Adaya Gonzalez |
Madrid (EFE) a chronic disease, but for which the patient is still blamed.
“It is the most stigmatized disease along with the mental one, by society and even by professionals. We must change this vision that it is a vice: it is a disease in itself, complex, chronic and multi-causal ”, the vice president of the Spanish Society for the Study of Obesity (Seedo), Albert Lecube, argues to EFE.
Metabolic, endocrine, epigenetic or environmental causes such as stress, lack of sleep or nutrition that can generate this abnormal or excessive accumulation of fat in the body, which require a multidisciplinary approach in specialized units.
“Who has edema in their legs because their heart doesn’t work well and they drink water, it’s her fault because they drink water and their legs swell? Well, that happens with obesity. One does not choose obesity, obesity chooses you”, sums up the researcher.
It is precisely against this backdrop that the World Obesity Federation is convening tomorrow, with the motto “Changing Perspectives: Let’s Talk About Obesity”, a new World Obesity Day with which it wants to eradicate forever the misconceptions and stigma that still surrounds this sickness.
The more prevalence, the more phobia
Nearly 2,000 million people are overweight in the world, 650 million of them obese, three times as many as in 1975. The WHO estimates that one in four inhabitants of the planet (1,900 million) will be obese in 2035.
In Spain, according to the Global Obesity Observatory, 37.8% of adults weigh more than recommended and 16% are obese; With average annual growth of 1.9% since 2010, the forecast is that in 2030, the prevalence of obesity will be 37%, seven points higher than the calculation made a year ago, which was 29.4%.
The figures for children are not much better: the Gasol Foundation’s Pasos study estimates the percentage of overweight children at 21.6% and obese children at 11.8%.
That obesity is equivalent to gluttony, laziness and lack of will is so established in the common ideology that the phobia it arouses increases in the same way as its prevalence: according to the WHO, 63% of obese school-age children are more likely to being bullied, 54% of adults feel stigmatized by their work colleagues and 69% by healthcare professionals.
The professionals, part of the blame
Because fatphobia begins in schools in the form of “bullying” and from there it spreads to other areas, including healthcare.
“We have to be very honest and self-criticize because we have been partly to blame for obese people not coming to the clinic,” says Cristóbal Morales, a specialist at the Endocrinology Research Unit of the Virgen de Macarena Hospital in Seville.
No one with hypertension hesitates to ask for treatment, but with obesity there is an “extreme guilt” that has made the patient, tired of being held responsible for his situation and given “the same photocopied diet that is taken out of the drawer for everyone, seek outside the health field, such as the Internet or home remedies, with all that this implies for their health”.
Discrimination in treatment is also in treatment: drugs that have been shown to be effective with obesity and that are already on the market are only financed for diabetics. “They feel like second-class patients,” criticizes the doctor.
You can’t be a fofisano for life
Obesity is still measured according to the Body Mass Index (BMI) established by the WHO, but this instrument is beginning to be questioned by scientific societies.
“It is an old tool: obesity cannot be defined by weight, today the diagnosis is made by analyzing the lean mass, which is what increases the size and what can cause complications” such as diabetes, cardiovascular diseases or cancer, To cite just some of the more than 200 comorbidities that it brings with it, Morales lists.
Being obese is incompatible with being healthy, agree the experts, who flatly reject the concept of “fofisano”.
“The metabolically healthy obese people have their breeding ground and it is only a matter of time before they develop the diseases. One is not a fofisano for life, it is impossible ”, settles Lecube.
the mental impact
70% of the obese have symptoms of anxiety and 66% depression, but in public health only morbid cases are referred to clinical psychology for evaluation of bariatric surgery.
The Infanta Leonor Hospital in Madrid is one of the three that gives nutrition workshops; the profile of the patient who goes there is “the one who is very aware that at certain times they eat for emotional reasons”, the one who “has tried everything and thinks they need another type of help” or a combination of both, comments the clinical psychologist expert in eating disorders and obesity, Miriam Félix.
Although the prevalence is similar between men and women, women go more to the health system and men opt for environments related to sports; but within those who go to the doctor, they respond much better to treatment than women. And that is also the result of stigma.
Of all the eating behaviors that terrify these people -although not all develop it- binge eating is “the one that generates the most feelings of guilt and anguish. Nobody wants to binge, if it was just a matter of willpower, nobody would.”
Psychological intervention helps to understand why they occur, and when it is achieved, you can already begin to “change things so that this behavior disappears in the future.”
Some patients remain more committed to changing their habits than others – those with hypothyroidism or those who have undergone bariatric surgery usually respond well – but, in general, “everyone comes out eating better and exercising more.”
Hence, the conclusion that Félix makes is that “psychological intervention should be part of the multidisciplinary approach to obesity, is what the clinical guidelines say. In the end, everything is mixed up, which is why the future must be a joint approach”.