Le défi de l’acceptation de soi dans une culture narcissique

Dealing with overweight subjects is made particularly difficult in our narcissistic western society, a society that does not just focus on appearances but confuses appearance with personality, value and state of health. Most overweight people have taken on board the negative self-image they see reflected in society’s view of them and thus suffer from low self-esteem. Our attempts to manage the health of subjects such as these must always bear this problem in mind, in order to avoid any approach that discounts the moral suffering they endure.     

« 3es rencontres médecins-chirurgiens » sur la chirurgie de l’obésité » Chirurgie bariatrique: qu’est-ce qu’un échec?

Abstract There is currently no consensus as to what is considered a failure following bariatric surgery. Weight loss then weight stabilisation must be taken into consideration, but so also must any effects on comorbidity and quality of life. The reference goal is no longer achieving an ideal weight but one that corresponds with a BMI of 25 kg/m². Weight loss objectives are seen differently by doctors, surgeons and patients. Those undergoing surgery dream of losing 50% of their preoperative weight, whereas preliminary results suggest that the average weight loss is 32%. More studies are needed to assess how effective therapeutic education is with respect to how results are viewed over time. The SOS Study demonstrated that while some of the surgery’s effects on psychological parameters and quality of life depend on weight change, others do not. Delta weight and its development are thus key biopsychosocial indicators that must be analysed several years after surgery.     

Expérience d’un groupe de parole d’adolescents obèses avant une chirurgie bariatrique

Facing the increasing demand for bariatric surgery in obese adolescents, we developed discussion groups in order to assess the level of teenagers’ development around the surgical procedure. This article describes exchanges between several adolescents awaiting bariatric surgery and one operated teen. They discussed several topics such as confidence to provide other, pain, body image, and difficulty of waiting as well as issues about post-surgical treatments.     

Traitement endoscopique par « rendez-vous » de l’obstruction complète d’une anastomose iléorectale

Benign anastomotic intestinal strictures are generally managed by endoscopic balloon dilation. Complete colonic anastomotic obstruction from benign disease is rare, with only a few reports of endoscopic management in the literature. We describe a case of successful endoscopic management of a completely obstructed ileorectal anastomosis by using a combined antegrade-retrograde endoscopic rendezvous technique.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient… et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A chief difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, stepby- step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a fast, simple questionnaire.     

Comment aborder l’éducation thérapeutique d’un patient obèse ? La motivation du patient... et du médecin: une des clefs du succès thérapeutique ?

Losing weight is a long, complicated, fastidious process that can quickly become discouraging for both patient and doctor. A main difficulty in the management of obesity, widely described by a number of authors, is arousing and maintaining patient motivation. In the educational therapy of the obese patient, the motivational interview is an extremely useful tool in this respect. The aim of this article is to provide general practitioners with tools for assessing the likely success of the treatment and also for helping patients change their behaviour in the long-term. The challenge for the doctor is to optimise treatment by making patient motivation the primary issue in a progressive, step-by-step behaviour modification program. This process is demonstrated by a practical example involving patient attitudes to physical activity, via a quick, simple questionnaire.     

Rôle du médecin de médecine physique et réadaptation dans un Centre d’Evaluation et de Traitement de la Douleur

Résumé  Le médecin de rééducation mérite d’être mieux intégré à la prise en charge des douleoureux chroniques au sein des Centres de Traitement de la Douleur. En effet, il participera á la mise en évidence des déficiences notamment neurologiques ou ostéo-articulaires, des handicaps qui en résultent et des possibilités de réadaptation. La notion de déconditionnement á l’effort du douloureux chronique, très fréquemment retrouvé, mérite d’être connu des médecins et soignants de la douleur, caril peut, plus encore que la pathologie causale, participer au retentissement fonctionnel parfois majeur constaté chez le patient; et faire l’objet d’un traitement spécifique par réentra?nement à l’effort progressif et dosé. Notre expérience de plusieurs années de présence hebdomadaire d’un médecin de rééducation au sein d’un Centre de Traitement de la Douleur nous para?t très utile pour les patients et l’équipe pluridisciplinaire: le dévelopement d’une culture commune d’évaluation et de la prise en charge mais aussi de fillières de soins pour les douloureux chroniques, en particulier lombalgiques, fibromyalgiques, patients porteurs de rhumatisme inflammatoire, nous para?t un des éléments clés de la prise en charge pluridisciplinaire, au même titre que les coopérations indispensables avec les collègues de la sphère psychologique et socioprofessionnelle.