SUS does not provide drugs to treat obesity

The SUS (Unified Health System) does not provide drugs with indications for the treatment of obesity. Medications are prescribed for more serious cases that may cause associated diseases or require bariatric surgery in the future.

Obesity is calculated using the BMI (Body Mass Index), which is the division of 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 obese people, 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.

In order for a drug to be added to the public health system, it must first undergo an evaluation by Conitec (National Commission for the Incorporation of Technologies in 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, nutritionist and co-founder of the NGO Obesidade Brasil.

Pereira explains that some research indicates that sibutramine, like orlistat, can have an impact on weight reduction of between 5% and 10% of a person. “Sometimes 10% doesn’t seem like such a good number, but for [reduzir] cardiovascular risk and to improve the prognosis, this loss already helps”, he 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 important in view of the worsening of this scenario in Brazil. One estimate indicates that by 2030 the country will have 30% of its adult 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 important to prevent the progression to more serious cases of obesity, which require bariatric surgery, available through the SUS — a more expensive procedure that can take time to do. In addition, the more critical the obesity, the greater the risks of associated diseases.

“If I manage to ensure that a person does not have severe obesity untreated at the beginning, this will greatly reduce expenses. In general terms, the cost of medication will not be the highest. The biggest cost is the complications of obesity”, he says. the doctor.

habits

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 has also been proven by experts.

“When you do exercise, you first see loss of fat in the waist region. With every centimeter of waist that is lost, the risk of cardiovascular diseases is reduced”, says Cláudia Cavaglieri, professor of the department of studies of adapted physical activity at Faculty of Physical Education at Unicamp (University of Campinas).

Studies carried out by the professor have already observed the impacts of physical exercise on obese people. In one of them, with obese men who performed activity for about six months, there was fat loss, an increase in lean mass and a reduction in inflammation, a factor that can lead to other comorbidities, such as diabetes and hypertension.

In another research, a similar result was seen in teenagers.

“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, the adoption of 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 greater health risks.

“It’s also no use having only medication if there is no change in lifestyle. It’s a set”, says Pereira, from the NGO Obesidade Brasil.

What Conitec says

Sought by the report, Conitec stated that it was unfavorable to the incorporation of sibutramine for cases of obesity “because it considers that there are uncertainties regarding the benefit attributed to the drug and the tendency to regain lost weight over time”.

The commission also cited the adverse events that could happen with the use of the drug and the budgetary impact it would have. A similar justification was given for orlistat, which also did not receive a recommendation to be incorporated into the SUS.

The commission said it has not yet evaluated liraglutide because there have been no requests for review to date.

Conitec declares that it acts whenever a demand arises and considers points “such as efficacy, accuracy, effectiveness and safety, in addition to the comparative economic evaluation of the benefits and costs in relation to existing technologies and their budgetary impact for the SUS”.