The specialist recognizes that obesity has a “very complex equation” and that “there are many factors interacting, whether environmental, biological, psychological and even genetic heritage”, but there are steps that must be taken early so that the disease does not take hold. And, as he says, “in the ideal world, the gateway to referral and treatment would be for the patient to seek out their family doctor in primary health care, which should already be organized with multidisciplinary consultations (with a doctor, psychologist, physiologist and nutritionist) and are not”.
“Cases that were identified from the outset as more complex should be referred to multidisciplinary consultations in hospitals for follow-up”, he says, adding: “I would even say that these consultations, more than multidisciplinary, should be transdisciplinary, because in multidisciplinary consultations, sometimes, each specialist is talking about their area and no one is looking at the patient as a whole, and this should be our focus”.
Paula Freitas knows that, “on paper, all this is thought out”, even remembering that in the Health Emergency and Transformation Plan (PETS) “a program to combat and control obesity in primary care is foreseen”. “On paper is also the so-called Integrated Care Process for Pre-Obesity in Adults. Now, we need to put all this on the ground and open the doors so that people who have the disease can have access to care, so that they improve their physical and emotional well-being, and, obviously, their health, so that they live longer and make a greater contribution to society.”
Carlos Oliveira, former patient and president of Adexo, reinforces the idea of more care and more inclusion, saying that the majority of situations received by the association are requests for help with referral. “People don’t know what to do, who they should look for and the path to follow.”
But when they call the association it is a first step. “Don’t be afraid to ask for help. Control your disease as quickly as possible, because the disease has several stages and when you reach some of them it becomes very complicated.” Carlos Oliveira gives an example: “Imagine when a person weighs 250 or 350 kilos and undergoes surgery. We have a chair that carries up to 350 kilos, but it is used in long-term care hospitals”, remembering that “the legislation states that hospitals that carry out surgical treatment for obesity must have equipment, but then, if the person loses mobility after surgery and this unit sends them to a long-term care hospital, they have nothing to transport or treat these people”.
As he says, and in criticism of the lack of support for patients with obesity, “these patients need physiotherapy and other care and, in the country, there are only two chairs of this magnitude”.
ADEXO has been providing whatever support it can to patients, but, as Carlos Oliveira highlights, “health entities need to do more”, because everyone needs to understand that “obesity is a treatable disease, but it is not curable and the patient must be monitored for the rest of their life”. For this reason, one of the objectives of the campaign now launched, “How much does fear weigh?”, is to mobilize the country for an urgent debate on public health.
Medicines without reimbursement
Obesity is a chronic disease, but until now these patients have not been able to have the medication they have to take when starting treatment covered by the State. For the president of the Portuguese Society of Endocrinology, Diabetes and Metabolism, Paula Freitas, “it is a major limitation in accessibility to treatment, which all patients should have access to”.
The president of the Association that represents patients also criticizes the situation, but says that “the contribution is now being negotiated between the association and the Secretary of State for Health, Ana Povo”.
Carlos Oliveira explains that the situation has caused great discrimination among obese patients, because “those who are indicated for surgery have all the treatment paid for and those who are not indicated have no support at all, but the disease is the same. This is unbelievable.” Therefore, he hopes that this time “it will be possible to resolve the situation”.