Dangerous Diseases in SUS: Untreated Risks
- A debate over cost-effective treatments for severe obesity and related cardiovascular risks is unfolding in Brazil, with advocates urging the government to reconsider its stance on medications like...
- Obesity,notably grades 2 and 3 (severe obesity),considerably increases the risk of cardiovascular disease,stroke,and related mortality.
- Specifically, medications like liraglutide and semaglutide - belonging to the GLP-1 analog class - have shown promise in clinical trials.
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Access to Obesity Medications in Brazil: A Critical Gap in cardiovascular Care
Table of Contents
A debate over cost-effective treatments for severe obesity and related cardiovascular risks is unfolding in Brazil, with advocates urging the government to reconsider its stance on medications like sibutramine and newer drugs such as liraglutide and semaglutide.
the Cardiovascular Risk and Obesity Link
Obesity,notably grades 2 and 3 (severe obesity),considerably increases the risk of cardiovascular disease,stroke,and related mortality. Individuals over 45 with these conditions are considered high-risk, and frequently enough have already experienced cardiovascular events. Recent studies suggest that certain medications can reduce the incidence of these life-threatening events in this vulnerable population.
Specifically, medications like liraglutide and semaglutide – belonging to the GLP-1 analog class – have shown promise in clinical trials. These drugs work by mimicking a natural hormone that regulates appetite and blood sugar, leading to weight loss and improvements in cardiovascular health. However, access to these medications within Brazil’s public health system (SUS) remains limited.
The Debate Over Medication Access and Cost
A central point of contention is the cost of these newer medications. While effective, liraglutide and semaglutide are expensive, creating a barrier to access for many brazilians who rely on the SUS. This has led to calls for consideration of more affordable alternatives.
In December 2024, three medical societies – details to be confirmed with official statements – jointly requested the incorporation of sibutramine into the SUS formulary. The Brazilian Ministry of Health vetoed this request. Sibutramine,an older appetite suppressant,is significantly cheaper,costing less than 30 Brazilian Reais (approximately $6 USD as of august 26,2025).
Advocates argue that the cost of providing polyvitamins to patients undergoing bariatric surgery could cover up to three months of sibutramine treatment. They believe that sibutramine, despite its more modest effects, could prevent some patients from reaching the point where bariatric surgery becomes the only option.
Bariatric Surgery: Limited Capacity in the SUS
The SUS currently operates on a binary approach to obesity treatment: lifestyle changes or bariatric surgery for severe cases. However, the system’s capacity for bariatric surgery is severely constrained. According to the Brazilian Society of Bariatric Surgery (SBCBM), only approximately 10% of patients eligible for bariatric surgery through the SUS were actually operated on between 2020 and 2024. The remaining 90% face lengthy waiting lists, potentially delaying crucial interventions.
This backlog highlights the need for intermediate treatment options – medications like sibutramine or GLP-1 analogs – to manage obesity and reduce cardiovascular risk while patients await surgery or for those who may not be suitable candidates for surgical intervention.
Addressing Misconceptions and the Need for Comprehensive Care
The columnist emphasizes that advocating for medication access does not imply a dismissal of the importance of lifestyle changes. Obesity is a complex disease requiring a multifaceted approach. Medication should be viewed as a complementary tool, used in conjunction with dietary modifications, increased physical activity, and behavioral therapy.
The current situation presents a challenge: a lack of affordable and accessible medical interventions for a significant portion of the Brazilian population at high risk of cardiovascular events due to obesity. A more nuanced and comprehensive strategy is needed to address this critical public health issue.