The first thing I have to explain to you is that there is a paradigm shift regarding people who are obese or overweight. We have to end the social stigma associated with this disease, we have to stop blaming these people because no one chooses to be fat. So all tools that enter the therapeutic field are welcome. And in that welcome I include the new drugs that we have had very recently, the GLP-1 agonists, commercially known as Ozempic and Wegovy.
To treat obesity and overweight, until now we could only intervene in lifestyle. Just because this is no longer the case does not mean that changing lifestyle habits is not important. Even though we now have drugs, eating healthy, exercising and having good sleep patterns—in addition to taking care of psychological and emotional health—continue to be the cornerstone for anyone living with obesity.
The thing to keep in mind about obesity is that it is excess fat. For that reason, correcting it is not just about losing weight. What needs to be reduced is the accumulation of fat that generates metabolic alterations. And these alterations can cause other pathologies, which is why obesity is a risk factor for other diseases. Advances in the knowledge of what obesity and overweight are for people’s overall health force us to have a different vision than what we had, until recently, about what a fat or non-fat person is. And this in turn means that we cannot simplify the treatment either.
Fortunately, one of the most important scientific findings of 2023 has been drugs to reduce obesity and its risks. But you have to use them appropriately. It must be clear that these drugs are not useful for what we know as a operation bikini: They are not for losing two or three kilos. What they are used for is a comprehensive approach in the treatment of obesity or overweight. But we must not forget that the cornerstone continues to be intervention in a healthy lifestyle.
What has happened until now is that many times lifestyle intervention was not enough. People get tired of diets, you can’t always live on a diet, although you can always eat healthy. In this regard, it is key to have a therapeutic tool that is successful, that supports patients and prevents them from being blamed, such as these new drugs. It must be taken into account that obesity is the only disease in which not only are patients blamed, but also, until now, the entire burden of treatment fell on them. Not now, now we have other tools.
The keys to motivation
Obesity is a very complex disease in which very diverse components intervene because it is multifactorial. It is influenced by the obesogenic environment, which are those factors that surround us and that can lead to obesity or overweight; also genetics, the environmental framework, the socioeconomic situation and another series of circumstances. Acting on all of them was very complicated. But these new drugs, which are effective, help us to make patients more motivated, they see that effects are achieved and it is easier for them to maintain a healthy lifestyle.
But these drugs must be well prescribed and must serve medical therapeutic purposes. Their focus is long term. We cannot forget that obesity or overweight are chronic diseases, like diabetes or hypertension. When pharmacological treatment against obesity or overweight is started, monitoring must be continued. This is essential to accurately assess the effectiveness and safety of the treatment.
In summary, in answer to your question, the important thing to keep in mind is that in the treatment of obesity we cannot say that one option is better than the other. What needs to be done is an integrative approach of all the measures we have available; Psychological support with behavioral therapy is often necessary to help patients. And the message that society must stop blaming patients with obesity or overweight is also very important.
María José Castro Alija She is a doctor specializing in clinical nutrition, researcher and Professor at the Faculty of Nursing at the University of Valladolid, member of the VIMAS+ research group (Multidisciplinary Assessment and Intervention in Health Care and Sustainable Lifestyles).
Question sent via email by Paula Garcia.
Coordination and writing: Victoria Toro.
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