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.

a multidisciplinary team that saves lives

The Sepsis Code has been created to put an end to the mortality caused by severe sepsis and septic shock, a public health problem that the Hospital de La Princesa in Madrid has managed to reduce.

Health professionals from the La Princesa Hospital in Madrid. Photo by Carlos Gonzalez.

Sepsis is an unnatural response of the body to a bacterial infection that can cause the failure of one or more vital organs, a public health problem for which the Sepsis Code protocol has been created, which has already reduced mortality from 24% to 10% at the La Princesa Hospital in Madrid.

This pathology has a great impact on hospitals, it decreases the quality of life of the patient and their physical, mental and social deterioration, in addition to requiring a long stay in the hospital.

Affects 50,000 people in Spain each yearof which, according to 2018 data, 17,000 people die.

However, mortality can be reduced. Since 2015, the Hospital Universitario de La Princesa in Madrid has achieved this thanks to the Sepsis Code.

How has this been possible?

The answer lies in the multidisciplinary work of the Sepsis Code. we tell you in our YouTube channel.

“When sepsis is diagnosed and detected quickly, and the hospitals respond appropriately, the results are much better. This is achieved with the Sepsis Code»

explains Fernando Ramasco, head of the La Princesa Hospital Resuscitation Unit.

Fernando Ramasco, head of the La Princesa Hospital Resuscitation Unit

What is the Sepsis Code?

It is a set of organizational, training and care improvement measures “aimed at providing the best care possible for patients who develop symptoms of sepsis”.

“The pre-activation part would almost be the most important. The early detection of sepsis in the patient is essential and now we detect it earlier, something important for the survival of the patient»

informs the deputy doctor of the emergency service, Andrés Von Wernitz.

In the emergency department, 80% of patients who arrive at the hospital with sepsis are detected. Once the diagnosis is made, the entire team knows what to do, “all the services and levels”, they get to work.

When sepsis is diagnosed in the patient, the next step is “analytics and microbiology samples”.

“We are lucky that we are the first hospital in Europe to implement a technology called Accelerate that allows us to know the causal agent in a few hours to apply a much more targeted antibiotic treatment, thus improving the prognosis”

indicates the doctor.

Andrés Von Wernitz, assistant doctor of the emergency service of Hospital La Princesa

This new tool makes it possible to identify the pathogens that cause it in just 90 minutes and, in addition, offers the antibiotic sensitivity study in less than 7 hours, 28 hours less than those necessary with the conventional method.

“The sepsis code has given us a common language that makes the different services interact better and this is good for the patient, who is ultimately the center of the project.”

says the specialist.

“We have improved what we were already doing. We didn’t play badly, but with a tuned instrument the music sounds much better”, says the expert, referring to the multidisciplinary work of the parties included in the Sepsis Code.

Nursing role in the Sepsis Code

David Jiménez, ICU nurse at La Princesa Hospital in Madrid

David Jimenez He is a nurse in the Intensive Care Unit (ICU) of Hospital La Princesa.

He tells us how his work is “unique” since his work is carried out “at the patient’s bedside”.

“We can detect warning signs and symptoms early before the patient can worsen and the sepsis ends up developing septic shock with the failure of different organs”

the nurse reports.

The work of this service also covers the part of the treatment, its administration being important in the first hours.

Benefits of the Sepsis Code

The results after the implementation of the Sepsis Code in 2014 at Hospital La Princesa show encouraging data: «In our hospital, in 5 years, Mortality has been reduced to almost 10%».

Ana Barrios, infectious disease service at Hospital La Princesa.

This is due to the great speed with which the antibiotic to be administered is defined, as well as “how to get it right from the beginning so that it is effective”.

“Many factors are taken into account, especially risk factors to be taken resistant bacteria. The entire population is important in this because taking antibiotics without a medical prescription can lead to an increased risk of resistant bacteria”

warns Ana Barrios, internist at the Infectious Diseases Service.

Martín Hernández, 46 days in the ICU

Martin is a diabetic patient who suffered from sepsis. One day he began to notice shortness of breath, heavy sweating, and an infection in his right leg.

Martín’s reaction was to take a taxi and go to his hospital, a decision that saved his life.

“I suffered septic shock that caused multi-organ failure in my leg, kidneys, lungs, and cross-pneumonia that forced me to stay in the ICU for 46 days”

Martin account.

The aftermath led him to rehabilitation both physically and emotionally because his mental health was affected after spending a long period in the hospital.

Martín Hernández, former Sepsis patient

«I had consequences: tremendous fatigue, loss of muscle mass and a strong weakness that you have to recover little by little»

Add.

This patient thanks the Sepsis Code and all its professionals for their professionalism and effort, because “they really saved my life”stands out.

In this way, the Sepsis Code demonstrates its effectiveness and allows the patient to be removed from danger as soon as possible, reducing mortality and cases of serious infections.

Its implementation will continue to spread and the figures will continue to give hope.

The multidisciplinary treatment of POP women

«The main objective of the different treatments for pelvic organ prolapse (POP) is focused on recomposing the woman’s anatomy to redirect the situation and, in turn, return normality to her altered bodily functions, such as urination, deposition or sexuality”, informs the urologist and surgeon, Carmen González Enguita.

The multidisciplinary treatment of POP women

“But we should not always go to treatment once the diagnosis has been established,” says the head of the Urology Service at the Fundación Jiménez Díaz University Hospital in Madrid. If women have no or mild symptoms, the emphasis should be on avoiding risk factors.”

“Even so, the specialists will carry out regular follow-up consultations to control the woman’s POP progression in detail,” he adds.

An organ prolapse is any descent into the pelvic floor or perineum of part of the bladder, uterus, rectum, including bowel loops, through the vagina. It is a frequent condition that up to 40% of multiparous mothers can suffer, that is, who have had several births.

“For the doctors who treat POP it is quite a challenge”

In these surprising cases, the most important thing is that the multidisciplinary team virtuously demonstrate their knowledge of the anatomy and physiology of the pelvic floor.

“We must be sure of what is happening in the pelvic area for this vaginal descent of organs to occur and at the same time understand the pathophysiology of prolapse. Both aspects are fundamental when we have to plan the treatment».

“Furthermore, I would say that all women who consult for this POP problem, once diagnosed, need a preventive guidance so that they understand it well and can take care of themselves properlyavoiding factors that facilitate the progression of the pathology».

We CANNOT avoid age, or past pregnancies, or complex deliveries, or perhaps that musculoskeletal weakness characteristic of each person, or the stages that women go through throughout their lives… but we CAN avoid all those situations that increase, inappropriately, abdominal pressure.

Obesity, constipation, lung pathology that leads to chronic cough, so you have to stop smoking, important efforts performed incorrectly, such as carrying or pushing weights, and impact sports.

However, it is usually advisable to maintain healthy physical exercise, as well as rehabilitate and strengthen the pelvic floor.

Dr. Carmen González Enguita

Rehabilitation and physiotherapy with Kegel and pessaries

«They make up a specialty within Physical Medicine, which is in charge of helping to know where the muscles of the perineum are, those that participate in these pelvic problems, to learn how to exercise them, train them and strengthen them to prevent prolapse, stop its advance or even push it back,” he says.

With the kegel exercises it is possible to firmly tighten the musculature that surrounds the vagina, the urethra and the rectum.

“We must contract the muscles for one or two seconds, approximately, and then relax them for ten seconds. Little by little, the contractions lengthen until they reach periods of ten seconds, thus equaling the relaxation time », he explains.

This exercise, which women can do sitting, standing or lying down, will be repeated about ten times in a row, recommending doing each series several times a day.

Women can also use vaginal cones: inserted into the vagina, they help to contract the correct muscles to prevent the cone from falling to the ground under its own weight”, she describes.

In Rehabilitation, they also work with biofeedback devices, sensors that show the muscle contractions of the pelvic floor on a screen, and electrical stimulation, with a probe to transmit current and contract the target muscle.

The pessaries They are circular devices, although there are different shapes and models, which are inserted into the vagina to support the pelvic organs.

“They reduce prolapse and reduce symptoms, but they are not a cure. They are especially beneficial for women who are waiting for surgery and for those who do not want or cannot undergo surgery, “says the urologist.

Anatomical reconstruction of the pelvic floor and the use of mesh

When pelvic floor rehabilitation does not achieve its goals, surgical intervention is necessary to definitively treat pelvic organ prolapse (POP).

“Surgery is used in those POP cases that cause an alteration in the patient’s quality of life, whether due to discomfort, pain, loss of urine, urination difficulty, constipation or problems in sexual relations,” he relates.

There are several types of interventions, most based on anatomical reconstruction of the pelvic floor. Always try to use the patient’s own tissues.

“When these tissues are very weak and in poor condition, or when we believe that the repair cannot be carried out with these tissues, we will use tissues designed and manufactured for this purpose, such as the well-known tights«, exposes.

Dr. Carmen González Enguita

Surgeries can be performed vaginally and/or abdominally. The decision of one or the other approach will depend on the type of prolapse, the anatomical characteristics of the patient, her age, her sexual life and the skills of the surgeon.

“There are many different types of surgeries and ways to perform them. In this section, the specialist should be consulted, with whom the best agreement will surely be reached, depending on both the POP problem and the patient’s preferences and values”, concludes Dr. Carmen González Enguita.

Recovery time will depend on the type of surgery. Most women will be able to gradually resume their physical activity in a few weeks, normality conditioned by the surgical technique used.

During the six months after the intervention to correct a pelvic organ prolapse (POP), straining or lifting heavy weights should be avoided, as they can affect healing.