Decalogue of comorbidities associated with obesity

For World Obesity Day, GPs are preparing a decalogue on obesity-related comorbidities and will promote research into social stigma in their consultations.

As part of World Obesity Day, March 4, physicians from the Diabetes, Obesity and Nutrition (DON) group of the Spanish Society of Internal Medicine (SEMI) prepared a decalogue revealing the comorbidities associated with this disease.

The main goal is to recognize obesity as a chronic and multifactorial disease that has many associated complications.

At the same time, a study was launched to find out the extent of social stigma against obesity. Data collection will take place at internal medicine consultations starting in May next year.

suffer from obesity

Dr. Juana Carretero, President of SEMI, emphasizes that “you should not talk about a metabolically healthy person who is obese. We must view obesity as a chronic, relapsing and multifactorial disease. Obesity is not a risk factor for diabetes and other metabolic and nonmetabolic diseases, but is itself a chronic disease that results in other metabolic diseases.

Obese people are more susceptible to developing metabolic diseases. For example, they can lead to diabetes or metabolic-associated liver dysfunction (MASLD).

Other comorbidities may include cardiovascular disease (coronary artery disease, heart failure or stroke), sleep apnea, chronic kidney disease, up to 32 different types of cancer, and fertility and infertility problems. In addition, they have joint problems (osteoarthritis) and are at greater risk of needing prosthetics and replacement of any of the damaged joints.

“We must change the minds of the scientific community and help the public become more aware of the risks associated with obesity. Excess body fat leads to a significant decline in health and quality of life and is not an aesthetic problem, but rather a health problem,” says Dr. Carretero.

Obesity in numbers

The current prevalence of obesity among adults in Spain is 23%. However, according to the World Obesity Atlas 2023, it is expected to be 30% by 2030 and 37% by 2035.

In addition, all this complicates the correct identification of sarcopenic obesity, which is widespread in internal medicine consultations. It consists, in addition to a high body mass index, in a lack of muscle mass.

“It is important to identify sarcopenic obesity in our patients because it is associated with less muscle mass, poorer muscle quality, and more comorbidities,” explains the medical professional.

The truth is that, overall, obesity remains underdiagnosed (less than 40% of obese people are diagnosed), undertreated (less than 20% receive evidence-based medications), and less than 1.3% of professionals prescribe such medications.

Decalogue of comorbidities associated with obesity

Decalogue “Obesity in internal diseases of the 21st century. Construction of a decalogue of concomitant diseases associated with obesity in the treatment of internal diseases” was prepared by general practitioners.

This document contains ten keys to obesity, patient phenotypes, obesity assessment, considerations for pharmacokinetic and pharmacodynamic changes, cardiovascular benefits of weight loss, lifestyle, medications, surgery, sarcopenia, and frailty-related aspects.

Ten key points:

1. Obesity. Comorbid diseases in obese people are a consequence of the excess and localization of obesity.
2. Patient profile. The profile of the most frequently encountered obese person in internal medicine consultations is that of a patient with a very high cardiovascular risk.
3. Grade. The examination of people living with obesity should include an anthropometric assessment, identification of the main causes and complications of the disease.
4. Pharmacokinetic and pharmacodynamic changes. Pathophysiological changes observed in obese patients cause pharmacokinetic and pharmacodynamic changes. This may cause the medication to work properly if the usual dosage is used.
5. Cardiovascular benefits of weight loss. Cardiovascular benefits of 1–5% weight loss in obese patients have been demonstrated.
6. Lifestyle. In addition to weight loss, a healthy lifestyle should be recommended. This will improve the risk factors and comorbidities associated with obese people.
7. Drugs. Drug financing may be required for patients with severe obesity and comorbidities.
8. Operation. Bariatric surgery may be considered for some obese people.
9. Sarcopenia. When assessing obesity in older adults, it is important to assess functional status, sarcopenia, and cognitive status.
10. Fragility. In patients with established frailty, sarcopenia, or cognitive impairment, the goal is to prioritize nonpharmacologic interventions and maintain quality of life by avoiding restrictive diets. For patients with normal performance status, recommendations will be stratified according to the degree of obesity (based on BMI), ongoing promotion of a healthy lifestyle, and personalization of pharmacological treatment and bariatric surgery.

.