Excess weight, a women's problem

New weight loss drugs are revolutionizing the lives of thousands of people. In particular, helping those who live with obesity or are overweight to combat the most serious complications of these problems. A real revolution, according to the specialists who met in recent days in Albano Laziale for the “3rd Ame Obesity Update: treatment of obesity and its complications”, promoted by Ame (Association of Endocrinologists), at the auditorium of the Regina Apostolorum Hospital – Lifenet Healthcare Group.

Obesity on the Rise, But the Stigma Is All Female

Here is an overview of the problem that endocrinologists are facing. Obesity is a disorder that has been rapidly expanding in recent decades. It has increased by 38% between 2003 and 2023, according to the latest Istat data, involving approximately 6 million Italians, especially young adults (+1.6 million), with percentages going from 2.6% to 6.6% in the 18-34 age group, especially to the detriment of women, with an incidence that has tripled (it is estimated that 10% of the female population is obese) - compared to numbers that have “only” doubled in men. Things are no better in the 35-44 age range, where growth has been observed from 6.4% to 9.8%, and among the over 74s with rates that have increased from 11% in 2003 to 13.8% in 2023. Today, new drugs allow us to better manage and control obesity.

"The new drugs - explains Andrea Frasoldati , President of Ame - represent an innovative therapeutic tool capable of modifying the natural history of the disease, in synergy with a wide range of other treatment options such as dietary and psychotherapeutic counseling, bariatric surgery when indicated. Women traditionally bear the greatest "burden" of obesity, paying a higher price than men in terms of social stigma and guilt, due to cultural barriers and dominant aesthetic models, sometimes with sexist implications, which have led to the idealization of a female beauty tending towards thinness. Unlike men, in whom a few extra pounds are mistakenly interpreted as a sign of well-being. The implications on fertility and pregnancy in obese women exposed to significant risks for themselves and their unborn child should not be overlooked".

Fertility problems

Difficulty conceiving, problems carrying a pregnancy to term, miscarriage, preterm birth, placental abruption, gestational diabetes, fetal disorders (babies that are larger or smaller than their gestational age), neonatal hypoglycemia. These are just some of the problems that can arise in an obese woman trying to conceive.

"The new pharmacological treatments, specifically the GLP1 receptor analogues, can also be aimed at reducing weight 'in view' of a possible pregnancy - continues Silvia Irina Briganti , member of the Ame obesity commission -. However, in this regard, there are few studies due to the difficulty in carrying out randomised clinical trials in this specific population group and due to the recent introduction in Italy, therefore the limited evidence, especially in terms of safety, pushes for a cautious use. The administration of GLP1 and dual agonist requires, for example, the "obligation" to suspend semaglutide and tirzepatide in the two months preceding conception or in the case of liraglutide, now being discontinued, for a couple of weeks. In this regard, women must be correctly informed to avoid incurring risks especially of fetal malformations, as well as of the need to follow a well-defined, multidisciplinary therapeutic path that involves multiple professional figures, first and foremost the endocrinologist and the gynecologist, throughout the entire life cycle. pregnancy. Therefore, women must be an active part of a careful program, not only therapeutic, but also counseling and educational”.

An “emotional” hunger

Gaining weight is almost always not just a matter of bad habits. In fact, the impact that emotional disorders have on the development of obesity and overweight is often overlooked: the possible implication with a compulsive disorder, an emotional hunger, which pushes the person to seek food as a compensatory-consolatory act or as an anti-stress valve and an anxiety sedative.

"If the emotional aspect is not known or is not recognized - specifies Simonetta Marucci , coordinator of the Slow Medicine Reports Commission of Ame - there is a risk of failing in the approach to the patient, even in the case in which the drug is used, which is a support to the lifestyle not a substitute. Emotional hunger characterizes 1 in 3 obese people (35%) with compulsive eating disorder, to which is added a gray band with subthreshold manifestations, which can prelude the manifestation of a full-blown pathology. Recent studies seem to demonstrate the efficacy of GLP1 agonists also in the treatment of forms of obesity in which the compulsive aspect prevails, for example in Binge Eating Disorder (BED), thanks to the mechanism of action at a central level that impacts the centers that regulate hunger, satiety, pleasure and hedonic eating linked more to gratification than to nutrition. Today the objective of clinical research is to confirm the efficacy of GLP1 drugs even in the long term and therapeutic adherence given that abandonment of the therapy, as is known, leads to a rebound effect of weight. Currently these therapies are linked to at least two critical issues: the prescribability, allowed only to diabetic patients, the high cost, not sustainable for all patients and in any case not in continuity, making the drug in fact 'selective'.

The weight of stigma

Cultural, social, ethical, religious and sexual prejudices have decreased almost everywhere in recent years. But not those directed towards obesity, which are believed to be increasing worldwide, similarly to the numbers of the pathology, with a greater discrimination, as mentioned, for women.

"We witness externalized prejudices and stigmatization towards patients with obesity - says Anna Nelva , Coordinator of the Lipidology and Metabolism Commission of Ame - which have repercussions for example on the world of work leading to the estimation that the person with the pathology lacks discipline and organization, with penalizing effects in terms of hiring but also career advancement or prejudices in the social, family, school contexts with acts of bullying up to repercussions in healthcare contexts in which a patient with obesity could receive less frequent follow-ups than people of normal weight. On the other hand, the internalization of prejudices leads the person with obesity to accept negative stereotypes that undermine their self-esteem and trigger states of anxiety and depression, which in turn cause alterations in nutrition that worsen the obesity itself, as well as greater difficulty in accessing appropriate care. Society, health personnel, educators, scientific societies, institutions must join forces to combat prejudices and stigma that lead to the belief that obesity is a consequence of individual choices and behaviors determined by free will, not by a pathological condition such as obesity".

A change of pace

It is therefore time – Ame specialists underline – for a change of pace. In society. Among communication professionals and health professionals. But also and above all, at an institutional level.

"We need a change of institutional vision for the care of the obese patient, highly complex - concludes Marco Chianelli , Coordinator of the Ame Obesity Commission and scientific director of the Congress -. At the government level, greater participation must be placed through the inclusion of obesity in diagnostic therapeutic pathways and with processes that can involve important environments such as school, where the culture of proper nutrition and physical activity must be promoted from childhood or in the workplace. At the level of the national health system, not only public but also private, the major role is played on the management of over six million obese patients, a real pandemic, carefully investigating the different components that contribute to overweight and obesity: genetic, environmental, psycho-emotional. Only a systemic and collaborative approach, with the active participation of all the actors involved in the management of obesity and overweight will allow us to face the global challenge against this "pandemic".