Tratamiento farmacológico de la obesidad para médicos de Atención Primaria / Pharmacological treatment of obesity for Primary Care physicians

La obesidad es una enfermedad de alta prevalencia en las consultas de Atención Primaria. Se asocia a comorbilidades mayores (dislipidemia, diabetes, hipertensión) que aumentan la morbimortalidad, el gasto sanitario y disminuye la calidad de vida de los pacientes. Los cambios en el estilo de vida siguen siendo los pilares del tratamiento del exceso de peso. Debemos plantearnos tratamiento farmacológico cuando hay dificultades para alcanzar objetivos de pérdida de peso. En este artículo revisamos los fármacos autorizados actualmente para el tratamiento de la obesidad y del sobrepeso con comorbilidades mayores

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities

[Pharmacological treatment of obesity for Primary Care physicians]. / Tratamiento farmacológico de la obesidad para médicos de Atención Primaria.

Obesity is a disease of high prevalence in Primary Care clinics. It is associated with major comorbidities (dyslipidaemia, diabetes, hypertension) that increase morbidity and mortality, health expenditure, and reduces the quality of life of patients. Changes in lifestyle are still the pillars of the treatment of excess weight. Pharmacological treatment should be considered when there are difficulties in achieving weight loss goals. In this article, a review is presented on the currently authorised drugs for the treatment of obesity and overweight with major comorbidities.

Opinión y motivación del médico de Atención Primaria sobre la obesidad y el sobrepeso / No disponible

INTRODUCCIÓN. El objetivo del estudio fue conocer la opinión del médico de Atención Primaria (AP) ante la obesidad y su motivación para atender a estos pacientes. MATERIAL Y MÉTODOS. Estudio descriptivo transversal.Mil doscientos médicos españoles de AP, muestreo aleatorio estratificado por comunidades autónomas. Encuesta de63 ítems autocumplimentable, datos sociodemográficos, salud del encuestado, opinión sobre la obesidad, motivación para atender a estos pacientes y tratamiento. RESULTADOS. Se repartieron 897 encuestas, respondieron519 (57,9%). Entre estos, el 63,5% eran hombres, grupo de edad entre 45-54 años (61,0%). Un 18,5% fumaban, un91,7% consumió alcohol y un 45,5% practicaban ejercicio. El35,5% tenía sobrepeso y el 4,9%, obesidad. De estos, el15,4% nunca realizó dieta. El 91,9% tenía una percepción buena, muy buena o excelente de su propia salud. El 90,7% (IC 95%; 88,2-93,2) considera la obesidad una enfermedad y el 71,9% causa de muerte prevenible (64,4%zona norte de España p < 0,05). El 58,7% diagnosticó hipertensión o diabetes antes que obesidad. Un 88,3% observó un incremento de la tasa de obesidad entre sus pacientes. El54,1% (IC 95%; 49,8-58,4) consideraban tener habilidad para motivar al paciente. El 50,1% (IC 95%; 45,8-54,4) prefería trabajar con pacientes con normo peso. Un 61,9% veía al obeso como gran comedor, inactivo y que no hacía caso al consejo médico, el 81,3% creían que el obeso se resiste a cambios del estilo de vida a largo plazo. Un 31,8% cree que los profesionales presentan actitudes negativas hacia estos pacientes (20% en la zona sur-este, p < 0,05). Un 52,3% había leído el último año 1-5 artículos sobre obesidad, 34,7% más de seis (44,2% en la zona centro, p < 0,05)...(AU)

INTRODUCTION. The main objective of this study was to know the opinion of primary care physicians (AP) toward obesity and their motivation to attend to these patients. MATERIAL AND METHODS. This was a cross-sectional study that included 1200 Spanish primary care physicians, obtained by stratified random sampling by the Autonomous Communities. Data were obtained regarding a 63 self-administered item survey, socio demographic aspects, health survey, opinion on obesity, motivation to care for these patients and treatment. RESULTS. A total of 897 surveys were distributed, obtaining519 responses (57.9%). Among these, 63.5% were men, with an age group 45-54 years (61.0%), 18.5% smoked,91.7% consumed alcohol, 45.5% practiced exercise, 35.5%were overweight and 4.9% obese. A total of 15.4% had never gone on a diet and 91.9% had a good, very good or excellent perception of their own health. It was found that 90.7% (95% CI; 88.2-93.2) consider obesity as a disease and 71.9% consider that it is a preventable case if death (64.4% north zone of Spain p < 0.05). Hypertension or diabetes, had been diagnosed in 58.7% rather than obesity and 88.3% observed an increase in the rate of obesity among their patients. A total of 54.1% (95% CI; 49.8-58.4) believed that they have ability to motivate the patient, but 50.1% (95% CI; 45.8-54.4) would rather work with normal weight patients. The obese patients are considered to be overeaters, inactive and those who do not follow medical advice by 61.9% and 81.3% believe that obese patients are resistant to long-term lifestyle change. A total of 31.8% believe that the professionals have negative attitudes towards these patients (20% south-east, p < 0.05); 52.3% have read 5articles on obesity, 34.7% more than six (44.2% in the center zone, p < 0.05) in the last year...(AU)

Riesgo coronario en una población hipercolesterolémica mediterránea: ¿sobreestimamos o infraestimamos el riesgo? / Coronary risk in a Mediterranean hypercholesterolemic population: do we over estimate or under estimate the risk?

OBJETIVOS. Determinar la concordancia en el cálculo de riesgo coronario (RC) entre la tabla de Framingham y la tabla REGICOR y las implicaciones terapéuticas al aplicar la guía de hipercolesterolemia del Institut Català de la Salut con el dintel de RC alto del 20% de Framingham (G-ICS-F), con el 20% de REGICOR (G-ICS-R20%) y con el 10% de REGICOR (G-ICS-R10%). MÉTODO. Estudio descriptivo transversal en un Área Básica Urbana. Participan 413 pacientes hipercolesterolémicos sin cardiopatía isquémica. Se analizaron edad, sexo, antecedentes familiares de cardiopatía isquémica, tabaquismo, hipertensión arterial (HTA), presión arterial sistólica (PAS) y perfil lipídico completo previo al tratamiento. Se calculó el RC usando las tablas de Framingham y de REGICOR y se analizaron las indicaciones terapéuticas. RESULTADOS. La concordancia entre el RC calculado con Framingham y REGICOR es muy débil (kappa = 0,066). Aplicando la G-ICS-F tratamos farmacológicamente al 22,8%, con la G-ICSR20% al 10,4% y con la G-ICS-R10% al 20,8%. La concordancia de la intervención terapéutica entre G-ICS-F y G-ICS-R20% es moderada (kappa = 0,535), siendo buena entre G-ICS-F y G-ICS-R10% (kappa = 0,688). Presentan discordancia dos grupos: el 4,3% sin tratamiento según G-ICS-F y con tratamiento G-ICS-R10% y el 6,3% con tratamiento según G-ICS-F y sin tratamiento G-ICS-R10%. CONCLUSIONES. El cálculo del RC con REGICOR puede infraestimar el riesgo de nuestra población y con Framingham sobreestimarlo. Nos parece un opción razonable aceptar como alto el RC > 10% con REGICOR en nuestra guía terapéutica para estimar el riesgo de forma correcta, reduciendo ligeramente el número de tratamientos a aplicar, con el consiguiente impacto fármaco-económico

OBJECTIVES. To determine concordance in the coronary risk (CR) score between Framingham and REGICOR charts and the therapeutic consequences in following the hyperlipidemia guideline of Institut Català de la Salut for high-level coronary risk with 20% Framingham function (G-ICS-F), 20% REGICOR function (G-ICS-R 20%) or 10% REGICOR function (G-ICS-R-10%). METHOD. Descriptive cross-sectional study in a Primary Health Care Center. Four hundred and thirteen patients with hypercholesterolemia and no history of ischemic heart disease were enrolled. Age, gender, family history of coronary disease, smoking habits, hypertension, systolic blood pressure and complete lipid profile before treatment were studied. Coronary risk was estimated by means of Framingham and REGICOR functions. Theoretical indications of lipid-lowering treatment were analyzed. RESULTS. There is strong disagreement between coronary risk calculated with Framingham and REGICOR charts (kappa coefficient 0.066). Lipid-lowering treatment is indicated in 22.8% patients with G-ICS-F-10,4% with G-ICS-R-20% and 20.8% with G-ICSR-10%. The agreement of recommended treatment between G-ICS-F and G-ICS-R-20% is moderate (kappa 0.535), while between G-ICS-F and G-ICS-R-10% is good (kappa 0.688). There is no agreement in two groups: 4.3% without treatment by G-ICS-F and treated by G-ICS-R-10% and the 6.3% treated by G-ICS-F and without treatment by G-ICS-R-10% CONCLUSIONS. The estimation of coronary risk may be either overestimates (Framingham) or underestimates (REGICOR) in our patients. We conclude that a reasonable option may be to accept G-ICS-R-10% in our therapy guideline to properly estimate the coronary risk. Furthermore, it will reduce the number of patients under treatment with the consequent drug-financial impact