The figures speak. And they say a lot. With worrying trends. In the future, on a global scale it is thought that almost one in four people will become obese. With an impact that promises to be dramatic in terms of healthcare spending: estimates are of over 4.3 trillion dollars. Yet speaking only in numerical terms is reductive. Because we also have to deal with discrimination that leads to underestimating the problem, almost eliminating it. And obese people are the object of blame, almost as if it were a choice. In short, there is an underestimation, almost a sort of “distancing” from the problem which risks creating an unfair stigma. And above all it removes the need to explore the profound causes of the phenomenon, which develops thanks to a mix involving various elements, from food to genetic, psychological, sociocultural, economic and environmental ones. Without obviously forgetting the lifestyle.
Obesity numbers in the world and in Italy
There are many sources on the impact of obesity. And a choice needs to be made. But very reliable sources can be taken to give a measure of what is happening and, above all, of the future. In this sense, research recently published in The Lancet, which involved experts from the NCB Risk Factor Collaboration together with the WHO, is of great help. The analysis that emerges from the study is sobering. The global prevalence of this disease in the last thirty years has doubled in women, tripled in men and quadrupled in children and adolescents, reaching 159 million children and 879 million adults in 2022, thus representing a real global health emergency with an equally dramatic economic impact. If the trend is worrying around the world, in Italy we can see even more how the social and educational sphere is fundamental. According to the most recent data from the PASSI surveillance system relating to 2020-2021, the prevalence of obesity in the Italian adult population is 11.1% among men and 9.7% among women. Not only that: it is also highlighted that the prevalence of obesity is greater in less wealthy social classes and with a lower socio-cultural level. It is more than doubled in people who report many economic difficulties, reaching up to 17.9% compared to people who report none, where it drops to 8.3%. Instead, the national data on the prevalence of overweight and obesity in pediatric age are provided by two surveillance surveys conducted by the Istituto Superiore di Sanità: the first, OKKIO alla Salute, refers to children aged 8-9 years and highlights a prevalence of obesity of 9.4% with slightly higher percentages in males than females (9.9% vs 8.8%).
A chronic and relapsing disease
Let’s get it out of our heads that obesity is a condition that the person chooses. And let’s instead consider it what it is, that is a real pathology. Technically, in fact, we are talking about one chronic, progressive, non-communicable, relapsing disease caused by a complex network of factors, including genetics, psychosocial and environmental factors. And this is not a casual definition. The World Health Organization (WHO) has classified obesity as a disease since 1948 and in 2021 updated its definition as a chronic, progressive and relapsing disease. Not only that: in 2013, the American Medical Association approved a motion that describes obesity as a “pathological state with multiple pathophysiological aspects”. Since then, a number of medical associations have expressed similar views. In March 2021, the European Commission issued a brief defining obesity as a “chronic relapsing disease”, which in turn serves as a gateway to a number of other non-communicable diseases. In Italy, obesity is not recognized by the NHS as a chronic non-communicable disease in its own right, however the parliamentary process is underway. On the medical front, when do we talk about obesity? In the presence of an excessive accumulation of body fat in relation to lean mass, both in terms of absolute quantity and distribution in specific points of the body. The measurement of body fat distribution can be carried out with different methods, from measuring skin folds, to the ratio between the circumference of the waist and hips, or with more sophisticated techniques such as ultrasound, CT scan or magnetic resonance imaging. Obviously the BMI, or Body Mass Indexrepresents the measure to define when we talk about normal weight, overweight or obesity of various degrees.
What are the risks associated with obesity
The list is long. But let’s try to define why an obese person is at greater risk in terms of health. First of all, obesity increases the risk of premature death. Every 5 Units above body mass index 25 is associated with a 31% greater risk of premature mortality. Overweight and obesity represent the fifth leading risk of global deaths. At least 2.8 million adults die every year as a result of this disease. Serious obesity-related complications include cardio-cerebrovascular diseases (CVDs), type 2 diabetes and at least 13 types of cancer and are among the main causes of mortality globally. At least 5 million deaths per year among adults are due to diseases attributable to overweight and obesity. On the metabolism front, people with obesity are 3.43 times more likely to contract type 2 diabetes. Not only that: people with obesity compared to normal weight adults have a 12 times higher risk of developing 4 or more diseases related to excess weight. Furthermore: obesity, in addition to favoring the onset or worsening of respiratory pathologies, increases the probability of developing joint diseases and also various types of tumors. As if that wasn’t enough, this pathological condition has a strong impact not only on the body, but also on the psyche. Those who are obese, in addition to often experiencing limited quality of life, are more likely to suffer from anxiety and depression.
The importance of a targeted approach
We’re not just talking about scales. And let’s remember how impactful people’s judgment can be when referring to those suffering from obesity. For this reason, the path that leads to a particularly significant weight increase must be addressed through professional collaboration between the various fields: medical, psychological, political, sociological, so that everyone makes their knowledge and resources available to form a network capable of stemming and cure the problem. Collaboration is essential for an optimal result. Obese people have to face every day the stinging judgment of a society that is based on standards of aesthetic perfection, which are poorly suited to being overweight. Something well coordinated must be done to break the cycle of blame and to all work together, only in this way can we tackle this complex global public health problem. There are many strategies and they must be implemented from childhood. With the certainty that research is continuing. Because from a scientific point of view there are different strategies to deal with obesity, intervening in the optimal way with targeted treatments. “Despite the progress made in recent years, obesity remains a very complex condition to deal with for healthcare professionals and systems, with significant cultural and healthcare deficiencies due to its multifactorial nature, its chronic and progressive course, and the many clinical complications associated and, ultimately, with the difficulty in obtaining lasting results in reducing body weight. – he comments Rocco Barazzoni, President of SIO, Italian Obesity Society – Today we are finally entering one new phase in the treatment of obesitywith a new pharmacological paradigm that will allow us not only to provide answers to care needs that have so far been largely unsatisfied, restoring time and quality of life to patients, but also to prevent the numerous associated pathologies in the end and reduce their dramatic impact today” . In this sense, among the various options available, it is worth mentioning the recent availability of a new drug, tirzepatide, indicated for the treatment of obesity, overweight in the presence of at least one comorbidity, and type 2 diabetes.
With the contribution of Eli Lilly Italia
