It is not very common to find, within the scientific program of a medical congress, an act that deviates from the norm of conferences, round tables and great magisterial presentations.
Even less, the call for a demonstration in the street after a talk, for example, on precision medicine in obesity.
But sometimes it happens.
At its annual meeting, the Spanish Society for the Study of Obesity (SEEDO) has made room in its agenda to hold a concentration this Thursday "in favor of people with obesity."
There is a lot to make visible, justifies the president of SEEDO, María del Mar Malagón (Madrid, 59 years old).
Starting with the most basic —that obesity is a full-blown disease, not a condition related to the free choice of lifestyle habits—, and continuing with the need for attention and awareness to tackle one of the great epidemics of the 21st century. .
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Malagón, who is scientific deputy director of the Maimonides Institute for Biomedical Research in Córdoba and professor of Cell Biology at the University of Córdoba, has developed her professional career in the field of basic research.
With a degree in Biology, she has focused her line of work on unraveling the secrets of adipose tissue, a structure that, despite its complexity and influence on obesity, barely occupied a page of space and time in the study plans of her time, remember.
Now, she assures her, things have changed, the findings in the study of obesity have multiplied and this ailment, little by little, is gaining ground and attention among the scientific community.
Ask.
Why is obesity not considered a disease?
Response.
Because
it is assumed that it is the will of the person that has to define whether he is thin or not.
That is part of the stigma and is one of the most misconceptions about obesity right now and that prevents it from being considered a disease.
In fact, even in professional environments, not specific to obesity, but scientific, when I say that it is a disease, everyone's response is: "Well, shut up, right?"
And it is more complex than all that.
Q.
Where is the origin of obesity?
Is it multifactorial?
A.
It is multifactorial.
There are genes whose mutations determine the development of the disease [mutations in leptin genes, for example], and there are other genes that favor moderate or sequential weight gain and that, with certain diets, make you more susceptible to gain of weight.
Other factors that are present in the openly obesogenic environment that surrounds us also have an important influence, which not only invites you to eat hypercaloric foods or drinks, but also modifies our intake —makes you eat more—;
All this, together with a sedentary lifestyle, contributes enormously to this obesity pandemic.
In addition, as if that were not enough, there are other environmental factors, such as endocrine disruptors or lifestyle habits that were not considered before, such as hours of sleep, which condition our weight through epigenetic mechanisms and allow faster adaptations towards weight gain. weight.
We also have illnesses, such as mental illnesses, for example, that have treatments that make people gain weight.
There are many other factors: education, which reinforces eating habits, or purchasing power, are important.
That is why we propose a multifactorial approach, because there are many obesity, defined by different combinations of these factors that I have mentioned.
“Until recently, having a few extra kilos was a sign of health and opulence, but that paradigm has to change”
María del Mar Malagón, president of SEEDO
Q.
What does it mean for a person to be obese?
A.
Obesity is a very important risk factor for the development of many other non-communicable chronic diseases such as diabetes, cardiovascular and liver diseases, hypertension, certain types of cancer and also some mental illnesses.
There is a high probability that you will have such ailments when you have obesity.
On a psychological level, moreover, people with obesity internalize that it is their fault and that message is so terrible, that even their body language is going to be that "it's my fault".
Q.
The first thing you see in a person with obesity is excess weight.
How heavy is the stigma?
A.
It depends a lot on the person, but what a person with obesity suffers from having this disease and everything that it entails is important.
Because she feels sick, misunderstood and that she doesn't control the disease.
And knowing that you do not control the disease is terrible, it generates anxiety.
Q.
Does the population know what obesity means or does it trivialize it?
R.
I think you don't know and that's why we need to make noise.
The paradigm must be changed.
For example, until not so long ago, in this country having a few extra kilos was a sign of health and economic health, of opulence.
But we have to change that brutally.
Q.
There is a movement, HAES (
Health at every size
), which defends that health is not just a physical pattern and claims health in all bodies and sizes.
He defends that a person with obesity can have a good analysis.
It's possible?
Can an obese person be healthy?
R.
Let's see, this generates a bit of controversy.
You can be healthy for a while, but it's a matter of time before it creates problems.
Obesity gallops with aging, with the advancement of life and the damage accumulates.
And the time that you maintain that metabolic health depends on your genetics, your lifestyle... but it is a path that we know where it can end.
This does not take away from the fact that a person has to be proud of his body as it is and think that his body is precious, but his health too.
Q.
Is medicine
pesocentric
?
A.
Yes, totally.
We have to change the paradigm and not only measure the body mass index, but also the body composition.
There are thin people who have an accumulation of fat in the abdominal part.
This is a matter of fat distribution and muscle loss.
And that is very important.
Q.
One of the conference papers talks about how fat tricks the brain.
As it does?
A.
Fat sends signals.
It's like a sensor: when your fat deposit is full, they send hormones to your brain as a satiety signal, so you don't eat more.
But, in obesity, this is short-circuited.
Resistance to these signals is generated, you lose control and it sends you signals to accumulate and not burn fat.
A person with obesity feels sick, misunderstood and that they do not control the disease.
María del Mar Malagón, president of SEEDO
Q.
What therapeutic alternatives are there for people with obesity?
R.
Right now, few.
But there are very good prospects for pharmacological treatment in the almost immediate future.
From now to 2025. But in this highly multifactorial disease, many parameters must be controlled, because since a large part of the body is affected, when we are talking about obesity, it is necessary to check that all these aspects are well controlled.
Q.
Bariatric surgery is one of the interventions with the longest waiting list.
A.
It is not prioritized.
With which, in the organization chart of a hospital, depending on how the other surgeries are in demand, there will be more or less.
It is true that bariatric surgery has been the solution for many people, but it also has its complications.
That is why I believe that, with pharmacological treatments and a multidisciplinary approach, this type of intervention could be reduced, which, although extremely good, is not the best for all patients.
It is necessary to influence individualized treatment and the most important thing is to have more therapeutic options.
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