OPEN Spain

Obesity in Spain

Economic impact
In Spain, the current cost to the National Healthcare System caused by obesity-related health problems is already €2,000 millionⁱ. If the trend continues, by 2030 there will be more than 27 million overweight people in Spain, which will mean an extra cost of €3,000 millionⁱⁱ. This makes it essential that the responsible administrations act to curb an unsustainable situation for patients themselves and for the system.
Currently in Spain there are no reimbursed drugs for obesity while there are more than 11,000 patients on the waiting list for bariatric surgeryⁱⁱⁱ. People with obesity have health complications, leading to additional costs due to the treatment needed for up to 236 comorbidities or pathologies associated with obesity^iv. In Europe, people with obesity incur 20% more healthcare costs and 68% treatment costs than people who do not have the disease^v,vi.

Societal impact
In Spain, obesity is recognised as a disease and is included in the National Health System (SNS) Portfolio of Services^vii. However, there is no active policy on specialised centres for the diagnosis and treatment of obesity. Due to the lack of an effective national response, 22% or more of adults suffer from obesity^viii, a figure that doubles when we talk about the rate of overweight^ix. With children and adolescents, the most conclusive studies indicate that between 15% and 18% have obesity^x.

Individual impact
Obesity is a chronic disease which is not recognized, often even by those affected^xi. It presents a large number of comorbidities and associated pathologies. Between 2014 and 2017 there was a 14,37% increase in diabetes diagnoses^xii, which might be related to the increase in cases of obesity and overweight. Obesity is the number one cause of type 2 diabetes mellitus, and the rate of diabetes in adults is currently 13,8% of the population^xiii,xiv. In addition, diseases associated with obesity include dyslipidemia, hypertension, fatty liver, obstructive sleep apnea syndrome (OSAS), infertility, some of the most prevalent tumours such as breast cancer, and a large proportion of heart disease and strokes^xv,xvi.

Clinical challenges
Obesity is seen as the patient’s individual responsibility due to the lack of training, information and system involvement, which also affects the current clinical practice^xvii. This lack of training and up-to-date information prevents professionals from providing appropriate diagnosis and treatment to their patients^xviii. For these reasons, an integrated, unbiased approach is needed to communicate with patients about different treatment options. The creation of multidisciplinary teams is necessary, with Primary Care to diagnose patients early, establish appropriate treatments and, if necessary, refer the patient to specialist care.

Key Achievements

Although OPEN Spain is relatively new, we have already accomplished important milestones:

• Development of an OPEN Spain Position Paper: after several digital and face-to-face meetings, a position paper was developed reflecting the current Spanish situation, its positioning and recommendations for progress.
• COVID-19’s impact on people with obesity: due to the impact of COVID-19 on people with obesity, OPEN Spain is planning to address and reinforce this evidence to health authorities, warning them from the increased risk that people with obesity have shown^xix and the consequences that the lock down has had (approximately +3kg on average, as seen in a national survey developed by SEEDO and SEEN^xx) and asking for solutions. In addition, bariatric surgeries have been postponed and weight increases have been seen.

Priorities in 2020 and Beyond

The year 2020 has not progressed as expected due to COVID-19. Despite this, OPEN Spain remains committed to its mission and remit:

• Increasing awareness of obesity among politicians, healthcare professionals and society in general.
• Developing initiatives which lead to better obesity management, for instance encouraging the coordination of multidisciplinary teams for diagnosis and treatment of the disease.
  Maintaining collaboration within the international OPEN network in order to achieve global objectives and share national experiences.

Members of OPEN Spain

Status: June 2020

• Dr. Francisco Tinahones Madueño, Head of the Endocrinology and Nutrition department in Virgen de la Victoria Hospital (Málaga, Spain), President of SEEDO (Spanish Obesity Scientific Society) and member of CIBERobn’s Board of Directors
• Dr. Felipe F. Casanueva, Professor of Medicine- Department of Medicine, Endocrine Section Santiago de Compostela University and Biomedical Research Institute IDIS. Head Obesity Unit HM Hospitals Galicia. Past president of Spanish Society of Obesity (SEO) and CIBER Obesity & Nutrition. Editor in Chief of Reviews Endocrinology Metabolism Diseases)
• Dra. Susana Monereo Megías, Head of the Endocrinology and Nutrition department in Gregorio Marañón Hospital (Madrid, Spain) and Secretary of SEEDO (Spanish Obesity Scientific Society)
• Dr. Antonio José Torres García, M.D., Ph.D., F.A.C.S., FASMBS. Professor of Surgery, President of IFSO (2011-2012), Chairman IFSO´s Board of Trustees (2015-2019), Governor Capítulo Español del American College of Surgeons (ACS), Chief General Surgery Service Department of Surgery Hospital Clínico San Carlos, Medical Director Multidiciplinary Obesity Unit Hospital Madrid Monteprincipe, Complutense University of Madrid
• Prof. Gema Frühbeck, Co-Director of Obesity Area & Head of the Metabolic Research Laboratory of the Endocrinology and Nutrition Department in Clínica Universidad de Navarra (Pamplona, Spain), Full Professor & Vice Dean for Research of the Faculty of Medicine of the University of Navarra and CIBERobn group leader
• Dr. Andreu Palou Oliver, Professor of Biochemistry and Molecular Biology at the University of the Balearic Islands (UIB, Islas Baleares, España), Director of the Laboratory of Molecular Biology, Nutrition and Biotechnology and Director of the ‘nutrigenomics and obesity’ group at UIB, IDISBA and CIBERobn