Obesity, an underdiagnosed disease in Spain

XVII Meeting of the Diabetes, Obesity and Nutrition Group.

More than 285 internists have gathered in the XVII Meeting of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine (SEMI)held on January 26 and 27 in Valladolid, where the main diagnostic and therapeutic innovations in the fields of study of the working group (diabetes, obesity and nutrition) have been analyzed with inter and multidisciplinary participation of patients and of different medical-scientific societies.

During the meeting, topics of scientific relevance were discussed such as: “The past, present and future of the treatment of the person living with obesity”, a ‘SEMI Algorithm for the comprehensive approach to the hyperglycemia hospital’ or how to approach the obesity in the elderly, among many others, such as the role of the appropriate nutrition in hospitalized patients, novelties in the ADA-EASD 2022 consensus, ultrasound in morphofunctional assessment in Internal Medicineinsulinization in special patient profiles, the anticoagulation of the patient with obesity and the main projects, algorithms and initiatives carried out or underway by the Working Group in the last year (Customized Course, MIDIA Registry, Type 2 Diabetes Approach Algorithm SEMI 2023 or the Obesity Algorithm in the elderly person”, among other relevant topics.

Past, present and future of the person living with obesity

Juana Cartero, president of the SEMIhas reiterated that “obesity is a chronic illnessthus declared by most official bodies such as the WHO in 1997 or the EU in 2021. However, in Spain it remains unrecognized as such and, therefore, without receiving adequate treatment”. In addition, Carretero has put highlights that “it is estimated that by 2023 the prevalence figures in Spain will be 30 percent of the adult population, with growth at all ages, especially worrying in children and adolescents, with an expected growth of 1.9 percent.” annual cent and representing 2.43 percent of the total health expenditure”.

Likewise, it has put on the table that “in the past and currently, the person living with obesity of his disease, simplifying it to a matter of eat a lot and move little. This concept, so far removed from the true mechanisms that lead to obesity, leads the person to follow restrictive diets, with little weight response and recovery of lost weight in a short time”. In this regard, Carretero has highlighted that, at present , “obesity remains underdiagnosed (less than 40 percent of people with obesity have this diagnosis), undertreated (less than 20 percent receive medication with scientific evidence) and less than 1.3 percent of professionals prescribe said medication. He has reiterated that “obesity must be understood as a chronic illness based on excess fat. Thus, your treatment should focus on preventing excess fat, avoiding the appearance of complications such as diabetes wave hypertension and of final complications, such as atrial fibrillation, heart failure, sleep apnea or osteoarthritis”. He also recalled that 2015 has meant “a before and after in drug treatment with the authorization of GLP1 receptor analogues (arGLP1) specifically indicated for obesity” and that “the bariatric surgery It is currently a safe and effective technique indicated for BMI greater than 35 regardless of the presence of comorbidities, between 30-35 if DM2 or major comorbidities (osteoarthritis, sleep apnea, AF, fatty liver, CHF)”.

“In the past and currently, people living with obesity have been blamed for their disease, simplifying it to a matter of eating a lot and moving little”

Finally, Carretero recalled that the “future of the obesity treatment It is promising, but unfortunately, since it is not recognized as a disease, there are no financed drugs and, moreover, people living with obesity are blamed for using other therapeutic options for this purpose”. In the future, thanks to research, we will have drugs with a dual mechanism of action, such as Pemdivutide (glucagon/GLP1), Cagrilintide (amylin/GLP1) or triagonists (Retratutide (GIP, Glucagon, GLP1)” and also that “the New technologies, big data and “machine learning” techniques will allow us to anticipate the appearance of obesity, predict which people will develop it and how obesity will be expressed in said person, with which we will be able to offer personalized medicine that improve their care, their treatment and the response to it”.

initial approach to hyperglycemia in non-critical hospitalized patients

Francisco Xavier CarrascoSEMI internist, former coordinator of the DON-SEMI Group and Head of the Internal Medicine Service of the Juan Ramón Jiménez University Hospital de Huelva, lectured on the management of hyperglycemia in the non-critically hospitalized patient. He stressed the importance ofperform glycemia at breakfast, lunch, and dinner in all patients for 24-48 hours from admission to detect stress hyperglycemia and unknown diabetes” and that “correction of stress hyperglycemia will be initially performed with rapid insulin analogues.”

He also remembered the guidelines on “How to act in the event of hypoglycemia?” and, regarding intravenous insulin, “When and how to start it on the ward, how much and how to monitor it, and for how long?”. All of this is part of a 2023 consensus document presented in the framework of this meeting of the DON-SEMI Group.

Obesity in the elderly

As indicated Pablo Perez Martinezinternist, member of the JSEMI Board of Directors and Scientific Director of IMIBIC, “when considering the clinical management of obesity in people over 65 years of age, it is important to assess functional status and whether the patient presents sarcopenia or cognitive impairment.”

“When considering the clinical management of obesity in people over 65 years of age, it is important to assess the functional status and whether the patient presents cognitive impairment”

Pérez Martínez has reiterated that, if these are preserved, “different clinical scenarios are considered: in a patient with a BMI between 30 and 34.9, it would be indicated to intensify a healthy lifestyle; In those patients with BMI between 35 and 39.9, it is important to also assess if they present other comorbidities and the impact that these have on the patient’s limitation, as well as the possible prescription of medication and, in the last clinical scenario, above BMI out of 40, it is recommended to intensify a healthy lifestyle, pharmacological treatment and in some specific group of patients even assess bariatric surgery”.

What role can or should nutrition and exercise play in this type of patient?

In the words of Pedro Pablo Casado Escribano, coordinator of the Diabetes, Obesity and Nutrition Working Group (DON) of the SEMI: “all hospitalized patients may be at risk of suffering a deterioration in their functionality during admission and, to avoid this, both adequate physical conditioning and optimal nutrition are essential.” In addition, he has reiterated that, in patients with frailty already present, “this becomes even more relevant due to their greater risk of functional deterioration, but it is important to take into account that we must not only attend to these needs in frail patients, but in the group of patients hospitalized for acute pathology”.

Regarding multimorbidity in people with obesity, Casado Escribano also recalled that “the obesity It is a disease associated with a high morbidityonly managing a body weight in a patient who lives with obesity would be a mistake, and as integrative doctors, internists must face the challenge of addressing the set of problems that these patients can present”.

“Obesity is a disease that is associated with high morbidity, only managing the body weight of a patient who lives with obesity would be a mistake”

In relation to the different training activities and projects of the Workgroup, Casado Escribano has reiterated that “the group has remained very active in the last year, thanks to the drive of many of its members. It is worth highlighting the algorithm for managing hyperglycemia in hospitalized patients (which will try to provide an answer for a wide range of patient profiles that Internal Medicine deals with), the new Algorithm for Diabetes Management 2023 (update since 2019), the MIDIA registry (to evaluate the management of patients hospitalized in Internal Medicine with DM or stress hyperglycemia) and many other different training activities.

About 33 percent (between 30-35 percent) of the patients admitted to Internal Medicine have type 2 diabetes, even if the reason for admission is not the diabetes. In addition, it is estimated that between 30 percent and 40 percent of people with diabetes who are seen by internists have obesity.

The information published in Redacción Médica contains affirmations, data and statements from official institutions and health professionals. However, if you have any questions related to your health, consult your corresponding health specialist.

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