On the occasion of the World Day which is celebrated on March 4, the Association of Endocrinologists presents the first Guideline on the treatment of overweight and obesity resistant to behavioral treatment in the adult population with metabolic comorbidities. If applied, through the control and prevention of obesity-related complications, they could generate savings of approximately 16 billion euros over 5 years for the entire NHS
27 FEB –
Doctor you go, therapy you find. It is something that unfortunately often happens to people with obesity even when complicated by metabolic pathologies such as diabetes, hepatic steatosis, dyslipidemia and arterial hypertension.
A research conducted byEndocrinologists Association (Ame), just published in the magazine Frontiers in Endocrinology, found that only 2 out of 5 specialists prescribe to their patients with obesity, even of a high degree, drugs approved for this pathology in association with diets and lifestyles. In particular, metformin, a drug not approved in Italy for the treatment of obesity, is used on average in 30% of patients, drugs approved for the treatment of obesity to a lesser extent, liraglutide only in 10% of cases and again more rarely orlistat and naltrexone buproprion.
“The trend towards underprescribing medicines – he explains Renato Cozzi president of Ame – demonstrates that the axiom ‘the obese patient is obese because he eats’ is still widespread, even among specialist doctors. In reality, obesity is not a lack of willpower or just bad habits, it is a real chronic disease that must be treated by evaluating all therapeutic options, including drugs and surgery”.
To achieve the goal of greater therapeutic appropriateness, the first Guideline “Therapy of overweight and obesity resistant to behavioral treatment in the adult population with metabolic comorbidities” was published. Approved by the Istituto Superiore di Sanità, this Guideline was drawn up by AME, in collaboration with Adi (Italian Association of Dietetics and Clinical Nutrition), Sio (Italian Obesity Society), Sicob (Italian Society of Surgery of Obesity and Metabolic Diseasese) e Say (Italian Society of Gastroenterology and Digestive Endoscopy).
“Using a rigorous methodology capable of guaranteeing the most objective systematic review of the scientific literature, the Guideline represents a new point of reference for all doctors who deal with obesity – he explains Marco Chianelli, coordinator of the Obesity and Metabolism Commission of Ame – the document, 373 pages long, is focused on pharmacological and surgical therapy in overweight and obese patients suffering from metabolic comorbidities. Physicians now have evidence-based guidance at their disposal, which gives precise indications on lifestyle changes, medications, surgery, to prescribe to patients based on age, sex, socioeconomic situation, body mass index and comorbidities present “.
The new Guideline puts an end to misconceptions. “It clears medical and surgical therapy – underlines Chianelli – and highlights that prescribing the right therapy to patients is not only possible, but also a duty”. Correctly treating obesity reduces the risk of developing the metabolic complications associated with it.
“The publication of this Guideline confirms the existence of a chronic and disabling disease, obesity, for which there are effective and safe pharmacological and surgical therapies – he says Olga Eugenia Disoteo, national coordinator of the Ame Diabetes Commission – . This pathology is often underdiagnosed, stigmatized, sometimes treated with generic indications and diets that are not always effective, the availability of a guideline, in addition to giving dignity to a pathology still neglected today, provides a clear prioritization of therapeutic interventions aimed at the individual patient and his needs clinics. The new document has medico-legal value and helps the doctor in therapeutic decisions to guarantee patients”.
According to the estimates contained in the new document, if all the recommendations contained in the Guideline were followed faithfully, savings of 16 billion euros could be generated in 5 years for the NHS, linked to the preventable complications of obesity.
Finally, the new Guideline also provides indications on new drugs for the treatment of obesity, such as semaglutide which has been shown to be able to reduce body weight by an average of 15%. “Semaglutide is already approved by AIFA – underlines Chianelli – and will soon be available for a fee in Italy. At the moment, however, no reimbursement by the NHS is foreseen for obesity drugs”.
An important sign of the ongoing cultural change comes from a private supplementary health fund which from this year reimburses up to a maximum of 1,000 euros a year for the cost of liraglutide and naltrexone bupropion in severe obesity. Furthermore, there is an application filed in March 2022 by Sio in which institutions are asked to recognize the reimbursement of obesity drugs for patients with severe or complicated obesity. In this context, therefore, the Guideline is a further impetus for the institutional recognition of the obesity pathology and, it is hoped, for the reimbursement by the NHS of drugs for the treatment of obesity.
February 27, 2023
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