“From minute one you already feel that you are different from other patients. When you enter the office, you can’t even sit down. The chair has arms and you don’t get into it. Your ass doesn’t fit. Standing up, then, you explain to the doctor what is happening to you, pain somewhere, stomach discomfort, tiredness… whatever is happening to you. And you see in his eyes the answer that he is going to give you, that you are obese (as if you didn’t know) and that everything is related to weight. That the first thing is to lose dozens and dozens of kilos and, to do so, exercise and follow a diet that appears in a photocopy that is barely readable. See you later. “You can’t imagine how it feels!”
Federico Moya is exobese. Although he lost 100 kilos, he assures that he is still an obese person. He cannot forget what he felt and what they made him feel since he was little because of his excess weight, which is nothing more than rejection, that he was a person without will, lazy, lazy, abandoned, who did not want to remedy their obesity situation. “This has a very negative impact on psychological well-being and increases his propensity for low self-esteem, poor body image and depression,” he explains.
Moya is executive director of the Híspalis National Bariatric Association and the Association of Bariatric and Obesity Patients and is part of the European Coalition for People Living with Obesity (ECPO). He, together with a multidisciplinary team convened by the Humans Foundation, has participated in the preparation of the Haspo Report (Humanization of Social and Health Care for People Living with Obesity), with a clear conclusion: it is necessary to expand the training of physicians, especially primary care, so that they know what obesity is, its severity and that they stop measuring it only by the body mass index (BMI). “We are not fat or chubby, we are people who live with a chronic illness. And there are many shortcomings that we find in the health care we receive,” says Moya.
Obesity is a chronic disease based on liposity (new definition from 2017) that is related to more than 200 pathologies. Its causes are multiple, from genetics, hormonal alterations, interaction of certain drugs, psychiatric disorders, intestinal microbiota, dietary misinformation or chronic stress, among many others, indicates Ana Zugasti, head of the clinical nutrition section at the university hospital of Navarre.
The endocrinologist is one of the experts who most raises her voice against the lack of training of doctors on a complex disease with a high cost for the patient, for the family and for society. You can’t treat this disease, she points out, with a “photocopied diet” and saying “walk.” The treatment must be individualized, listen to the patient, accompany them throughout the process, which is long, and do it with multidisciplinary teams. “Do you really believe that you can lose 40 or 50 kilos in a few months?” she asks.
Dr. Zugasti believes that health professionals must be trained to participate in the prevention of obesity, a true pandemic that threatens not only the economy (the direct or indirect cost in 2020 was $29 billion, according to a study of the World Obesity Federation), also the lives of those affected. According to the latest data, almost 17% of the population over 18 years of age is obese, in the case of minors, 14.2%.
The high percentage of childhood obesity is of particular concern because 55% of children with obesity will remain obese into adolescence. And 80% of obese adolescents will be obese in adulthood. The OECD has warned, after verifying the progression of the disease, that the life expectancy of the world population will be reduced by three years in 2050.
The Haspo Report proposes numerous recommendations to address obesity, many of them to reduce stigma. Recommendations, sometimes as simple as having adequate wheelchairs in health centers, larger size nightgowns (“they don’t know how it feels in the hospital with your butt in the air,” says Federico) or wider doors .
But it doesn’t just stop at health centers. Also in sports centers, which he points out as poorly prepared for people with obesity. And they ask that mirrors be eliminated in the rooms so that users focus more on the movement of their body than on the physical; machines appropriate to their sizes and, in the case of children, parents are encouraged to enter the locker rooms, because those spaces “are a source of stigmatization.”
In addition to raising awareness among health professionals about people with obesity (insisting on the concepts of obesity as a disease and the importance of the associated stigma), experts propose specific training on healthy habits for the prevention of obesity in the educational field, Mandatory minimum university training on obesity in Medicine and Health Sciences degrees or creating a decalogue of actions in hospitals that guarantee the privacy of people with obesity.
