José Miguel Seguí and Juana Carretero.
The importance of active diagnosis to detect obesity in high-risk patients and with other associated pathologies It does not catch on among health professionals. A fact that is causing a infradiagnóstico of a disease that has just been recognized as chronic in Europe, but not yet in Spain, so its detection is not included in the clinical guidelines.
“We are late to the diagnosis of obesity because we don’t do an active search. Unless the patient enters the consultation with an obesity that comes out of our eyes, we do not see it ”, claims the vice president of the Spanish Society of Internal Medicine (SEMI), Jane Carterduring the Round Table on Obesity held at the XVI meeting of the Working Group on Diabetes, Obesity and Nutrition of the SEMI.
At a table moderated by Jose Miguel Seguiattached to the Internal Medicine Service at the University Hospital of San Juan de Alicante, and in which he has also participated Maria Isabel Perez Sotoattached to the Internal Medicine Service of the General University Hospital of Elche, has revealed the change in approach that health professionals must undertake.
“Obesity is not a problem of individual weight, but of excess fat, which raises the risk of suffering or worsening other diseases such as atrial fibrillation, chronic obstructive pulmonary disease (COPD) or other metabolic problems”, claims Carretero. A feeling that Pérez Soto also shares: “We must believe and be convinced that obesity is a chronic disease with excess adiposity.”
A tailored suit for the obese patient who arrives at Interna
For the internist, in the era of “Personalized Medicine” the doctor must make the patient the best possible tailored suit. “We must stop measure them, weigh them, carve them and see how this affects the rest of their diseasesyes Obesity must be diagnosed and classified by the Edmonton Obesity Staging System (EOSS), measuring the Abdominal perimeter and performing the test de sarcopenia”highlights the vice president of the SEMI.
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Pérez: “We must believe and be convinced that obesity is a chronic disease with excess adiposity” |
These clinical habits become especially decisive in Internal consultations, since the patients they receive are usually older, with other comorbidities and a high degree of obesity. “Obesity is much higher than the average in patients older than 65 years, which are what we receive. In addition, they also have high abdominal obesity”, details Carretero, who also recalls that they are usually in an advanced stage of EOSS with great metabolic damage, many comorbidities and associated diseases. “The patients we receive are high risk and, therefore, we must be curious to see how obesity influences them”, he claims.
How to get the patient to lose weight?
According to Pérez Soto, the key for the patient to lose weight and maintain it lies in Teach him to eat and exercise daily, since diets are not effective. “In the first year following concluding a treatment, the individual regains up to 30 percent of the weight lost. Only one in ten obese patients is able to maintain weight loss a year later”, explains the specialist, who believes that you should stop talking regarding diet because the day that ends is the day that weight regain begins.
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Carretero: “The patients we receive are high risk and, therefore, we must be curious to see how obesity influences them” |
The internist understands that the only non-pharmacological strategy they have is to eat healthy and exercise, especially resistance exercise. For this reason, she considers that the only person responsible is the individual, who is not doing things right. Although, these bad practices are influenced by many factors. “Obesity is influenced by biological factorschanges that are inherited or differences between the sexes; genetic, we inherit a susceptibility to suffer it; from around, here influence behavior patterns that mark the decision making that lead us to eat even if we are full; and psychological”, details Pérez Soto.
As for more effective habits, scientific evidence marks a similar weight reduction in the Mediterranean diet and a low carbohydrate diet. “The Mediterranean provides better glycemic control and the low carbohydrate content creates a favorable effect on lipids and metabolic syndrome, in addition, it does not have caloric restriction”, details the internist.
Regarding medications, there are three approved drugs for obesity. Among them, stands out thepast tense. “He is the most powerful. Increases satiety and reduces appetite. It also gives good results in patients who have not undergone bariatric surgery”, explains Pérez Soto. Some effective drugs that are expected to be added more in the short term, however, these cannot be prescribed. “Drugs for this type of patients should be financed and for that, consideration should be given to Obesity as a chronic disease. We can make them lose fat without reducing muscle”, claims Carretero.
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