Obesity and pharmaceutical treatment

Dr. Hermann Toplak
Univ. Prof., Medical University Graz, Austria

Obesity is probably the most emerging disease of the 21st century. It’s prevalence has more than doubled since the 1980s when attention to it started to emerge. It is a gateway to ill health and plays a central role in the development of a series of other non-communicable diseases like diabetes, hyperlipidemia and hypertension – with the consequences of myocardial infaction and other atherosclerotic diseases as well as cancer and many other health issues like osteoarthritis.

In October 2016 the latest European Health Interview Survey dealing with the weight situation in Europe was released. While 46.1% of people above 18 were considered to be normal weight, 35% were overweight (pre-obese) and 15.9% were obese, only 2.3% were underweight. The share of obesity ranged from below 10% in Romania to 26% in Malta (which is the country with the highest prevalence in children also).

There is no systematic difference in obesity levels between men and women (men 16.1, women 15,7%). The proportion of obesity was higher for men in half of the Member States, and higher for women in the other half. Within a Member State however, significant gaps can be observed, with the proportion of obese men being much higher than that of women in Malta (28.1% for men compared with 23.9% for women, or +4.2 percentage points – pp) and the percentage of obese women being much higher than that of men in Lithuania (19.9% for women compared with 14.1% for men, or +5.8 pp).

In nearly all Member States, the share of obesity increases with age. The widest gaps between the proportion of young people (aged 18-24) and older persons (aged 65-74) being obese were recorded in Slovakia (33.0% for people aged 65 to 74 compared with 2.7% for those aged 18 to 24, or +30.3 pp). At EU level, a 16.4 percentage point gap is observed between young adults (5.7%) and older persons (22.1%) as regards obesity. In brief, about 1 young adult out of 10 is considered obese in Malta (12.0%) and the United Kingdom (10.8%), and about 1 in 3 older persons in Malta (33.6%), Latvia (33.2%) and Slovakia (33.0%).

In almost every EU Member State for which data are available, the share of obesity decreases with education level. In 2014, the largest difference in obesity between adults with a high educational level and those with a low educational level was observed in Slovenia (9.2% for people with a high education level compared with 26.0% for those with a low education level, or -16.8 pp). At EU level, an 8.4 percentage point gap is observed between high educated (11.5%) and low educated adults (19.9%).

Besides advances in lifestyle and behavior management as well as bariatric surgery only a single anti-obesity drug – Orlistat – was registered in Europe until 2015, when a Naltrexon-bupropion combination and the drug liraglutide were registered for obesity. They are starting to be intoduced in recent guidelines and daily clinical practice.

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