In Spain, the Ministry of Health does not fund any medications to treat obesity, a chronic disease that is increasingly prevalent (affecting 30% of the adult population) and which, so far, is not considered “serious enough,” Antonio regrets. Pérez, Director of the Endocrinology and Nutrition Services Unit at La Santa Creu y Sant Pau Hospital (Barcelona). Doctors demand treatments funded by Social Security to treat this condition, just as happens with other chronic diseases. Today, obese patients have access to effective medications but have to pay for them entirely out of pocket.
“Obesity is a disease that carries a very high public health burden. It is a source of many diseases and should be considered like any other chronic disease such as cholesterol and type 2 diabetes.” [molt associada a l’obesitat] “And high blood pressure,” Perez says. For him, the treatment of obesity should follow “the same rules” as the treatment of other diseases: if diet and exercise are not enough, there must be access to effective and financeable medicines.
Ozempic, a diabetes drug, has proven highly effective in treating obesity. This has for some time caused a shortage in pharmacies across Spain, where doctors prescribe it to people suffering from obesity, especially in private healthcare. If these patients do not have diabetes, they have to pay for it in full. Pharmaceutical company Novo Nordisk also plans to market Wegovy in Spain, which will be indicated only for obesity. Both depend on the hormone GLP-1, which is responsible for diabetes and obesity.
“People buy Ozempic because there is a before and after. Also, obesity is the gateway to diabetes [un 25% de persones amb obesitat tenen diabetis tipus 2]. “It is nonsense not to treat obesity, which in turn leads to type 2 diabetes,” explains Andrea Ciodin, coordinator of the Comprehensive Obesity Unit at Hospital de la Val d'Ebron (Barcelona). Rather, “several types.” So there are genetic, environmental, and even hormonal factors that mix and make the metabolism of these people work in a “deficit manner.”
“Eating too much food is a symptom, not a cause. The circuits that regulate appetite and calorie consumption change due to the different metabolic pathways in which different enzymes are involved,” emphasizes this specialist, who explains that obesity is a disease and it is a “biological” disease and not a “biological” one. Psychological”, has a huge impact on the lives and self-esteem of these people, who often suffer from more depression and anxiety.
Like Perez, the endocrinologist from the Hebron Valley advocates for fundable treatments for obesity, but she also recognizes that some petty attitudes have “hurt” drugs like Ozempic. “It is unethical for people to buy Ozambik because they have five extra kilograms. It is not a cosmetic medicine or a nutritional supplement, but a drug with a hormone that must be monitored. There are celebrities who have injected it to enter the body.” “The wedding dress, it was prescribed from beauty centers… This is painful. The message of stealing diabetes medicine is a negative message,” reflects the endocrinologist. Ozempic can cause a patient to lose up to 16% of their body weight.
Between 130 and 150 euros
For Dr. Perez, the visibility of obesity is “low” everywhere. In Spain and other European countries, the cost of obesity medications ranges between 130 and 150 euros. In the United States, its price is about 800 euros. “We have to assume that obesity is an important disease, with a significant public health burden,” laments this endocrinologist. “It is often understood more as a vice than as a disease in itself.”
While people who eat more are more likely to develop obesity, there are those who eat less and suffer from it. “It is a more complex disease than one might assume,” Dr. Perez added regretfully. “An obese person is not as appreciated as a cancer patient or someone else who has had a heart attack.” In his opinion, the strategy to address it should be to develop programs similar to those for tobacco or drug addiction.
Ozempic is the brand name of a type 2 diabetes drug that has been shown to be effective for weight loss and that doctors see as a solution for people suffering from obesity. “It happens very often in medicine that a drug comes out with one indication and then proves effective for another drug,” says Dr. Kudin.
The active substance of this medicine is semaglutide. As this doctor tells it, semaglutide was discovered accidentally in the venom of a lizard in a zoo in the United States. The animal's caretaker had type 2 diabetes and obesity, and insulin was injected. One day, he was bitten by a lizard, and its venom contained a molecule similar to GLP-1 (on which semaglutide is based), and since then, the caretaker has not needed to inject himself with more insulin. “It was observed that in the saliva of this animal there is a molecule similar to the human molecule and it can be given as a treatment. Thus this drug was developed to indicate diabetes. But then we had to see that these drugs were also used to treat obesity,” explains Kudin.
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