Recognize Obesity as a Chronic Disease, Urge Spanish Experts

The Obesity Working Group of the Spanish Society of Endocrinology and Nutrition (GOSEEN) conducts various awareness campaigns to address the growing global and national health challenges of obesity. “Only by recognizing obesity as a chronic disease will it be possible to implement more measures to help control it,” said Irene Bretón, MD, PhD, assistant physician in the Endocrinology and Nutrition Service at Gregorio Marañón General University Hospital in Madrid, Spain, and president of GOSEEN.

Obesity is a metabolic disease that leads to multiple complications; however, it is not treated as a chronic condition. “It is often viewed as a result of personal willpower and lifestyle choices. While this may be partly true, genetics also play a significant role, accounting for 40%-70% of the risk of developing obesity. This genetic predisposition typically involves multiple genes,” Bretón stressed.

GOSEEN reported that obesity is linked to more than 200 diseases. It significantly affects the quality of life of individuals by contributing to joint pain, mobility issues, fatigue, and poor sleep. Additionally, it increases the risk for cancer and cardiovascular disease.

Speaking with Univadis Spain, a Medscape Network platform, she acknowledged that obesity results from an alteration in the mechanisms that regulate energy balance, leading to excess adipose tissue. “Obesity is not just about weight. The body regulates adipose tissue, and when this regulation fails, excess fat is maintained, triggering an inflammatory response. People with obesity experience changes in this balance, often making it difficult to address through will power alone.”

A recent article published in The Lancet Diabetes & Endocrinology, endorsed by more than 76 medical organizations worldwide, advocated moving beyond the body mass index (BMI) in diagnosing obesity. “We need to change the narrative of obesity, which has long been wrongly defined by weight and BMI.”

The commission defines clinical obesity as a disease caused by excess adiposity that impairs organ and tissue function and recommends treating obesity similar to other chronic diseases in medical practice. However, BMI remains a sufficient diagnostic criterion when it exceeds 40.

“Obesity is a disease that manifests itself in a diverse manner. It is essential to assess the location of adipose tissue accumulation, whether in the liver, abdomen, or intestines. As clinical presentations vary widely, the evaluation must be comprehensive,” Bretón said.

“Factors such as diabetes must be considered, as many individuals remain undiagnosed. So, treatment should not focus solely on weight loss but also on identifying and managing complications,” Bretón explained further.

In July 2024, the European Association for the Study of Obesity published a new diagnostic framework for obesity in Nature Medicine, recommending body composition analysis whenever possible. The framework also highlights practical measures, such as the waist-to-height ratio, an easy-to-calculate indicator of cardiovascular risk and metabolic complications.

Treatments

The success of certain weight loss drugs has opened new avenues for the treatment of obesity.

“These drugs are highly effective, whether or not they receive funding from the Spanish public health system. The drugs have been approved following rigorous European regulations and not only aid in weight loss but also significantly improve obesity-related complications,” Bretón said.

Bariatric surgery is another treatment option for severe obesity, particularly when medications fail to provide sufficient benefits.

“It is covered by Spain’s national health system, yet access remains inequitable due to poorly regulated waiting lists, similar to other surgical treatments,” Bretón said, adding that “obesity is a shared responsibility, including that of families and the educational system, which play a role in promoting healthier lifestyles.”

“Endocrinology and nutrition professionals are essential for treating obesity. However, it is crucial that the teams addressing this pathology are well-structured and also include different healthcare professionals from primary care and from specialties responsible for dealing with complications, such as cardiology, digestive system, pneumology, and bariatric surgeons, dieticians-nutritionists, psychologists, among others,” she concluded.

This story was translated from Univadis Spain using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.