Body responsible for inclusion points out uncertainties regarding benefit and cost; doctor says drugs are indicated in more severe cases
The SUS (Unified Health System) does not provide drugs with indications for the treatment of obesity. Medications are prescribed for more severe cases that may cause associated diseases or require bariatric surgery in the future.
Obesity is calculated using the BMI (Body Mass Index), dividing weight by height squared. When the value is above 30, the individual is considered obese. Currently, it is estimated that 22% of adult Brazilians have this condition.
Among several recommendations for weight loss for people with obesity, there is drug treatment. The Brazilian Obesity Guidelines document, released in 2016 by ABESO (Brazilian Association for the Study of Obesity and Metabolic Syndrome), explains that Brazil has three drugs approved for this purpose: sibutramine, orlistat, and liraglutide 3 mg.
None of them are distributed by SUS.
For a drug to be added to the SUS, it must first undergo an assessment at CONITEC (National Commission for the Incorporation of Technologies to the SUS). The commission analyzes several aspects, such as the scientific evidence of effectiveness and the costs that the incorporation may represent. For sibutramine, for example, CONITEC stated in a 2020 report that the evidence provided was not sufficient".
"In the treatment of obesity, medication is indicated," says Andrea Pereira, Clinical Nutrition Physician, and co-founder of the NGO Obesidade Brasil.
Pereira explains that some research indicates that sibutramine, like orlistat, can impact weight reduction of between 5% and 10% of a person. "Sometimes 10% doesn't seem like such a good number, but to [reduce] cardiovascular risk and improve prognosis, that loss already helps," she explains.
Liraglutide, according to Pereira, is more effective in reducing weight than the other two. The drug, however, has not yet been analyzed by CONITEC.
The discussion about the use of drugs as one of the ways to control obesity is essential given the worsening of this scenario in Brazil. One estimate indicates that by 2030 the country will have 30% of its population living with the condition.
The situation can also affect mainly the poorest population that depends more on public health to use the medicines in case of medical indication.
Pereira says that the drugs are essential to prevent the progression to more severe cases of obesity, which require bariatric surgery, available through SUS. This more expensive procedure can take time to do. In addition, the more critical the obesity, the greater the risks of associated diseases.
"If I can get a person to not have severe obesity by treating it initially, that will greatly reduce the expense. In general terms, the cost of the medication will not be the highest. The highest cost is the complications of obesity", says the doctor.
With no drugs in the SUS for obesity, CONITEC indicates that the practice of physical activities and the adoption of a more balanced diet are important for weight reduction, something that experts have also proved.
"When you exercise, you first see fat loss in the waist area. For every centimeter of the waist that is lost, the risk of cardiovascular diseases is reduced", says Claudia Cavaglieri, professor at the Department of Studies of Adapted Physical Activity at the Faculty of Physical Education at UNICAMP.
"Physical exercise has the ability to significantly modulate all these metabolic parameters that are altered by obesity," explains Cavaglieri. In addition, the constant practice of physical activity makes weight gain after weight loss rarer.
However, adopting physical activity and diet tends to have slower positive results. In cases where a patient is already in a more advanced stage of obesity, medications used under medical supervision can speed up weight loss and avoid more significant health risks.
"It is also no use having only medication if there is no change in lifestyle. It's a set,". says Pereira from the NGO Obesidade Brasil.