“Obesity is a chronic disease and not a condition associated with the person, but in Spain it is still not recognized as such and, consequently, it does not receive adequate treatment.” As president of the Spanish Society of Internal Medicine (SEMI), a position for which she was elected last November, Dr. Juana Carretero (Guareña, 1973) has set out to make visible two chronic diseases that are behind most health problems that internists treat in hospitals: obesity and alcoholism.
You demand that the health authorities declare that obesity is a chronic disease. Because?
The WHO and the European Union already recognize it (since 1997 and 2021, respectively), but Spain has not yet. And the fact that it is recognized as a disease and not as a condition associated with the person and other comorbidities means that the person can have a correct diagnosis and treatment with a perfectly established care route (that is, they know which doctor to go to for the diagnosis). and who treats and monitors it), and also implies investing in prevention and early detection, as is done with all chronic diseases.
If the EU already recognizes it, why isn’t it like that in Spain?
I think it is a fundamentally economic problem. Admitting that obesity is a disease would imply providing resources to treat it. If we consider that twenty percent of the population is obese, imagine sending all those people to primary care, we would overload the system even more. There is also a problem of reaching a consensus among health professionals, those affected, and the health authorities on how obesity is defined, which patients need more specialized care, which group deals with it, and what treatment is offered. Because now we have a treatment indicated for people with obesity but it is not financed by Social Security, and it is very expensive.
Perhaps it is an unaffordable cost in view of the saturation and deficiencies that public health currently has…
If one thinks of it as a long-term strategy, we would save a lot, because we would gain a lot in community health; but the issue is not on the social or political agenda, which are short-sighted.
What is the obesity rate in Spain?
Before the pandemic it was 22%, but it has grown a lot and continues to do so and it is estimated that in 2030 it will reach 30% of the population. In fact, as weight problems increase with age, among those over 65, that 30% is already exceeded.
And among the children?
Childhood obesity is estimated to affect 7%-10% of children, but it is growing faster than among adults, at a rate of 1.9% per year, and this also causes the rate of complications to rise and we are going to see a large disease burden in the future. The problem is that it is becoming normal for children to be somewhat overweight.
Because?
Due to lack of awareness, because the issue of obesity has been trivialized as something merely aesthetic, and it is not. For most of those who live with obesity, it is a health problem, because this excess weight in the form of pathological fat promotes an inflammatory state in the body and limits their daily life due to joint problems, apnea and poor quality of sleep. fertility, diabetes, thrombosis and cardiovascular diseases…
Does the social relevance given to body image have an influence?
The issue of body image has been trivialized, associating being handsome with being thin and, as a reaction, trying to normalize living with morbid obesity as a choice, but it cannot be a life choice because that leads to medical complications.
On the other hand, this trivialization does little to help those who live with obesity in the face of public opinion and to demand treatment from the health authorities, because it perpetuates the vision that the person with obesity deserves to be obese because what happens to them is that they eat a lot and He moves little, and seeks to lose weight without effort. And that is not so, obesity is a very important personal health and public health problem.
What are the causes? What makes eating the same thing one person gain weight and another not?
There is a polygenic predisposition and it is influenced by the microbiota, what we eat, physical activity, sleep quality, meal times, the protein content of the diet…
And what would then be your advice for those who want or need to lose weight?
We have to learn to take care of ourselves, to eat and to have healthy habits. It is not a question of being on a diet or doing something artificial like fasting, but of educating ourselves to eat a healthy diet and be physically active throughout our lives, not for a few weeks or months. We should not talk about quantity of food but quality: eat legumes, fiber, avoid fat and processed food. And have achievable and sustainable goals over time: it is preferable to lose 10 kilos in a year and maintain it than to lose 15 kilos in two months and then recover them.
From the SEMI they have also called attention to the excessive consumption of alcohol that some people normalize; for example, the elderly
We have a problem of hidden and highly internalized alcohol abuse: that of those who are used to drinking wine or beer daily, lunch and dinner; It is assumed but excessive and harmful consumption, and it must be brought to light and remedied. We see it in hospitals, people between the ages of 65-70 or 80 who are unaware that they have a problem with alcoholism because their daily consumption is very internalized and their dependency is revealed when they are hospitalized .
Is eating with wine or beer abusing alcohol, does it carry a risk of alcoholism?
Yes of course. An occasional glass of wine or beer may be allowed, but we cannot normalize having it every day for lunch and dinner. This harmful hidden consumption must be brought to light.
