Depression and obesity are globally prevalent diseases that place substantial burdens on personal well-being and public health. According to World Health Organization criteria, overweight and obesity are defined as having a body mass index (BMI) of ≥25 kg/m2 and ≥30 kg/m2, respectively. Depression has a 20% lifetime prevalence, and symptoms can vary widely, impacting psychological, physical and social aspects of everyday life. Given the global prevalence of obesity and depression it is not surprising that the two can co-occur, but the relationship appears to be more complex. A growing body of literature describes the bidirectional relationship between the two, where the presence of obesity may increase the risk for developing depression, and vice versa.
The World Health Organization declared severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) a pandemic in March 2020. Since then, there have been numerous waves of COVID-19 infection and evolving viral strains. There is accumulating evidence of worse prognoses for people with COVID-19 and existing comorbidities, and a link between acute COVID-19 and new onset cardiovascular disease (CVD) and diabetes mellitus (DM) has been identified. However, it is currently not clear whether COVID-19 has longer-term effects on cardiometabolic risk.
People living with obesity face stigmatization and weight discrimination daily, resulting in poor life choices, maladaptive coping strategies, social anxiety and psychological distress. Alarmingly, evidence suggests that weight stigma might even be associated with reduced life-expectancy. Healthcare settings are supposed to offer a ‘safe space’ where people can speak openly about their health without fear of being judged, yet weight bias and discrimination are highly prevalent among healthcare professionals (HCPs). These biases, although often unconscious, can promote healthcare avoidance among people with overweight and obesity, resulting in poor health outcomes.
I have defined myself as a doctor of bodies and souls. It is not easy to assume this role, due to the responsibility that this implies, since it considers evaluating the human being in an integral and integrated way, not only biologically, but also psychosocially and spiritually. In addition, I work in an institution whose promise of value is C.A.R.I.S.M.A, which implies offering warm (cálida), friendly (amable), responsible (responsable), informed (informada), safe (segura), enhanced and academic care (mejorada y académica), that is, patient-centred, humane and safe care.
From lifestyle and behavioural interventions to pharmacotherapy and bariatric surgery, there is significant variation in response to treatment among people living with obesity. Anti-obesity pharmacotherapies are becoming increasingly efficacious and are associated with good safety and tolerability. However, it is not yet possible to predict who will respond to which agent, presenting a challenge for treating physicians.
Lifestyle and behavioural changes are the foundation of all weight management approaches, but weight loss achieved via these means is often not sustainable over the long term. Numerous nutritional interventions exist, and no single approach is universally recommended for treatment of obesity. Importantly, any dietary approach should be safe, healthy, nutritionally adequate and sustainable over the long-term.
The global prevalence of diabetes is rising and is estimated to reach 8% of the global population by 2030. Approximately 90% of this is estimated to be type 2 diabetes. Most people living with type 2 diabetes have coexisting overweight or obesity, and this is a significant contributor to the worsening diabetes epidemic, yet weight reduction is often not prioritized in treatment plans. Type 2 diabetes and obesity are associated with increased risk for numerous health complications, including cardiovascular disease (CVD), and early mortality. The aim of chronic disease management is to reduce disease burden, improve health and help to ensure a good quality of life for individuals, so why aren’t we doing more?
The year 2022 marks 100 years since the first patient, Leonard Thompson, was treated with insulin for his diabetes. Once a death sentence, diabetes became a treatable disease, and the many developments in insulin over the last century have resulted in dramatic improvements in patient outcomes and quality-of-life.
A key challenge facing healthcare professionals (HCPs) when managing people living with diabetes is reducing risk for cardiovascular (CV) events, which can be a significant concern for patients and cause substantial pressure on healthcare services. However, it’s not always how patients should be managed, which risk factors should be prioritized and why glycaemic control is so important.