Friday, March 31, 2023

Obesity, a “chronic disease” diagnosed in 60%

XVII meeting of the Diabetes, Obesity and Nutrition Group.

has gathered more than 285 internists XVII Meeting of the Diabetes, Obesity and Nutrition Group from Spanish Society of Internal Medicine (CM)Held on January 26 and 27 in Valladolid, where the analysis of the main diagnostic and therapeutic innovations in the field of study of the working group (Diabetes, Obesity and Nutrition) with the differential and multidisciplinary participation of patients and various medical-scientists has been done. Society.

During the meeting, topics of scientific relevance were discussed such as: “Past, present and future of treatment of a person with obesity”, ‘SEM algorithm for a comprehensive approach to a person living with obesity’ hyperglycemia Hospital’ or how to contact obesity in the elderly, among many others, such as the role of appropriate nutrition Ultrasound in Morphological Evaluation in Hospitalized Patients, an Update in the ADA-EASD 2022 Consensus internal Medicineinsulinization in specific patient profiles, anticoagulation The obese patient and other relevant issues among the main projects, algorithms and initiatives taken or ongoing by the working group in the last year (Customized Course, Media Registry, Type 2 Diabetes Approach Algorithm SEMI 2023 or Obesity Algorithm in the Elderly”, ).

past, present and future of the obese person

Juana Cartero, President of semireiterated that “obesity is a chronic diseaseThus declared by most official bodies like WHO in 1997 or European Union in 2021. However, in Spain it is unrecognized as such and, therefore, without receiving adequate treatment. Furthermore, Carretero highlights that “it is estimated that by 2023 the prevalence figures in Spain will be 30 percent of the adult population, with an increase in all ages, especially worrying among children and adolescents, to an expected 1.9 percent.” with growth.” annual percentage and represents 2.43 per cent of the total health expenditure”.

Similarly, it has put on the table that “in the past and in the present, obese person about his illness, simplifying it into a matter eat a lot and move a little, This concept, which is far removed from the actual mechanisms leading to obesity, leads individuals to follow restrictive diets, which have a lower weight gain response and a shorter time to recover lost weight. obesity persists infradiagnosticada (less than 40 percent of people with obesity are diagnosed), treated (less than 20 percent receive a drug with scientific evidence), and less than 1.3 percent of professionals prescribe said drug. He has reiterated that “obesity should be understood as a chronic disease Based on excess fat. Thus, your treatment should focus on preventing excess fat, such as avoiding the appearance of complications. diabetes from o high blood pressure and eventual complications, such as atrial fibrillation, heart failure, sleep apnea or osteoarthritis”. Similarly, he recalled that 2015 meant “before and after pharmacological treatment with the authorization of GLP1 receptor analogs (ARGLP1) specifically indicated for obesity” and that ” bariatric surgery It is currently a safe and effective technique indicated for BMI greater than 35, regardless of co-morbidity with DM2 between 30-35 or major comorbidities (osteoarthritis, sleep apnea, AF, fatty liver, CHF) have the presence of


“In the past and at present, obese people have been blamed for their disease, simplified to a case of eating too much and moving too little”


Finally, Carretero recalled that “the future obesity treatment This is promising, but unfortunately, since it is not recognized as a disease, there are no financed drugs and, moreover, people with obesity are blamed for using other therapeutic options for this purpose. Is. In the future, thanks to research, we will have drugs with a dual mechanism of action, such as pemiduvite (glucagon/GLP1), cagrilintide (Amylin/GLP1) or trigonists (ritretutide (GIP, glucagon, GLP1))” and that too ” New technologies, big data and “machine learning” techniques will allow us to predict the presence of obesity, predict which people will develop it and how obesity will be expressed in said person, with which we can develop improved personalized medicine. Will be able to offer their care, their treatment and respond to it”.

initial approach to hyperglycemia In non-critical hospitalized patients

Francisco Javier CarrascoSEMI Internist, Former Coordinator of the DON-SEMI Group and Chief of Internal Medicine Services Juan Ramon Jimenez University Hospital de Huelva, lectured on the management of hyperglycemia In the non-critically hospitalized patient. he stressed the importance ofdo glycemia at breakfast, lunch, and dinner in all patients for 24–48 hours from admission to detect stress hyperglycemia and undiagnosed diabetes” and “correction of stress hyperglycemia will be initially done with rapid insulin analogs.”

He asked “How to act in case of hypoglycemia?” But also remembered the guidelines. and, regarding intravenous insulin, “when and how to start it on the ward, how much and how to monitor it, and for how long?”. All this is part of the 2023 Consensus Document presented in the framework of this meeting of the DON-SEMI Group.

obesity in the elderly

as indicated Pablo Perez MartinezInternist, Member of JSEMI Board of Directors and Scientific Director of IMIBIC, “When considering the clinical management of obesity in people over the age of 65, it is important to assess functional status and whether the patient presents sarcopenia or cognitive impairment. “


“When considering the clinical management of obesity in people over the age of 65, it is important to assess functional status and whether the patient presents cognitive impairment”


Pérez Martínez reiterates that, if these are preserved, “various clinical scenarios are to be considered: in a patient with a BMI between 30 and 34.9, this would indicate a healthy lifestyle uptake; 35 In patients with a BMI between 10 and 39.9, it is also important to assess whether they present other co-morbidities and the impact of this on the patient’s threshold, as well as in the possible prescription of medication and the final clinical scenario. , with a BMI above 40, a healthy lifestyle, pharmacological treatment and assessment of bariatric surgery are also recommended in some specific group of patients.

What role can and should be played by nutrition and exercise in this type of patient?

In the words of Pedro Pablo Casado Escribano, coordinator of Diabetes, Obesity and Nutrition Working Group SEMI’s (DON): “All hospitalized patients may be at risk of a decline in their functionality during admission and to avoid this, both adequate physical conditioning and optimal nutrition are essential.” Furthermore, they reiterate that, in patients with pre-existing vulnerabilities, “this becomes even more relevant because of their greater risk of functional decline, but it is important to note that we only need to address these needs in vulnerable patients.” should not be given, but in a group of patients hospitalized for acute malignancy”.

Regarding multimorbidity in people with obesity, Casado Escribano also recalled that “the obesity it is a disease associated with high number of diseasesIt would be a mistake to manage only body weight in a patient living with obesity, and as integrative doctors, internists face the challenge of addressing the set of problems that these patients may present.


“Obesity is a disease that is associated with high morbidity, it would be a mistake to manage only the body weight of the obese patient”


Regarding various training activities and projects of task GroupCasado Escribano reiterates that “the group has been very active in the last year, thanks to the campaign of many of its members. It is worth highlighting the algorithm for the management of hyperglycemia in hospitalized patients (which is related to the patient profile of internal medicine will attempt to provide answers for a wide range of Diabetes Management 2023 (updated from 2019), MIDAE Registry (to evaluate the management of patients hospitalized in internal medicine with DM or stress hyperglycemia) and many other different training activities.

About 33% (between 30-35%) of admitted patients are internal Medicine have type 2 diabetes, even if not the reason for admission diabetes, In addition, it is estimated that between 30 percent and 40 percent of people diabetes Those seen by internists have obesity.

The information published in Redaccion Médica consists of confirmations, data and statements from official institutions and health professionals. However, if you have any queries regarding your health, please consult your respective health expert.

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