What care do the morbidly obese individuals need?

Today March 4th, is World Obesity Day, which aims to raise awareness of obesity and the many other diseases that excess weight and obesity cause.

The obesity epidemic is one of the biggest health problems of our time. Globally, 1.9 billion people are estimated to suffer from obesity in 2035, which is one in four adults. Among children, obesity will increase by 100 percent between the years 2020 and 2035.The cost to society is estimated at 4400 billion dollars.

In Sweden, more than half of all adults are now overweight and of them 18 percent are obese. In addition, 4,980 bariatric operations were performed and there are over 400,000 people with type 2 diabetes. Obesity is estimated to cost Swedish society SEK 70 billion annually.

The consequences of obesity are enormous. In addition to human suffering with limited mobility and a lot of guilt and shame, there is a high risk of diseases such as type 2 diabetes, high blood pressure, high blood fats, cardiovascular disease, infertility, pregnancy complications, multiple cancers and chronic pain. The cost to society for obesity is enormous, but also increases the burden on healthcare, and could decrease capacity to treat other patients, thus if there were fewer obese patients there would be more room for others. 

So how do we stop this trend? Here are some areas society and healthcare should focus on:

Stop discriminating against the obese. Being overweight today is filled with guilt and shame. You are often told that you are lazy and stupid and have yourself to blame. Obesity is a chronic, largely hereditary disease. Central to obesity is a hormonal disturbance in those affected, where incorrect interaction between appetite and satiety plays a very large role. The result is increased hunger, increased calorie intake and gradually increased fat mass. The reasons are complex and we must take this disease very seriously. However, many obese people are discriminated against when they seek care, and are all too often given perfunctory, ineffective exhortations to eat less and move more.

Embrace the new medical revolution.There has been extensive debate about medications in the media recently. Among other things, about medicines based on the hormone GLP-1 which is found in the substance semaglutide. The respected medical journal ‘The Science’ named treatment with GLP-1 drugs for obesity as “the breakthrough of the year” - all categories, in 2023. The reason was that these medications, originally developed for type 2 diabetes, have now shown great positive effects on people who are only overweight. Beyond weight, the medicine decreases symptoms of heart failure, heart attack and stroke. The new medications are therefore very effective. Let's embrace them and stop debating whether obese patients or type 2 diabetes patients should have access to them. The medicine is a revolution in the fight against the obesity epidemic.

Towards a digital care model. To cure obesity, a series of lifestyle changes are required. It is not only a question of medicine, but several measures must be taken to change the lifestyle through dietitians, doctors, personal trainers and psychologists. Offering all this via physical care is expensive and complicated. Instead, let's look at Britain, which has an even bigger problem with obesity. There, the National Institute for Care and Health Excellence (NICE) has introduced guidelines stating that obesity care in particular should be digital.

Much of our view on obesity is outdated. This is perhaps one of the reasons why we have not yet managed to treat this chronic disease.

I would like to urge everyone in healthcare to see this issue as even more of a priority for both the individual and society. And I want to urge the public to stop seeing overweight people as lazy and that they have themselves to blame - they have a chronic disease that most often cannot  be solved with a diet or more jogging. And not least - I want to address all overweight people: there is hope and help. Today we know that there is effective treatment for obesity.

Martin Carlsson

Professor, doctor and specialist in endocrinology/diabetology and internal medicine and is one of the founders of the service Yazen, a digital healthcare provider that works with drug and lifestyle treatment for obesity.

(press photos are available here)

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