Obesity is a chronic disease and not a condition associated with the person, but in Spain it continues to be unrecognized as such and, consequently, does not receive adequate treatment. As president of the Spanish Society of Internal Medicine (SEMI), a position for which she was elected in November, Dr. Juana Carretero (Guareña, 1973) has set out to make visible two chronic diseases that are the main cause of the problems of health that internists treat in hospitals: obesity and alcoholism.
It demands that the health authorities recognize obesity as a chronic disease. Because?
The WHO and the EU already declare it as such, but Spain does not. And 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, that he knows which doctor to go to for to the diagnosis and who monitors it), and it also implies investing in prevention and early detection, as is done with all chronic diseases.
If the EU already recognizes it, why doesn’t Spain recognize it?
It is a fundamentally economic problem. Admitting that it is a disease would involve providing resources to treat it. If we consider that twenty percent of the population is obese, imagine sending these people to primary care, we would overload the system even more. There is also a problem of reaching a consensus between health professionals, those affected and the health authorities on how obesity is defined, which patients need more specialized care, which group addresses it and which 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 shortcomings that public health now has…
If it is thought of 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-term.
What is the obesity rate?
Before the pandemic, 22%, but it has grown and continues to grow and is estimated to reach 30% by 2030. In fact, since weight problems increase with age, among those over 65 this number already exceeds 30%.
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, which also increases the rate of complications and that we will see a high burden of disease in the future. The problem is that it is becoming normal for children to be a little overweight.
Because?
Due to a lack of awareness, because the issue of obesity has been trivialized as something purely aesthetic, and it is not. For most of those who live with obesity, it is a health problem, because excess weight in the form of pathological fat promotes an inflammatory state in the body and limits daily life due to joint problems, apnea and mala sleep quality, fertility, diabetes, thrombosis and cardiovascular diseases…
Does the social relevance given to body image influence it?
It has trivialized the issue of body image by associating being good-looking with being thin, and as a reaction has led to the normalization of living with morbid obesity as a choice, but it cannot be a life choice, because that causes you to have complications medical On the other hand, this trivialization does little to help those living with obesity in the face of public opinion and in demanding treatment from the health authorities, because it perpetuates the view 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 what he wants is to lose weight without effort. And this is not the case, obesity is a very important personal and public health problem.
What are the causes? What makes one person gain weight by eating the same thing and another does 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…
What is your advice for those who want or need to lose weight?
We must learn to take care of ourselves, eat and have healthy habits. It’s not a question of being on a diet or doing anything artificial like fasting, but of educating ourselves to have a healthy diet and do physical activity throughout life, not for a few weeks or months. We should not talk about quantity of food, but quality: eat legumes, fiber, avoid fats and processed food. And have affordable and sustainable goals over time: it’s better to lose 10 kilos in a year and keep it off than to lose 15 kilos in two months and then gain it back.
SEMI has also drawn attention to the excessive alcohol consumption of some people; for example, the elderly.
We have a hidden and very internalized alcohol abuse problem: that of those who are used to drinking wine or beer daily; it is an assumed consumption, but excessive and harmful, and it is necessary to bring it to light and remedy it. We see it in hospitals, people aged 65, 70 or 80 who are not aware that they have an alcoholism problem and their dependence becomes evident when they are hospitalized.
Eating with wine or beer is abusing alcohol, does it carry a risk of alcoholism?
Yes, of course. An occasional glass of wine or beer can be allowed, but we cannot normalize having it every day for lunch and dinner.
