Obesity is not the same as the desire to lose weight, says professor – 7/6/2023 – Equilíbrio

It is necessary to separate the “cultural desire for thinness” from obesity, according to Lee Kaplan, professor of medicine at Harvard University and director of The Obesity and Metabolism Institute in Boston, Massachusetts (USA).

The condition is considered a disease by the WHO (World Health Organization). The understanding, however, is not a consensus among specialists, some of whom indicate that it is possible to be obese and have good health conditions. According to them, classification is a pathological view of fat bodies. Kaplan, however, disagrees.

For the professor, obesity can be characterized as a malfunction of the body. Understanding the condition as a disease would be one of the ways to control the shortage of medicines like Ozempic, according to him. Thus, it would be easier to prioritize those who need it most.

In an exclusive interview with Sheetthe Harvard professor talks like the high cost and lack of medication, attributed by physicians to indiscriminate use for weight loss, are some of the current bottlenecks in the treatment of obesity. Blame the patient, too. In Brazil, a prescription is not necessary to access the drug, it is used off-label for weight loss.

“Doctors and other caregivers blame the patient, so they won’t prescribe drugs even if they are available or cheap,” he says. “The most important thing is to blame the disease, not the patient, and support him in the treatment, as the doctor would with any other illness.”

For him, the new drugs for obesity have revolutionized treatments for the condition, and that those with health complications, such as cardiac and metabolic conditions, need to have priority in accessing this type of drug – even ahead of obese patients without comorbidities .

“If you have obesity, sleep apnea, heart attack, fatty liver, diabetes and kidney failure, I would probably put it at the top of the list. But if you don’t have any of those things, even if you weigh a lot, I might put it on further down the list”.

He was in Brazil at the invitation of Novo Nordisk, manufacturer of Ozempic and Wegovy, for a presentation at the congress of Abeso (Brazilian Association for the Study of Obesity and Metabolic Syndrome).

Wegovy, Ozempic and Mounjaro (tirzepatide from Eli Lilly) are drugs that simulate the hormone GLP-1, responsible for controlling the amount of sugar in the blood and appetite. The results caused by the substances in weight loss have gone viral on social networks and have contributed to their scarcity in different countries, compromising the treatment of patients. According to the manufacturer, Ozempic will have committed availability in Brazil by the end of the year.

To avoid this type of damage, according to the professor, the correct thing would be to prioritize patients according to the severity of the disease, including obesity.

“I would say that the people who need it most should get it first. Right now, the people who get the drugs first are the richest. That’s not fair. That’s what we call unequal access,” he says.

The WHO defines overweight and obesity “as abnormal or excessive accumulation of fat that poses a risk to health”. Those with a BMI (body mass index) equal to or greater than 25 are considered overweight, and those with a metric equal to or greater than 30 are considered obese.

According to the organization, “the issue has grown to epidemic proportions, with more than 4 million people dying each year as a result of being overweight or obese in 2017.” Also according to the WHO, “Overweight and obesity rates continue to grow in adults and children. From 1975 to 2016, the prevalence of overweight or obese children and adolescents aged 5 to 19 years increased more than fourfold, from 4% to 18% worldwide”.

In Brazil, according to data from the 2020 PNS (National Health Survey), 60% of Brazilian adults are overweight. Already obesity affects 26% of this population.

For Kaplan, what determines the condition as a disease is the body’s inability to regulate body fat.

“In obesity, the body is not functioning properly. The reason we know this is because the body normally regulates its fat correctly. For example, when you have a baby, it has baby fat. Baby fat goes away on its own, you doesn’t put a baby on a diet,” he says, giving examples of times when the body controls the amount of fatty tissue naturally, such as puberty or pregnancy.