Experts call for a multidisciplinary approach to obesity

Doctors and specialists in endocrinology ask to recognize obesity as a chronic disease, provide more adequate treatments and create prevention programs. March 4, World Obesity Day

Sports activity favors the prevention of obesity. Photo courtesy of Nacho Bazarra

According to the World Health Organization, obesity has tripled since 1975 worldwide. In 2020, 16% of the Spanish population suffered from this disease, according to data from the Ministry of Health.

Obesity is a chronic disease of pandemic dimension. Currently, more than half of the world’s population is overweight. In Europe, one in 5 people.

In Spain, the prevalence of overweight is 39.3% in adults and 21.6% of obesity. However, numerous factors prevent an effective and multidisciplinary approach.

Within the framework of World Obesity Day, the Spanish Society of Endicronology and Nutrition (SEEN) has launched a series of warnings about this pathology, as well as recommendations and requests for the approach and treatment of the disease.

little recognition

The lack of recognition by society and health professionals is one of the factors that makes an adequate approach impossible.

According to the ACTION-IO study, 59% of people with obesity recognize that it is a chronic disease and 80% believe that treatment is their responsibility.

From the association they denounce that many affected take up to 6 years to go to a health professional to request treatment.

In addition, only 44% of patients receive a diagnosis from their doctor and 24% have a follow-up.

This lack of attention is mainly due to factors such as stigmatization, lack of resources, difficult economic access to pharmacological treatment and long waiting lists for surgical treatment.

For this reason, experts ask that obesity be considered as a chronic disease and that a multidisciplinary approach be taken.

Likewise, the SEEN believes that it is necessary to carry out a strategic plan for prevention, diagnosis and treatment and recalls that the origin of obesity is complex and multifactorial.

Physical activity, the best prevention

Genetics, stress and a sedentary lifestyle are some of the causes that can produce this disease.

The health professionals explain that an adequate treatment of obesity can prevent the incidence of cancer, general mortality, cardiovascular problems and remit diabetes.

Similarly, physical activity and following a varied and balanced diet are key to preventing obesity.

For this reason, from the Spanish Society of Endocrinology and Nutrition they propose to involve the ministries of health and the different institutions to promote health and the creation of a healthier environment.

In addition, the association makes available to primary care a Comprehensive approach guide to obesity to facilitate care from the patients.

Its purpose is to promote greater knowledge and understanding of this disease to improve access to treatment and end stigma.

Photograph of a person weighing himself. EPA/ORESTIS PANAGIOTOU

Main recommendations

The high prevalence, the pleasure that food can bring, the aesthetic pressures, hoaxes and pseudosciences pose a challenge for the health approach.

On the other hand, many professionals lack training in healthy eating and there is a huge shortage of multidisciplinary teams that know how to treat this disease.

However, prevention is the best treatment.

From the medical team of Melio.es, an online blood analysis platform, they launch four recommendations to avoid obesity:

• Don’t go hungry: eat five meals a day to avoid binge eating and limit snacking. Choose healthy and filling snacks like nuts, dairy products and fruit.
• Increase the consumption of fruit: fruits provide essential vitamins and minerals for the functioning of the body. They are also rich in fiber and water, so they favor hydration and appetite regulation.
• Increase physical activity: start gradually with small challenges to keep you active. Change small habits like using the car and change them for a walk. Little by little you can increase the time and introduce more activity.
• Check your health: carry out regular check-ups of blood tests to determine the existence of dyslipidemia, diabetes or other diseases.

Obesity, a risk factor for severe covid

Obesity is one of the factors that influence covid-19 to develop seriously. A group of Spanish scientists has discovered the mechanisms involved in this relationship and proposes a biomarker, through a blood test, that can detect this risk

The research, led by the Obesity and Nutrition Network Biomedical Research Center (Ciberobn), focuses on the visceral adipose tissue of obese patients and on the ACE2 gene, which, in addition to functioning as a gateway for the SARS- CoV-2, is involved in inflammatory processes in the body.

An overweight person “usually” has the ACE2 gene less expressed in adipose tissue and, when infected, those levels decrease even more, which can make them more susceptible to the cytokine storm with which the body responds in occasions before the coronavirus and that aggravates the disease.

This is how Ana Belén Crujeiras, a Ciberobn researcher at the Santiago de Compostela Health Research Institute (IDIS) and leader of the research, explains it to Efe.

The team focused on the so-called methylation marks, a fundamental epigenetic mechanism in the regulation of gene expression and how they work.

This mechanism consists of chemical marks that are added to DNA in response to factors such as the environment, diet, physical activity, exposure to toxins or psychological state.

If DNA has been described as the “book of life, made up of a large succession of combined letters”, Crujeiras explains that the methylation marks would be the spelling.

A comma in the right place makes the body work correctly, but in the wrong place it can change the meaning of the sentence and lead to the development of diseases.

The interesting thing about these methylation marks, he says, is that, unlike genetic mutations, they can be reversed, for example, by going from a bad diet to a healthy one.

The team studied ACE2 in the adipose tissue of obese patients and others with normal weight, to verify that in the former it had “high levels of these methylation marks”.

Patients who were treated for weight loss on a very low-calorie ketogenic diet or a balanced low-calorie diet later had levels of methylation markers similar to people of normal weight.

ACE2 is involved in inflammatory processes in the body and, when highly activated, triggers anti-inflammatory mechanisms that exert a protective action in the body.

However, when a gene has high methylation marks, as occurs with ACE2 in overweight people, its expression generally decreases, Crujeiras details.

A person with obesity is in a chronic low-grade inflammatory state and, if the action of the ACE2 gene is also reduced, it will cause the inflammation to be greater after the covid-19 infection.

Crujeiras points out that this possibility “correlates perfectly with the results observed in visceral adipose tissue” and its implication in the development of other obesity-related diseases such as cardiovascular disease, diabetes or cancer.

The expert indicates that the methylation marks could be a biomarker to know the risk of a person with obesity to suffer from severe covid-19, since the same pattern observed in adipose tissue has been seen in leukocytes and can be detected with a sample minimally. blood invasive.

The study has been carried out in collaboration, among others, with the Biomedical Research Institutes of Malaga (IBIMA) and Girona (IdIBGi); the Research Institute of the Balearic Islands (IdIsBa); Lucio Lascaray and Bioaraba from Vitoria; the Health Research Institute of the University of Navarra (IdisNA) and the Endocrinology and Nutrition Research Center of the University of Valladolid.

The researchers Andrea G. Izquierdo (I) and Ana Belén Crujeiras (D) are the main authors of the research. EFE/Photo courtesy of Ciberobn