Overweight and obesity represent one of the biggest global problems and the figures are worrying. He foresees exponential growth in such a way that we will go from 38% of people with excess weight in 2020 to 51% in 2035, and 24% of them will be people with obesity.
In Spain, the outlook is very similar to most European countries, with an expectation that the disease will increase in adults from 22% in 2020 to 37% in 2035.
The Dr. Susana Monereohead of the Endocrinology and Nutrition service at Hospital Ruber Internacional and secretary of the , explains the reasons why this happens:
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“We are biologically made beings, that is, genetically designed to eat and store energy in the form of fat in adipose tissue, a fact that has a very important significance in survival.”
For thousands of years, human beings have survived, among other circumstances, thanks to their ability to search for food and eat or preserve it. According to the specialist in endocrinology and nutrition, food and the type of nutrients that were already being incorporated into the diet then have marked our evolution and have achieved what we are now.
So, “what has happened so that the biological functions that have saved our lives now cause us to lose it?”, the expert wonders.
Well, the answer that the doctor gives is that what has happened is that the environment that surrounds us has changed. “There is food everywhere, easy to get, cheap, high in calories, and the way of life has also changed, where moving costs effort.”
To all this we must add that:
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“We have more, lack of sleep, more environmental toxins and many other circumstances that favor weight gain.
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And if we add to this the hedonic importance of food, the emotional enjoyment, the reward phenomenon, and the fact that we continue to use food and give it the same social and cultural importance as our ancestors, when it was a scarce commodity and the one who had it was the one who dominated, we will understand that gaining weight is much easier than not gaining it or maintaining it”, qualifies Dr. Monereo.
People gain weight, obesity makes them sick and a vicious circle is established that is very difficult to break, because the more obese, the more hungry, less mobile and therefore more difficult to control.
The problem of regaining weight despite diets
According to the specialist at Hospital Ruber Internacional, the classic treatment for the disease has been:
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Lifestyle changes with caloric restriction
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Diets of different composition (, Dash, Keto, Paleo, etc.)
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Increased physical activity.
And it is true that thanks to them, around 5-8% weight loss was achieved. But the reality is that this type of diet, in addition to involving a significant effort for the patient, did not always achieve satisfactory results in the long term.
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“We knew that the weight came back quickly as soon as you got out of the way, and both the patient and the doctor felt the failure. This is how the circle of gaining weight/losing weight and starting again was established”.
So much so, that the , describes that half of people with obesity have done a minimum of 4 treatments to lose weight with diets and physical activity. And although it is true that thanks to them patients achieved significant weight loss, the truth is that a high percentage of them exceeds 20 attempts to go on a diet throughout his life.
But the recovery of lost weight also concerns specialists when the patient undergoes surgery against obesity.
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“When excess weight exceeded certain limits and what we call severe or morbid obesity appeared, causing more metabolic complications, other endoscopic techniques were used or with which weight loss was achieved between 15-40 or up to fifty%. But even in patients operated on, weight recovery planned like a curse”, says Susana Monereo.
Innovative treatments to not regain lost weight
In short, until very recently “there was no other way” to treat obesity and overweight, says the doctor. But relatively recently there was an important change:
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In 2018, the use of a drug, Liraglutide, commercially known as Saxenda, was authorized to lose weight with which losses of around 10% are achieved in people diagnosed with obesity, “we were beginning to see light at the end of the tunnel”, he highlights.
As Dr. Monereo explains, “for the first time we had a safe and effective drug that helped reduce hunger because it produces satiety. Research and scientific effort had paid off; Weight was lost and the weight lost could be maintained in the long term, something unthinkable 5 years ago”, acknowledges the specialist.
“Today, science and research have advanced, and on the market we already have a more powerful, more effective derivative of the previous drug that achieves higher weight loss that can reach 20%. It is Semaglutide, marketed in the US under the name Wegoby. In Europe it is not yet available as such, although we do have it marketed under the name of and it is authorized in diabetes”, Monereo indicates.
But also, things do not end here, and as expected, the research has gone a step further and Tirzepatide is already on the American market, another drug from the family of the two previous “incretins”, gastrointestinal hormones that help in weight regulation producing satiety and reducing hunger with consequent weight loss, with few side effects and spectacular long-term benefits in reducing metabolic and cardiovascular diseases.
This drug has already shown weight loss that can reach 30%.
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“It could be administered until the weight stabilizes, it is effective, safe and can be an alternative to bariatric surgery”, says Dr. Susana Monereo.
There are other drugs under development in phase 2-3 of clinical trials in humans from the incretin family Cagrilintide, Cagrilintide+ Semaglutide, Retratutide, Pemvidutide, and others from another class such as Bimagrumab that seems to reduce hunger and increase energy expenditure.
Dr. Susana Monereo is optimistic and predicts a promising future for people with obesity, until a few years ago it was unthinkable, “to have effective and safe treatments for their…