Sunday, April 2, 2023

Obesity is defined as a chronic disease by national experts

More than 285 internists have gathered at the XVII meeting of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine (SEMI), where they analyzed the main diagnostic and therapeutic novelties in the field of study of the Working Group (Diabetes) Have done , obesity and nutrition) …

More than 285 internists have gathered at the XVII meeting of the Diabetes, Obesity and Nutrition Group of the Spanish Society of Internal Medicine (SEMI), where they analyzed the main diagnostic and therapeutic novelties in the field of study of the Working Group (Diabetes) Have done , obesity and nutrition) with differential and multidisciplinary involvement of patients and various medical-scientific societies.

During the meeting, topics of scientific relevance were discussed, such as: “The Past, Present, and Future of Treating the Obese”has been submitted “The SEMI Algorithm for a Comprehensive Approach to Hospital Hyperglycemia” hey How to remove obesity in elderlyamong many others, such as the role of adequate nutrition in hospitalized patients, innovations in the ADA-EASD 2022 consensus, ultrasound in morphological assessment in internal medicine, insulinization in special patient profiles, anticoagulation of obese patients, and key projects, algorithms and initiatives taken or ongoing by the Working Group in the previous year (Customized Course, Media Registry, Type 2 Diabetes Approaches Algorithm SEMI 2023 or Obesity in the Elderly Algorithm”, along with other relevant topics).

past, present and future of the obese person

Dr. Juana Carretero, cm presidentreiterated thatObesity is a chronic disease, declared by most of the authoritative organizations like WHO in 1997 or EU in 2021. However, in Spain it is unrecognized as such and therefore, without receiving adequate treatment“. Furthermore, Dr. Cartero highlights that “It is estimated that by 2023 the prevalence figures in Spain will be 30% of the adult population, with an increase in all ages, especially worrying in children and adolescents, representing an expected increase of 1.9% per year and 2.43% of the total. health expenses with,

Similarly, he has put on the table that “In the past and, currently, the obese person has been blamed for their illness, simplified to a case of eating too much and moving too little. This concept, so far away from the true mechanism leading to obesity, leads the person to follow a restrictive diet with less weight gain response and recovery of lost weight in less time.“. In this regard, Dr. Cartero highlights that currently, “Obesity is under-diagnosed (less than 40% of people with obesity have this diagnosis), treated (less than 20% receive medication with scientific evidence) and less than 1.3% of professionals prescribe that medication writes”.

He reiterated that “Obesity should be understood as a chronic disease based on the prevalence of obesity. Thus, your treatment should focus on preventing excess fat, avoiding the appearance of complications such as diabetes or high blood pressure, and eventual complications, such as atrial fibrillation, heart failure, sleep apnea, or osteoarthritis.“He also remembered what 2015 means”Before and after pharmacological treatment with authorization of GLP1 receptor analogs (arGLP1) specifically indicated for obesity“and that”Bariatric surgery is currently a safe and effective technique indicated for BMI greater than 35, regardless of DM2 between 30–35 or co-morbidities with major comorbidities (osteoarthritis, sleep apnea, AF, fatty liver, CHF). presence of morbidity.,

Finally, Dr. Carretero recalled that “The future of obesity treatment is promising, but unfortunately, since it is not recognized as a disease, there are no financed drugs and, moreover, people with obesity are forced to use other therapeutic options for this purpose. is blamed for.“In the future, thanks to research, we will have drugs with a dual mechanism of action, such as pemidvutide (glucagon/GLP1), cagrilintide (Amylin/GLP1) or trigonists (ritretutide (GIP, glucagon, GLP1))” And that too “new technologies, big Data and the technique of ““Machine learning” will allow us to predict the presence of obesity, predict which people will develop it and how obesity is expressed in that person, with whom we can offer personalized medicine that improves care, treatment and response. Will be able to.,

Initial Approach to Hyperglycemia in Non-Critically Hospitalized Patients

Dr. Francisco Javier Carrasco, SEMI internist, former coordinator of the DON-SEMI Group and head of the Internal Medicine Service of the Juan Ramon Jimenez de Huelva University Hospital, Lectured on the management of hyperglycemia in non-critically hospitalized patients. He stressed the importance of “Perform blood glucose tests at breakfast, lunch, and dinner in all patients for 24-48 hours prior to admission to rule out stress hyperglycemia and undiagnosed diabetes“and that”Correction of stress hyperglycemia initially with rapid insulin analogs,

He asked “How to act in case of hypoglycemia?” But also remembered the guidelines. and, in relation to 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 by Dr. Pablo Perez Martinez, Internist, Member of the Board of Directors of SEMI and Scientific Director of IMIBIC“One 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.,

Dr. Pérez Martínez reiterated that, if these are preserved, “Different clinical scenarios are considered: in a patient with a BMI between 30 and 34.9, it would be indicated to intensify a healthy lifestyle; In patients with a BMI between 35 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 on the possible prescription of medication and the final clinical scenario In the U.S., at a BMI above 40, a healthy lifestyle, drug treatment, and in some specific groups of patients, even bariatric surgery are recommended to be assessed.,

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

in the words of Dr. Pedro Pablo Casado Notary Public, Coordinator of SEMI’s Working Group on Diabetes, Obesity and Nutrition (DON): ,All hospitalized patients are at risk of a decline in their functionality during admission and both adequate physical conditioning and optimal nutrition are essential to avoid this.Furthermore, they reiterate that, in a patient with pre-existing weakness, “This becomes even more relevant because of its greater risk of functional decline, but it is important to note that we must address these needs not only in the debilitated patient, but also in the group of patients hospitalized for acute malignancy. .,

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

With regard to the various training activities and projects of the Working Group, Dr. Casado Escribano reiterated that “The group has been very active during the last year, thanks to the campaigns of many of its members. It is worth noting that the algorithm for the management of hyperglycemia in hospitalized patients (which will attempt to respond to a wide range of patient profiles encountered by internal medicine), the new Diabetes Management Algorithm for 2023 (updated from 2019) ), Media Registry (to evaluate and manage patients hospitalized in internal medicine with DM or stress hyperglycemia) and many other different training activities,

Near to 33% (between 30-35%) of patients admitted to internal medicine have type 2 diabetes, even if the reason for admission is not diabetes. In addition, it is estimated that 30% to 40% of people with diabetes who are seen by internists are obese.

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