40% of people have no clinical history of pathology.

According to the agency, 21.6% of the Spanish population is obese. Spanish Nutrition Survey (ENPE)chronic, complex, multifactorial and relapsing disease1. To understand how this disease is treated in National health system the study was designed BUYINGwhich describes the fight against obesity in Spain from the point of view of doctors Primary health care, endocrinology and internal medicine. The data presented correspond to the results of a survey of 131 family doctors from different autonomous regions.

The study was supported by Pharmaceutical company Lilly, and reflects that 40.1% of patients with a body mass index (BMI) ≥30 kg/m2 do not have a diagnosis of obesity recorded in their medical records. “We’re trying to see the importance of coding the disease (obesity) as it does with stroke, diabetes or heart attack,” explains Dr. Jose Manuel Fernandez-Garciaone of the study authors, a specialist in family and community medicine and coordinator of the SEMERGEN Nutrition working group.

According to respondents, more than 95% of people receiving medical care for obesity in primary health care settings have some kind of associated complications. Among them is dyslipidemia, which is detected in 54% of people with obesity, type 2 diabetes mellitus (52%), high blood pressure (49%), osteoarthritis (45%), cardiovascular diseases (37%), sleep apnea (34). %). %), FASLD (fatty liver disease associated with metabolic dysfunction in 34%) and psychiatric diseases (31%).

Recognize obesity as chronic disease associated with obesity and that it underlies many diseases, it is important to recognize the importance of prevention and a comprehensive approach with effective evidence-based long-term care.

“People with obesity deserve access to comprehensive health care that includes, depending on each patient’s needs, lifestyle interventions such as nutrition, exercise and behavioral therapy, medications or bariatric surgery,” he says. Dr. Miriam Rubio de Santos, Medical Director of Diabetes and Obesity at Lilly. “And the work of a primary care professional is essential in the management of such a chronic disease, from prevention, diagnosis, treatment and follow-up.”

Improve functionality and quality of life in people with obesity and reduce risk of cardiovascular complications were the main reasons for starting treatment in primary care, according to the OBEQUIDA study. BMI level, psychological complications, pain and aesthetic reasons were also included among the reasons for starting treatment, although they were less significant.

Diagnosis of obesity

In Spain, there are specific guidelines for a comprehensive approach to the problem of obesity. 18.3% of respondents indicated that they did not use any clinical practice guidelines. “It’s good that the treatment of obesity is standardized; there are centers that do not have specialized departments for this disease. Interdisciplinary intervention and availability standardized guidelines to combat obesity, such as the GIRO guidelines.necessary for a more effective approach. This is a very complex disease with many aspects. One group of professionals will not achieve this; several people must achieve this. “This is a challenge for the whole society,” says the study’s author.

The study also indicates that the use of complementary methods to assess body composition is low. Additional method to BMI The most used for diagnosis is waist circumference measurement (79% of respondents), while methods such as bioimpedance They are not yet very common among health centers (8%). On the other hand, the study also shows that 9% of professionals indicate that they do not use any additional methods.

Numerous factors influence the development of obesity: genetics, age, gender, ethnicity, education, economic level, sedentary lifestyle, stress, sleep disorders, urban and socio-political environmentetc. The study shows that the majority of patients seek medical help for obesity due to an opportunistic diagnosis (44%) or at their own request (41%). The most common profile of primary care patients is women aged 40–64 years with stage I obesity.

Therapeutic interventions

Comprehensive treatment of obesity requires coordinated interdisciplinary intervention. In case of class III obesity, the study demonstrates more frequent use pharmacological and surgical treatmentaccording to 78% of participants, compared with obesity degrees I and II.

According to the majority of participants, changes in diet and nutrition and increasing physical activity were the most recommended interventions for people with the highest levels of obesity.