Line #2 Recalibrate medical training
Lack of training for health professionals
One third of general practitioners in Europe do not feel confident enough to tackle the complexities of obesity, according to the European Association for the Study of Obesity. This lack of preparation is mainly due to the lack of specialist training in obesity (43% of doctors has received fewer than four hours of training on the subject).
The scenario is much the same in Portugal. Lack of training for health professionals (especially in primary and secondary care settings) represents a barrier to diagnosis, treatment, monitoring, and referral to specialist appointments.
Mobilize resources for specialist training
We advocate that strategies and initiatives for training health professionals should be outlined so that such professionals can indeed be a first line of response in the diagnosis, monitoring, awareness, and treatment of people with obesity.
Specialist training for health care professionals is also a priority in order to:
The specialised training of professionals is also a priority for:
- eliminate doctor–patient discrimination and individual stigma on the person living with overweight or obesity;
- encourage a cross-sectional, multidisciplinary approach to obesity;
- facilitate early diagnosis and intervention;
- increase the success rate of behavioural interventions.
Line #3 Recalibrate the role of primary health care
Lack of access to appointments for obesit
There is an imbalance between the prevalence of the disease in Portugal and the capacity of primary health care units (Health Centres and Family Health Services) to offer specialized obesity services. Gaps in the availability of appointments for obesity within primary care are a barrier to early diagnosis and treatment of the disease.
Without specialized obesity care in public health units, economic inequalities in access to appointments and treatment stand out, waiting times increase, and the opportunity to create outreach strategies to tackle the disease is lost.
Create a program of appointments for obesity within primary health care services
We recommend that specialty consultations for obesity are implemented within primary health care, as is the case with consultations for diabetes and hypertension, for example. This is the only way to create a proximity network across the country that can act on the different causes and dimensions of the disease and on early treatment.
Increasing capacity within primary health care is essential for improved prevention, initial diagnosis, and follow-up of the disease. This increased capacity must include dietitians and psychologists, both crucial in supporting patients who are not eligible for surgery, within primary health care. This is especially important considering that the best results in promoting healthy lifestyles — a key strategy in preventing overweight and obesity — are achieved within primary care.
Having ensured proper training regarding obesity for health care professionals (Line #2), we also propose the development of specific indicators and objectives linked to preventing and treating obesity in primary health care.
Line #4 Recalibrate the treatment of obesity
Inequalities in access to obesity treatment
Drugs for treating obesity are available on the Portuguese market but are not reimbursed by the State. This fosters economic inequality when deprived populations (who show greater disease prevalence) attempt to access treatment and a treatment gap between behavioural therapy and surgery, which is reimbursed but not suited to all patients. At present, patients must pay for these drugs in full and the cost is between €80 and €257.
There is also an economic barrier to access the vitamin supplements recommended after bariatric surgery; these, too, are not reimbursed.
Reimbursement of obesity medicines
Dignified treatment of obesity can only be achieved if all citizens have fair access to the various therapeutic approaches available, which can be tailored to suit each patient. To do so, evidence-backed medicines for the treatment of obesity must be reimbursed by the State, thus closing the economic gap between the various treatment alternatives.
We further recommend State reimbursement of the vitamin supplements recommended in bariatric surgery (the post-surgical phase).
Line #5 Recalibrate public perception
There is still stigma, discrimination, and prejudice against people living with obesity
There is widely held stereotyped belief that obesity is an individual choice (i.e., “you are obese because you want to “) based on bad eating habits and being “too lazy” to change. This perception is a barrier to effective treatment of the disease and lies at the heart of discrimination experienced by patients with obesity. The Portuguese Association Against Childhood Obesity estimated in 2020 that 65% of children with obesity are bullied at school. International statistics show that 88% of citizens suffer discrimination or criticism due to overweight (Obesity Society, 2012). In adults, overweight increases the chances of discrimination at work. In addition, obesity is linked to lower levels of happiness (“Women in Portugal today” study, Francisco Manuel dos Santos Foundation [FFMS], 2019).
Stigma can come from doctors themselves as a result of lack of specific training in obesity. According to data shared by OPEN, 74% of health care professionals believe that individual patients should manage their own weight (without ongoing follow-up by a specialist) and 55% of doctors state that stigma prevents patients with obesity from being given a diagnosis. Discrimination contributes to low self-esteem and can affect the success of treatments (Weight bias and obesity stigma: considerations for the WHO European Region report, WHO).
Create mechanisms to eliminate stigma and discrimination related to obesity
Discrimination against those who are overweight or living with obesity is one of the main barriers to tackling the disease effectively. We must reflect and implement different mechanisms for informing and raising awareness in various stakeholders: health care professionals, decision makers, politicians, companies, and the general public.
In the specific case of existing barriers to taking out insurance policies, we recommend a change to the Portuguese Insurance Contract Legal Framework to include people living with obesity. We also propose that publicly owned banks can guarantee loans without life insurance or the need to take out credit insurance as ways to unlock access to home loans.
We also urge that other effective strategies are found to fight discrimination and prejudice in their various forms. We recommend that the work to define priority actions is carried on in its own forum, with the input of political decision makers, health care professionals, and specialist associations.