In Spain, only 56% of people with obesity recognise that they have the disease. The finding shows a gap between health concerns and personal recognition, even as medical groups treat obesity as a chronic condition.
In Spain, 76% of people with obesity say excess weight affects their health. Only 56% recognise that they have the disease. Those figures come from preliminary results of the Razones de Peso survey and show how far concern can sit from personal recognition. The World Health Organization says more than 1 billion people were living with obesity worldwide in 2022.
The gap is real.
The American Medical Association first classified obesity as a disease in 2013 and reaffirmed that position in 2023.
The survey was promoted by Lilly with support from the market research company IPSOS. It included 200 primary care doctors and 1,700 people with a body mass index of at least 30 kg/m², the threshold used to classify obesity. Sixty per cent of participants recognise obesity as a disease. Only 56% say they live with it.
The results also question the idea that weight can be managed with a simple instruction to eat less and move more. Only 38% of people with obesity describe it as a chronic disease that is difficult to control through lifestyle changes alone. Just 33% identify biological factors as the main cause. Only 26% know that the body can activate metabolic mechanisms that make weight loss harder.
The European Observatory on Health Economics reports that the prevalence of overweight and obesity among adults in Europe has risen substantially since 1990, with obesity increasing by more than 75%. This helps explain why the condition is increasingly discussed as a population-level health and economic issue rather than an individual failure.
That limited understanding affects treatment.
Obesity involves genetic and endocrine factors. Environmental conditions also matter, including an obesogenic environment and endocrine disruptors. Stress, disrupted sleep, behavioural patterns and sociocultural influences can affect energy balance. Fat tissue can then grow beyond the body's storage capacity. That can trigger dysfunction and inflammation across organs and systems.
The WHO describes obesity as a chronic, complex condition. It links obesity to cardiovascular disease, diabetes and some cancers.
Spanish summaries of recent estimates put the economic cost of overweight and obesity at 19.6 billion euros a year. That figure equals about 1.2% of Spain's GDP. The same summaries estimate obesity in about 14.9% of Spanish adults and 7.1% of children.
The scale is large.
Primary care doctors see the problem more clearly than many patients do. They place obesity alongside type 2 diabetes and high blood pressure in terms of treatment importance. Forty per cent say it is very difficult for a patient to control obesity through lifestyle changes alone. Another 86% equate it with other chronic diseases.
The approach matches the European Association for the Study of Obesity's description of obesity as a chronic, relapsing disease and a major cardiometabolic risk factor. The association says it should be identified earlier.
Patients most often connect obesity with high cholesterol and high blood pressure, at 59% each. Type 2 diabetes follows at 52%. Joint and mobility problems reach 51%.
When asked about the most serious consequences, 27% name myocardial infarction. Stroke comes next at 12%, followed by certain cancers at 11%. For 40% of doctors, the main benefit of weight loss is better control of other conditions linked to obesity.
The medical effects reach beyond weight itself. Cardiologist José Abellán says obesity is associated with more than 200 diseases. He also says cardiovascular complications can be frequent and potentially fatal. In his view, doctors should treat excess weight as the primary disease instead of waiting for another complication to appear.
Stigma adds another barrier.
More than half of the doctors surveyed believe patients do not see obesity as a serious problem that requires medical help. Doctors say they discussed excess weight with 66% of their patients. In 68% of those conversations, the immediate goal was to improve another complication that had already appeared.
Federico Luis of the Asociación Nacional de Personas que Viven con Obesidad, or ANPO, says fear of judgement can keep people away from care. So can the expectation of hearing only lifestyle advice.
The figures show a communication problem as well as a knowledge gap. Sixty per cent of respondents recognise obesity as a disease, yet only 56% of people affected identify it in themselves. Doctors also often raise the issue after related harm has appeared.
Lilly executive Teresa Millán says primary care doctors and patients should discuss obesity and excess weight earlier. She argues that these conversations should receive the same priority as discussions about other chronic diseases.
The survey does not support reducing obesity to personal discipline. Recognition needs to come earlier. Medical care cannot stop at advice about habits.
Obesity is chronic, complex, progressive and multifactorial. Treating it that way is the starting point for earlier care.
