice. Ideally, we should also carry out an assessment of body composition, with an assessment of abdominal perimeter being an excellent option. Is there a genetic predisposition to obesity? What does it mean to view obesity as a chronic disease? What is known today is that when people choose to adopt a more appropriate eating behavior, reducing calories and increasing exercise, there are results in terms of weight loss estimated at 3% to 5%. But if we talk about the long term – which ends up being what matters most, since this is a chronic disease – unfortunately, most people will end up returning to their previous weight. It is rarely possible to maintain the level of commitment and motivation throughout life when you need to lose more than 20 kilos, for example. This is not a question of lack of motivation and discipline, but a health problem. At the base of the pyramid, so to speak, there must always be behavior. Because, until very recently, we had no pharmacological options to treat the disease. The prevalence of obesity has been increasing steadily and has become a true epidemic in the Western world. Interestingly, recent data from the United States indicate that since new obesity drugs began to be used, for the first time prevalence figures for the disease appear to be decreasing. Obviously, it's still too early to draw any major conclusions, but there's little doubt that things are related and that we're on the right track. If I have no genetic predisposition to obesity, will I never be obese? How can I know if I have this predisposition? People subjected to the same environmental and social context and who have similar behaviors present different weights – this is one of the factors that shows us that there is a genetic predisposition to this disease. In most cases it is a polygenic disease, which makes it difficult to carry out specific genetic studies to understand this predisposition. It is not normally done in clinical practice. Why obesity should be treated This is a disease with many negative effects on the health of those who are obese. It is a risk factor for cardiovascular diseases, namely hypertension, diabetes and dyslipidemia. It is also linked to many types of cancer and associated with sleep apnea. It arguably implies worse than life expectancy. As explained above, behavioral changes rarely have long-term results. And what we are seeing now with the latest drug therapies is precisely an efficient response to this problem. For the first time, we have drugs that are safe, that are approved by the European and American drug agencies and that are considered effective, with positive evidence in clinical trials. And the results are seen, not only in weight loss, but also in the reduction of cardiovascular risk. In other words, we can improve quality of life and, at the same time, avoid heart attacks, strokes and many of the deaths associated with cardiovascular diseases. How do these new drugs work? Since obesity is a chronic disease, is the outlook for these patients that they must take them forever? New obesity medications act on the appetite and satiety center: they decrease appetite and the feeling of hunger and increase the feeling of satiety. They are, in essence, a facilitator of the process of ‘eating less’, which is always necessary to lose weight. As the person becomes less hungry and begins to feel full more quickly, this process is facilitated. And people actually eat less, starting to lose weight, feel better and improve their health parameters. Many patients ask this question: how long will I have to take this medicine? The answer is this: if it is a disease and it is chronic, the therapeutic approach has to be thought of in the long term. We cannot guarantee, of course, that it will always be the same medication that is prescribed today. There has been a lot of progress in pharmaceutical industry research in this area, so it is likely that in five years medicine will already be different. However, to treat this disease, it will most likely be necessary to maintain some type of pharmacological therapy for the next few years. Clinical trials show that stopping taking it tends to lead to weight gain again. ‘Recreational’ use of these new drugs These drugs are approved and indicated for the treatment of overweight and obesity and are intended for people with a BMI above 27 kg/m2 with other associated diseases or above 30 kg/m2. They do not exist on the market in astronomical quantities, therefore, recreational’ use - just to lose a few kilos - increases the global problem of accessibility to these medicines. Healthcare professionals should therefore prioritize prescribing to people who really need the drug, to the sick and to the obese. Only in this way can we treat the disease and combat the scourge of obesity. New drugs: no need to go to the gym anymore? This is a fundamental point. In fact, we can enter a phase of complacency and think that, by having these remedies, we no longer need to worry about what we eat or exercise. Nothing like that. New drugs don't solve all problems. And they won't end the disease. They are an important tool to help correct behaviors, but they are not enough. Relevant work must be done in education and prevention: it is essential to talk about this problem from a very early age in schools and explain to the population that obesity is a disease to which they must be alert; and, therefore, it is essential to prevent its appearance, promoting appropriate eating habits and regular physical exercise. Obesity is a disease, and it is in the hands of each person at risk to prevent and treat it. Meet the endocrinology team from Hospital da Luz network The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
