«Obesity is never due to lack of will»

1. It is said that obesity is the silent pandemic. What is the prevalence of this pathology in our country?

We learned the word pandemic with covid, and it indicates the presence of a disease that affects all countries, all ages, all genders. And that is obesity. The silent nickname is because we have been letting it grow and it has invaded us without wanting to see it, even though the numbers are impressive and its growth unstoppable. In Spain, obesity affects 21% of the adult population and 18% of the child and youth population. The growth expectations, according to the “World Obesity Atlas”, if we do nothing, are that in 2035 there will be 37% of the adult population with obesity, with similar growth in children, and it will affect men more than women.

2. Why should it be considered a chronic disease?

Obesity should be considered a chronic disease and not a one-time alteration of lifestyle, because it is a disease of the adipose tissue itself that when it increases due to gaining weight, it is damaged and this damage alters practically all the organs and systems of the body. Also, once it starts it can be controlled, but not removed. You always have to be treated because if there is no recurrence, that is, the weight is recovered. It is a biological mechanism known as metabolic adaptation, which kicks in as soon as we lose weight and causes us to always regain it. Statistics show that only 5% of patients who have lost weight with any method are able to maintain it, a figure that seems optimistic to me.

3. The “Models of Care Survey”, which has been carried out worldwide by the Obesity Policy Engagement Network (OPEN), reveals that 63% of health professionals do not believe that obesity is a chronic disease. What is this position due to?

Obesity has always been associated with a lack of will, laziness or simply bad habits on the part of patients, and that has meant that it was not considered within the concept of a disease, but I think that it is also a lack of knowledge or disinterest in the disease and , sometimes, inability to face it due to the large number of patients, lack of resources, such as time in consultation, few specialists and, until now, poor tolerance for the failure that the treatment of obesity entailed when we did not have the appropriate tools.

4. What percentage of obese people “only” have obesity and how many have another associated disease such as diabetes, cardiovascular problems, etc.?

Around 25% of people who suffer from the disease may not have associated metabolic alterations. They are the ones we consider metabolically healthy, although it is simply a matter of time, because it is most likely that over the years they will all end up developing one of the more than 200 complications that we know are associated with this disease.

5. By how many years does obesity reduce life expectancy?

It depends on when it starts. If it is suffered from a very young age, the average is about 11 years, and if it develops when older, in six or seven, but I think that despite this the most important thing is not that it shortens life expectancy, but rather what it deteriorates. the quality of life of those who suffer from it.

6. It is still thought that obese people are due to a lack of willpower. But really, to what extent is it more difficult for them to lose weight than the rest?

Obesity is never due to lack of will. I don't know anyone who, being obese, wants to be. The disease has a genetic basis and then the circumstances of each person's life lead them down a path in which they end up losing control of the regulation of intake. If we add that energy expenditure has plummeted due to the type of life we ​​lead, we would say that it is the perfect storm. A genetic base of individuals with high energy efficiency who have survived 2 million years of hunger, suddenly put us in a totally sedentary environment, full of food. It is easy to understand that anything that happens (an upset, an illness, changing jobs, stress, etc.) produces an imbalance that makes it easier for us to accumulate more fat and get sick. It must be understood that hunger is a symptom of the disease itself. I would say that obesity chooses you.

7. What is the treatment?

The treatment is to lose weight and maintain it, a fact that until now has been almost impossible. To do this, as with any illness, it is necessary to change the circumstances that have led you to become ill, improve intake and increase energy expenditure. To achieve this, psychological support and specific drugs to treat obesity are essential in most cases. Today, the use of new drugs has clearly taught us that the patient, when they lose weight, becomes enormously motivated and that is when they achieve or at least fight to achieve that change in habits, which, a priori, is difficult to do. Drugs, which are here to stay, are really the main asset that not only helps you lose weight, but above all will help you keep it off, a fact that until they appeared was very difficult, if not impossible, to achieve.

8. In the case of bariatric surgery, how many kilos does the patient have to lose beforehand?

Weight loss before surgery helps with patient management in the operating room, but is not strictly necessary.

9. How many, after the operation, gain weight again until they become obese again after a while?

Weight recovery after bariatric surgery is variable and depends on the initial weight, the technique applied and the time after surgery. In different series, patients who undergo surgeries that only restrict the size of the stomach can reach 70% in 10 years, while in those in which in addition to restriction, malabsorption is performed, such as gastric bypass, it is somewhat less.

10. What is it due to?

The causes are very variable, but as in patients who lose weight with other methods, the syndrome of weight regain or metabolic adaptation occurs and to this is added poor dietary reeducation, lack of activity and, of course, psychosocial stress produced by the disease itself.