Our country is the first in the world to identify obesity as a “progressive and relapsing” disease. A step forward to help the over 6 million severely overweight Italians. The objective is to increase treatment, prevention, legal recognition and welfare coverage.
The stigma weighs more than the kilos themselves. It hurts at school, at work, in social life. You’re fat, you don’t have willpower, it would be enough to eat less: phrases pronounced as a brand of guilt. Meanwhile, one Italian in two lives with weight problems and over six million are obese.
Italy, however, is a pioneer this time and is trying to change history, even if in small steps. Last October 2, with the approval of Pella lawour country has become the first in the world to officially recognize obesity as chronic, progressive and relapsing disease: other nations already define it as a medical problem, but not with a unitary and national law that includes all parties, embracing prevention, treatment, awareness, legal recognition and welfare coverage.
A law of civilization
A rule strongly supported by the government, because for too long society has looked at the body as a measure of will or value, ignoring the complexity of a pathology that has dramatic effects.
«Obesity is the pandemic of the 21st century» writes Michele Carruba, honorary president of the Obesity Study and Research Center of the University of Milan, and author of the book Obesity, instructions to rebel (Guerini publisher). «It spreads silently with devastating effects. Overweight is often the basis of chronic non-communicable diseases – including cancer and diabetesamong the leading causes of death in the world. It generates very high economic costs and produces stigma and social discrimination.”
The economic weight of fat
It is therefore time to consider fat as a global enemyto be fought by all means. Also because in a healthcare system in crisis we need to be pragmatic: think about the future, where there will have to be less and less space for obesity for the simple reason that it costs too much.
Precisely for this reason the new law also addresses the issue of money: but it is little.
«We must look at the issue with De Gasperian spirit» states the MP from Forza Italia Roberto Pellawhich gives its name to the law. «Invest today to achieve long-term savings and benefits. It’s not easy: the economic impact of obesity is enormous, with figures higher than those of Covid. And the path to its inclusion in the LEAs (Essential Levels of Assistance) is tortuous, intertwined with different regulations and multiple actors, from healthcare to regional policies, from businesses to welfare measures”.
Sore points: the new law provides one allocation of up to 1.7 million euros per yearbut the money is not enough. New molecules against obesity – semaglutide And tirzepatide – they are very expensive. When the blanket is short, questions of priorities and sustainability which will not be resolved any time soon.
Anti-fat drugs and prejudices
Provocatively: let’s think about those who suffer from other diseases, do not receive adequate reimbursements or struggle to access innovative treatments. How will you react when faced with the fact that obese people – for whom the prejudice of “it would be enough to eat less” – could be provided super anti-fat drugs for free?
«For this too there was an absolute need for a law of civility» underlines Pella. «We need a change of mentality about the disease. Obese people have the right to be treated just like those suffering from other pathologies. It is a transformation that requires coordination: the initial costs are high, so the path will have to be modulated and gradual.”
A model of the possible path forward had already been imagined. The president of Aifa, Roberto Nisticohad stated months ago that, in the event of approval of the law, it would be evaluated reimbursement of new medicines following the “English model”: free administration to severely obese people already affected by an adverse cardiovascular event.
The English model and the Italian way
A “real life” clinical trial on thousands of patients, to understand not only the clinical but also the social impact. But would the English model be replicable here?
«It could be valid: patients with severe obesity who have already had a cardiac event cost the healthcare system a lot, because they have continuous hospitalizations and comorbidities» he explains to Panorama Stefano Genovesehead of the Diabetology, Endocrinology and Metabolic Diseases Unit of the IRCCS Monzino Cardiology Center in Milan. «The study Select has already shown that semaglutide is protective for this category of people. At this point, it is better to reimburse the drug, lose weight and reduce overall costs. In Italy, however, this step has not yet been defined: it will take a great deal of work by the commissions to precisely identify who will benefit from it.”
Prevention and culture
As Carruba reminds us again, it is not enough to attack diseases when they are full-blown: we need to make sure that healthy people don’t get sick. In fact, scientific studies demonstrate that every euro invested in prevention saves more than twelve in treatment. The problem, therefore, can only be overcome with one great cultural operation.
Among the specialists who every day, in the hospital wards, fight the serious complications of obesity, the relief is palpable.
«The link between obesity and diabetes is very close» admits the professor Riccardo Candidopresident of the Association of Diabetologists. «Those who are obese are ten times more likely to develop type 2 diabetes than those of normal weight. And behind these numbers there are people who often reach the diagnosis after years of decompensation, with cardiovascular complications, kidney problems, hypertension and a profoundly compromised quality of life.”
The real revolution: in the looks
Obesity, in fact, acts as a sort of metabolic trigger which alters the entire body, often without noticeable symptoms until the damage is already underway. «We welcome any initiative that can stem these problems» concludes Candido.
There is therefore a price to pay, always: we can choose if spend it today on prevention and drugs, or tomorrow on hospitalizations and complications.
And perhaps, in the end, the real revolution will not be in miracle drugs or Lea tables, but in the looks. When we stop thinking that those who weigh more are worth less, we will really have made a step forward.
Meanwhile, Italy – the one with accounts always in the red but also with great firsts – he decided to give it a try.
