About 20% of PC doctors do not use clinical guidelines for the treatment of obesity.

According to the Nutrition Survey of the Spanish Population (ENPE), 21.6 percent of the Spanish population suffers from obesity, a chronic, complex, multifactorial and relapsing disease. In this context, to analyze how the condition is treated in the National Health System (NHS), the OBEQUIDA study was conducted, which explores the perspectives of primary care (PC), endocrinology and internal medicine doctors in treating obesity. in Spain.

The first data presented comes from a survey carried out with the participation of 131 family doctors from various autonomous communities and announced during the 46th National Congress of the Spanish Society of Primary Care Physicians (SEMERGEN). The OBEQUIDA study, promoted by Lilly, shows that 40.1 percent of patients with a body mass index (BMI) of 30 kg/m² or more do not have a diagnosis of obesity recorded in the medical history. Similarly, among the data collected, it is worth emphasizing that, according to those surveyed, more than 95 percent of patients receiving care for obesity in primary care settings have associated complications. Among them are dyslipidemia, which affects 54 percent of obese people, type 2 diabetes – 52 percent, high blood pressure – 49 percent, osteoarthritis – 45 percent, cardiovascular disease – 37 percent of these patients, and sleep apnea. affects 34 percent of those affected, fatty liver disease associated with metabolic dysfunction 34 percent and psychiatric diseases 31 percent.

In this work, as explained Jose Manuel Fernandez Garcia one of study authors, specialist in family and community medicine and coordinator of the SEMERGEN nutrition working group.“We’re trying to see the importance of coding obesity, just like it does for stroke, diabetes or heart attack.”

Recognize Obesity

Recognizing obesity as a chronic, obesity-related disease responsible for various pathologies is critical to emphasizing the importance of prevention. At the same time, it is extremely important to solve this problem comprehensively, ensuring effective long-term healthcarebased on evidence.

According to the OBEQUIDA study, the main reasons for starting treatment in primary care (PC) are to improve functional capacity and quality of life in people with obesity, and to reduce the risk of cardiovascular complications. Other factors such as BMI level, psychological complications, pain and aesthetic reasons, although less significant, also influence the decision to initiate treatment.

“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 therapies, medications or bariatric surgery.” said Miriam Rubio de Santos, medical director of diabetes and obesity at Lilly.who also noted that “the work of a primary care professional is fundamental in the management of such a chronic disease, from prevention, diagnosis, treatment and follow-up.”

Diagnosis of the disease

In Spain, there are specific guidelines for the comprehensive treatment of obesity. However, according to the data collected in this study, 18.3% of respondents indicated that they do not use any clinical guidelines in their approach to this disease.

“It’s good that the treatment of obesity is standardized; there are centers that do not have specialized departments for this disease,” said the author of the study. “A more effective approach requires multidisciplinary intervention and the availability of standardized guidelines to combat obesity, such as the GIRO guidelines, since it is a very complex disease with many aspects,” the expert said, stressing that one group of professionals will not be able to implement such a comprehensive approach. “This is a challenge to the whole society,” he emphasized.

In this direction, 14 scientific societies collaborated in creating Spanish GIRO Guidelines: Spanish Guidelines for the Comprehensive and Interdisciplinary Treatment of Obesity in Adults

presented on March 4. The main purpose of this document is to propose tools that change the approach to obesity in our country. Although these new national guidelines are based on the internationally recognized Canadian Clinical Guidelines (CPG), they have been specifically adapted to the Spanish context for the comprehensive management of obesity in adults. The goal is to turn recommendations into practical actions. “They say that a disease does not exist unless it is described in books, and this guide was created precisely for this purpose,” emphasized Alberto Lecube, vice-president of the Spanish Society for the Fight against Obesity (SEEDO), during the presentation. This guide is intended to be a living entity, open to input from organizations that see fit to contribute.

For its part, the OBEQUIDA study also highlights that the use additional methods assessment of body composition remains limited. Although body mass index (BMI) is the most used standard, waist circumference is the most commonly used secondary method, with 79 percent of respondents using it. However, more advanced methods, such as bioimpedance, which allows a more precise analysis of body composition, are not widely used in medical centers: only eight percent of specialists use them. Moreover, nine percent of specialists indicate that they do not use any additional diagnostic methods.

The development of obesity is influenced by numerous factors, such as genetics, age, gender, ethnicity, educational and economic level, sedentary lifestyle, stress, sleep disorders, and urban and sociopolitical environment. According to the study, the majority of patients seeking medical help for obesity do so because of an opportunistic diagnosis (44 percent) or on their own (41 percent). The most common patient profile in primary care corresponds to women from 40 to 64 years old with stage I obesity.

Multidisciplinary intervention

Comprehensive treatment of obesity requires interdisciplinary and coordinated intervention. The OBEQUIDA study shows that in cases of grade III obesity, 78 percent of respondents indicated a higher use of pharmacological and surgical treatments compared to grade I and II obesity. Additionally, changes in diet and nutrition, along with increased physical activity, were identified as the most recommended interventions for patients with the highest levels of obesity.

The introduction of new drugs to treat obesity in Spain in 2024 marks a significant change in the treatment of this disease. However, experts insist that such treatment should be carried out under the supervision of medical professionals and always within the framework of an integrated approach. In this sense, accredited obesity units in Spain play a crucial role, providing comprehensive and multidisciplinary care with the aim of offering the best possible care. Currently, according to SEEDO, there is 21 accredited units throughout the countrydesigned to provide optimal treatment for obese patients.

According to experts, these accredited units are necessary because they employ a multidisciplinary team. In fact, one of the requirements is that they include professionals from various fields, such as psychology, endocrinology, nutrition and bariatric surgeryamong others. Extension of this model to primary health care centers is being considered, but it is too early to implement it as they will need to be adapted. However, they play a critical role in the fight against obesity, so their future integration will be key. Primary care will be the first filter, and accredited departments will be the last step in the patient journey.

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