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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 obesityiv. In Europe, people with obesity incur 20% more healthcare costs and 68% treatment costs than people who do not have the diseasev,vi.

Societal impact
In Spain, obesity is recognised as a disease and is included in the National Health System (SNS) Portfolio of Servicesvii. 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 obesityviii, a figure that doubles when we talk about the rate of overweightix. With children and adolescents, the most conclusive studies indicate that between 15% and 18% have obesityx.

Individual impact
Obesity is a chronic disease which is not recognized, often even by those affectedxi. It presents a large number of comorbidities and associated pathologies. Between 2014 and 2017 there was a 14,37% increase in diabetes diagnosesxii, 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 populationxiii,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 strokesxv,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 practicexvii. This lack of training and up-to-date information prevents professionals from providing appropriate diagnosis and treatment to their patientsxviii. 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.

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About OPEN Spain

OPEN aims to build national support for improving obesity care through a partnership between public health policy makers, patients, scientific societies and experts in the field of obesity. The core focuses of OPEN Spain include:

Recognition of obesity as a chronic and prevalent disease
The recognition of obesity as a chronic and prevalent disease is essential in order to develop policies that will address the obesity epidemic. Without this recognition it will continue to grow, and the economic costs will continue to increase, affecting the sustainability of healthcare and placing an unprecedented burden on both the National Healthcare System and society in general.

Collaboration with the OPEN Network
Collaboration with the different members of the global OPEN network in order to share global resources, discuss the progress in our countries, exchange learning with other experts, and develop tangible tools to help meet our shared goals.

Design of multidisciplinary therapeutic strategies
Bringing together expertise (medical, surgical, psychological, etc.), to combat the current obesity epidemic by developing specialised centres for the correct diagnosis and treatment of obesity.

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 shownxix and the consequences that the lock down has had (approximately +3kg on average, as seen in a national survey developed by SEEDO and SEENxx) 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

References

i Hernáez,A. Zomeño,M. Dégano,I. et al.. Excess Weight in Spain: Current Situation, Projections for 2030, and Estimated Direct Extra Cost for the Spanish Health System. Revista Española De Cariología. 2019,72, 916-924
ii Ibid.
iii Arteaga-González, I.J., Martín-Malagón, A.I., Ruiz de Adana, J.C. et al. Bariatric Surgery Waiting Lists in Spain. OBES SURG 28, 3992–3996 (2018). https://doi.org/10.1007/s11695-018-3453-z
iv Yuen, M.M., et al. (n.d.). A systematic review and evaluation of current evidence reveals 236 obesity-associated disorders. Massachusetts General Hospital & George Washington University. [Poster presentation]
v Von Lengerke T, Krauth C. Economic costs of adult obesity: A review of recent European studies with a focus on subgroup-specific costs. Maturitas. 2011; 69:220–9.
vi Pendergast K, Wolf A, Sherrill B, Zhou X, Aronne LJ, Caterson I, et al. Impact of waist circumference difference on healthcare cost among overweight and obese subjects: The PROCEED cohort. Value Health. 2010; 13:402–10.
vii Cartera de servicios comunes del Sistema Nacional de Salud y procedimiento para su actualización (2009). Ministerio de sanidad y politica social. [online]. Available at: https://www.mscbs.gob.es/profesionales/prestacionesSanitarias/publicaciones/docs/carteraServicios.pdf
viii Aranceta Bartrina J, et. al. Prevalencia de obesidad general y obesidad abdominal en la población adulta española (25-64 años) 2014-2015: estudio ENPE. Sociedad Española de Cardiología; 2016.
ix Organisation for Economic Co-operation and Development (2017). OECD analysis of national health survey data [online] available at http://www.oecd.org/health/obesity-update.htm (Accessed May 2020)
x Franco,M. Sanz,B. Otero,L. et al. Prevention of childhood obesity in Spain: a focus on policies outside the health sector. SESPAS report 2010. Gaceta Sanitaria.2010.24, 49-55
xi Martinez C.A., Llano Señarís J., Gol-Montserrat, J. La Obesidad en Espana y sus Consecuencias. Fundación Gaspar Casal (2019). [Online]. Available at: https://fundaciongasparcasal.org/publicaciones/Libro-obesidad-y_consecuencias.pdf
xii Ibid.
xiii Federico Soriguer, Sergio Valdes, Gemma Rojo. The Di@bet.es study: and now what?, vol. 28 (2), pp 35-37, March-April 2012. https://DOI: 10.1016/j.avdiab.2012.06.001
xiv Consenso Seedo (2016). Sociedad Espanola para el Estudio de la Obesidad. [online]. Available at: https://www.seedo.es/images/site/ConsensoSEEDO2016.pdf
xv Organizacion Mundial de la Salud. Obesidad y sobrepeso (April 2020). [Online]. Available at: https://www.who.int/es/news-room/fact-sheets/detail/obesity-and-overweight
xvi Consenso Seedo (2016). Sociedad Espanola para el Estudio de la Obesidad. [online]. Available at: https://www.seedo.es/images/site/ConsensoSEEDO2016.pdf
xvii Martinez C.A., Llano Señarís J., Gol-Montserrat, J. La Obesidad en Espana y sus Consecuencias. Fundación Gaspar Casal (2019). [Online]. Available at : https://fundaciongasparcasal.org/publicaciones/Libro-obesidad-y_consecuencias.pdf
xviii B. Gil Barcenillaa, A. Lupiáñez Castillob, G. Longo Abril, Redes de profesionales en la prevencia y el abordaje de la obesidad infantil. Rev Pediatr Aten Primaria [online]. 2012, vol.14, suppl.22, pp.15-22. ISSN 1139-7632. http://dx.doi.org/10.4321/S1139-76322012000200002.
xix Información científica-técnica. Enfermedad por coronavirus, COVID-19. [online] Available at: https://www.mscbs.gob.es/profesionales/saludPublica/ccayes/alertasActual/nCov-China/documentos/20200417_ITCoronavirus.pdf
xx Pharma Market (June 2020). Expertos reclaman que el control del peso se incluya entre las medidas de prevención del Covid-19. [online] Available at https://www.phmk.es/politica-sanitaria/expertos-reclaman-que-el-control-del-peso-se-incluya-entre-las-medidas-de-prevencion-del-covid-19