From obesity to comorbidities: a comprehensive care approach for improved health by the Spanish Society of Internal Medicine

Abstract

Obesity is currently recognized as a chronic, progressive, and relapsing disease, and constitutes a major global public health challenge. This document, promoted by the Spanish Society of Internal Medicine through its Working Group on Diabetes, Obesity, and Nutrition, outlines a comprehensive, multidisciplinary approach to care, with a specific focus on obesity-related comorbidities. Excess adipose tissue is conceptualized as a systemic pathogenic agent that actively contributes to the pathophysiology of numerous complications, including cardiovascular disease, heart failure, chronic kidney disease, osteoarthritis, obstructive sleep apnea, and metabolic dysfunction-associated steatotic liver disease (MASLD). Furthermore, the document reviews the current evidence base regarding pharmacological interventions for obesity, addressing both their overall efficacy in weight management and their specific therapeutic impact in the context of the distinct obesity-associated comorbidities for which clinical benefit has been demonstrated.

The document endorses the implementation of the Edmonton Obesity Staging System (EOSS) as a pivotal framework for the clinical stratification of risk in individuals with obesity, facilitating a more nuanced and personalized therapeutic approach that prioritizes the functional, metabolic, and prognostic dimensions of the disease. In this context, the document proposes a paradigm shift in the therapeutic objectives for obesity management, moving beyond a sole reliance on anthropometric metrics, such as body mass index (BMI) or absolute weight reduction. Instead, it emphasizes a pathophysiological and patient-centered approach focused on the prevention of obesity-related complications, the early detection and management of its comorbid conditions, and the sustained improvement of both quality-adjusted and overall life expectancy, while simultaneously promoting the elimination of stigma and discrimination.