Scientific societies unite to change the approach to tackling obesity in Spain

On the occasion of World Obesity Day on 4 March, the Giro Guidelines for the Comprehensive and Interdisciplinary Treatment of Obesity in Adults were launched, the most widely agreed upon initiative to combat the disease.

Its value and significance lie both in the evidence, suggestions and recommendations it includes, and in the fact that it enjoys the support and collaboration of 14 leading medical and scientific societies in Spain, which include thousands of health professionals directly or indirectly involved in work. fight against obesity.

The Giro leadership calls for work on multiple fronts to achieve a paradigm shift that views obesity as a multifaceted pathology and requires its understanding as a chronic and multifactorial disease (beyond body weight) as it focuses on underlying causes and factors. that contribute to this disease.

The four fundamental principles on which this document is based are:

  • Consider obesity as a chronic and complex disease that requires long-term monitoring.
  • Focus on the causes of the problem and stop stigmatizing the patient.
  • Take a holistic approach to the situation.
  • Provide the affected person with the opportunity to participate in the management and treatment of their illness.

Adapted to the Spanish context

A distinctive aspect of this initiative, inspired by the Canadian Clinical Practice Guidelines, a global reference, is that it takes into account the Spanish context. “We have conceptualized and developed a national CPG adapted to our country for the comprehensive treatment of obesity in adulthood,” emphasizes Dr. Maria del Mar Malagon, President of the Spanish Society Against Obesity (Seedo), who emphasizes “the fact that it is based on the latest evidence, have a practical purpose and be a living and constantly updated document.

“This document provides updated information on the management of obesity, addresses unmet needs and proposes recommendations to address them in clinical practice in Spain,” says Dr. Albert Lecoube, vice president of Seedo.

Thus, the Giro guide includes 131 recommendations, including the need to talk about “obesity” and be able to visualize each patient individually in order to introduce personalized medicine into the disease management algorithms. At the same time, he insists on overcoming the fact that obesity is not a choice. “We can no longer accept that obesity remains an open door to inequality and discrimination throughout the health care process,” emphasizes Dr. Lecoube.

Development by Giro

Jiro’s development was divided into two stages: checking more than 150 references and preparing recommendations.

The guide is divided into 5 large blocks, which cover:

  1. Recognizing obesity as a chronic disease to move toward destigmatizing patients.
  2. An assessment to clarify that obesity cannot be determined solely by a person’s weight.
  3. Multidisciplinary and global treatment aimed at improving the quality of life and regaining those years of life that the disease takes away.
  4. Recommendations for its management in special populations, such as the transition from adolescence to adulthood or its impact on reproductive health.
  5. Suggestions for implementation and future challenges.

In addition to Seedo, experts from the Spanish Society of Endocrinology and Nutrition (Seen), the Spanish Society of Obesity and Metabolic Surgery (Seco), and the Spanish Society of Primary Care Physicians (Semergen) took part in the preparation of this document. Spanish Society of Family and Community Medicine (semFYC), Spanish Society of General and Family Physicians (SEMG), Spanish Society of Rehabilitation and Physical Medicine (Sermef), Spanish Society of Dietetics and Nutrition (Sedyn), Spanish Society of Nephrology (SEN), Spanish Society of Clinical Nutrition and Metabolism (Senpe), the Spanish Society of Diabetes (SED), the Spanish Society of Internal Medicine (Semi), the Spanish Society of Pulmonology and Thoracic Surgery (Separ) and the National Exercise Network Exernet.

Affirming nature

Experts from all the scientific societies involved in the preparation of this document hope that the Giro “will serve as a valuable tool for health professionals, health policy makers and all those people who are committed to promoting and improving the treatment and proper prevention of obesity.” In fact, they hope it will “represent a before and after” of their overall goal: “to give back to people living with obesity the dignity and years of life that the disease robs them of.”

“This guideline contributes to the definitive identification of obesity as a chronic disease of a pandemic nature,” says Dr. Ignacio Bernabeu, president of the Spanish Society of Endocrinology and Nutrition (Seen). “It promotes social and even medical changes to avoid stigmatization of the disease and blaming the sick person for their illness,” he emphasizes. “It shows obesity as a direct cause of many diseases and identifies ways for interdisciplinary collaboration and multilevel care to treat people with obesity,” he emphasizes.

“It is very important for us to have synergy with sister societies that advocate for people living with obesity, one side of the malnutrition coin,” acknowledges Dr. Julia Alvarez, president of the Spanish Society of Clinical Nutrition and Metabolism (Senpe). “Together we are stronger and can help improve the quality of life of patients by addressing obesity for what it is: a chronic, multifactorial and complex disease that requires multidisciplinary treatment and always a holistic vision,” he concludes.

family doctors

“The guidelines highlight the important interdisciplinary role of primary care professionals in the diagnosis and treatment of this disease, with so many cardiovascular comorbidities that have the greatest impact on mortality,” points out Dr. José Manuel Fernandez Garcia. , coordinator of the working group on nutrition of the Spanish Society of Primary Care Physicians (Semergen). “Obesity is also associated with certain types of cancer, type 2 diabetes, high blood pressure, dyslipidemia, as well as respiratory, digestive, joint, mental and reproductive health problems,” he lists.

In this context, the family doctor contributes through continuous treatment, knowledge of the family environment and training in the diagnosis and treatment of various diseases. For this reason, the three primary care scientific societies that contribute to this document emphasize that the family physician should be trained to assess continuity of care with hospital specialists and the primary care professionals themselves. “Community nursing activities both in health centers and in the community (schools, work centers…) are very important to reduce the incidence and prevalence of this disease,” points out Dr. Fernandez García.

Voice of patients

Sido led an interdisciplinary team of experts and oversaw the development of the Guide. All scientific and medical societies have provided evidence and are responsible for validating the content according to their specialty. In addition, the technical secretariat was provided by health consultancy Adelphi Targis, and the National Bariatric Association/Association of Obese and Obese Patients Hispalis (AB Hispalis) intervened to ensure that the interests of people living with obesity were taken into account.

“For things to improve, obesity must be recognized as a chronic and multifactorial disease,” says Victoria Buiza, president of AB Hispalis. “From now on, obese people will be able to be covered by the Guarantee Law and we will become patients recognized by the Spanish health system,” he adds. “This guideline is the ideal tool to enable all healthcare providers to begin treating obesity effectively and uniformly,” he predicts.

For requests and practical advice, Buiza recommends “putting health at the center” so that “all parties involved in treating this disease work as one team to achieve a reduction in overweight and obesity rates in our country.” Likewise, it is necessary to “evaluate the existing multidisciplinary units in Spain, which should exist “in every hospital center” so that patients with obesity “receive the best care.”

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