Treating Obesity as a Chronic Disease in Turkey
It is our pleasure to speak with Dr. Volkan Yumuk.
Dr Yumuk is a founding member and the current president of the Turkish Association for the Study of Obesity; he has since 2011 been a member of the executive committee of the European Association for the Study of Obesity (EASO) and currently sits as the Vice President responsible for the southern region of EASO.
Dr. Yumuk, Turkey is one of the few countries officially recognising obesity as a chronic disease. Can you give us the history here?
The Turkish Ministry of Health officially recognised obesity as a chronic disease after the WHO European Ministerial Conference on Counteracting Obesity took place in Istanbul in 2006. Implementations were initiated in 2010.
What are the implications of this recognition?
Ministry of Health has developed several action plans for the prevention of obesity:
- 2011-Policy-Healthy Nutrition and Active Life Program of Turkey
- 2013-WHOEuropeChildhood Obesity Surveillance Initiative (COSI-TUR)
- 2015-European Food and Nutrition Action Plan (2015-2020)
- 2015-Physical Activity Strategy for the WHO European Region
- 2016-Healthy Nutrition and Active Life Program of Turkey
- 2016-Nutrition Friendly School Initiative
- 2017-Food labelling requirements
- 2018-Multi-sectoral action plan update for 2018-2023
Re-organisation of the health system was initiated for obesity management:
- 2013-Tier1, Family Health Centre (FHC): Family physician
- 2016-Healthy Life Centre (HLC): Family physician, dietician, exercise specialist, psychologist, social worker
- 2018-Tier2, Comprehensive Obesity Centre (COC): Obesity specialist (internist, endocrinologist), bariatric surgeon, dietician, psychologist and exercise specialist
Family physician at the FHC may consult with HLCs, or Tier2 COCs (recently initiated as a pilot programme).Treatment services at COCs will be fully covered by the social security system.Can you share some of the challenges in Turkey in having obesity recognised as a chronic disease?
We have barriers ahead to overcome. Education of Health Care Providers (HCPs), other stakeholders and the public in terms of obesity and its complications is but one of the challenges. Availability and accessibility of obesity centres providing standardised obesity care are other challenges. As the EASO readership is aware, obesity is a chronic disease and treatment is lifelong, requiring long-term follow up. The level of expense for obesity care (professional medical service and possible surgical interventions) brings in coverage issues, mainly in the private sector, and pricing issues for anti-obesity drugs in general, which are additional challenges.
Education, training and inspiration
A representative of the Turkish Ministry of Health gave a talk at the “Beyond the Minister of Health: lessons from countries where obesity is classified as a disease” session at ECO2017in Porto. The Collaborating Centres for Obesity Management (COM) initiative that is jointly runby the European Association for the Study of Obesity (EASO) and Turkish Association for the Study of Obesity (TASO) has become an inspiration for many Turkish health organisations. TASO and other related Turkish associations are dealing with the issue of including the education and training of obesity and its complications in the curriculum of medical schools and faculties of health sciences.