They say that obesity is a silent pandemic affecting one in eight people worldwide. But this public health problem urgently requires a shock plan, as it gives rise to other diseases: diabetes, cancer, heart attacks, cholesterol, hypertension... that not only undermine people's bodies but also the capabilities of society. Here we talk about a drop in productivity that, in the OECD as a whole, represents 3.3% of GDP and the loss of 54 million full-time workers in its 52 member states. In our country, it 'eats up' 2.5% of GDP and generates a bill of 25.7 billion euros between direct and indirect costs.
Obesity goes beyond the extra pounds that raise blood sugar levels, blood pressure, and increase cholesterol plaques in arteries, among other disorders. Being overweight creates a stigma in those who suffer from it, living with the constant burden "of always being on a diet and it not working." The problem is that the forecasts are not promising: in a few decades, by 2050, six out of ten adults will be obese and a third of children and adolescents, according to projections from The Lancet.
To tackle these figures, the world has placed its hopes on new anti-obesity drugs: GLP-1, molecules based on the imitation of the glucagon-like peptide-1, which we already have in our bodies. It is secreted in the intestine and sends signals to the brain and the rest of the digestive tract indicating that food has arrived and that no more needs to be eaten. However, "it should not be just that," laments one of the fathers of the research that has shaped the now famous family of Ozempic, Wegovy, and Mounjaro.
Daniel J. Drucker (Montreal, 1956) argues that first we must find the answers to the origin of obesity. "Is it a change in the environment? Is it due to pollution? Does it come from chemicals in the environment? Is it because of changes in the family, modifications in cities, or alterations in the food supply? Is it due to increased use of processed foods or chemicals in them? Is there a different dynamic in how we interact with what we eat?".
Along with the endocrinologist, social psychologist Icek Ajzen (Chelm, Poland, 1942) raises more doubts about the problem and the health condition. "We don't really understand why we have this type of overweight epidemic and how to tackle it. We can try behavioral methods along with weight loss medications. But what caused it? Was there a change responsible for it?". This human behavior researcher from the University of Massachusetts Amherst points to the need to understand what drives people in their battle against the scale. "We must study how to combine behavioral theories with the use of medications in the future so that people lean towards healthier habits."
Drucker and Ajzen discussed obesity and its social impact a week ago in Bilbao. Both attended to receive the recognition of their contributions in the XVII edition of the Fronteras del Conocimiento Awards granted by the BBVA Foundation. The endocrinologist from Mount Sinai Hospital in Toronto received, along with his colleagues Svetlana Mojsov, Joel Habener, and Jens Juul Holst, the distinction awarded for achieving fundamental biological discoveries to create a new therapeutic arsenal against diabetes and obesity. Ajzen did the same alongside those distinguished in the category of Social Sciences for their theoretical and practical contributions to predicting and understanding human behavior: Dolores Albarracín, Mahzarin Banaji, Anthony Greenwald, and Richard Petty, whose applications range from designing vaccination campaigns to combating conspiracy theories.
In fact, four decades ago, both coincided, unknowingly, in research against obesity. While Drucker found in cell lines how the glucagon analog behaved in the laboratory, Ajzen launched a study on weight loss using the theory of planned behavior that the psychologist had developed years earlier.
Joking about the passage of time, both are clear that the situation has changed drastically since the beginning of the new century. "Until now, many people wanted to lose weight, they went on a diet planning their food intake and increasing their level of physical exercise. Not everyone succeeded," recalls Ajzen. In fact, in his study, only six out of ten achieved it. "And once the challenge was overcome, it had to be seen if they continued with these new healthy habits in the long term and why." Follow-up is crucial, he insists, knowing the variables that modify these behaviors must be studied and evaluated, "especially when it affects necessary medical treatments, even without knowing if they will be lifelong or not."
Now, for those for whom losing weight was difficult, they have found in the new drugs a definitive boost, or not. "We still need to know how time influences the maintenance of results. What we know so far is that many abandon the medication within a year. Do they maintain good eating and exercise habits? We don't know," says Drucker. At the same time, he recalls that just five years ago, "we only had a single option for the most severe cases: bariatric surgery."
"The challenge lies in that obese people are alone. They make their decisions in a personal context and we do not have enough access to them"
"We need much more research, work on the reasons for abandonment and motivations... We must find out in order to design better adherence plans and increase the positivity of the results," adds Ajzen. From his perspective, thanks to other work he has done in the healthcare field, "the implementation of planning always helps to improve therapeutic adherence." Because, as the psychologist reasons, "if one agrees with their doctor on when and how to take the medication, why it should be done in one way and not another, it has a greater impact."