De quelques maux de la prévention contemporaine. Le cas de l’obésité et du surpoids

Overweight and obesity are considered major public health issues, and many preventive campaigns are designed to prevent unhealthy eating habits among the French. But these campaigns may be ineffective, and even sometimes counterproductive. Firstly, because prevention is a moral enterprise that can lead to stigmatizing targeted people. Secondly, because the ‘merchandization’ of prevention fuels a ‘dietary cacophony’. Thirdly, the medicalisation of overweight/obesity involves some shortcomings: it can prevent us from understanding eating habits, and many general physicians are insufficiently trained to take care of overweight or obese patients.     

Carences nutritionnelles après bypass gastrique : diagnostic, prévention et traitements

In recent years, the recourse to obesity surgery to treat morbid obesities has grown. The number of “malabsorptive” interventions, such as the gastric bypass (RYGB: Roux-en-Y gastric bypass) increases each year. The RYGB, which combines two mechanisms promoting weight loss, restriction and malabsorption, has proven its effectiveness in term of weight loss and improvement of obesity-associated co-morbidities.However this intervention involves a profound change of the digestive physiology and is the source of nutritional and metabolic complications. The deficits observed most frequently relate to the proteins, iron, calcium, vitamin B12 and vitamin D. The deficiencies in vitamin B1 are rare but potentially serious. Multidisciplinary follow-up is essential to ensure prevention, diagnosis and treatment of these complications.Based on an analysis of the literature, this article summarizes the various nutritional complications observed after RYGB and the means to diagnose it. It proposes practical recommendations of follow-up, preventive supplementation and treatment of the deficiencies, both generally and in the more specific case of a pregnancy after RYGB.     

Gender and binge eating among bariatric surgery candidates

Bariatric surgery is an increasingly popular treatment for severe obesity. However, while rates of obesity are comparable across genders, women are much more likely to undergo bariatric surgery. Little research exists on gender differences among bariatric surgery candidates. This study examined gender differences and their correlates within a sample of 487 patients presenting for bariatric surgery. Results indicated that women were more depressed than men, dieted more, and were more likely to report that their weight interfered with feeling good about themselves. There were no differences in BED rates or binge eating. Furthermore, among women, both depression and self-esteem were associated with binge eating symptomatology. However, among men, only depression contributed to binge eating scores. These findings provide evidence for the significance of binge eating and depression among both male and female bariatric surgery candidates.     

Éducation et prévention de l’obésité de l’enfant. bilan des études en population

The prevalences of overweight and obesity are increasing in France as well as in many countries around the world. Results of randomised controlled primary prevention studies in schools are summarized. They show the feasibility of improving school meals and energy expenditure during PE classes. However, the effect on overweight and obesity prevention are often modest. It is clear that the out-of-school life can totally compensate the effect of an intervention at school. Studies that have been able to modify the children's sedentary and active behaviours out of school have shown the most promising results. The National Nutrition and Health Plan in France comprises a set of actions targeting the whole population, from young children to the elderly, for several years. In that context, we may hope that the different actions undertaken in France including those at school will end with more favourable results.     

Obesity and Eating Disorders in Children and Adolescents: The Bidirectional Link

Obesity, eating disorders and unhealthy dieting practices among children and adolescents are alarming health concerns due to their high prevalence and adverse effects on physical and psychosocial health. We present the evidence that eating disorders and obesity can be managed or prevented using the same interventions in the pediatric age. In the presence of obesity in the pediatric age, disordered eating behaviors are highly prevalent, increasing the risk of developing eating disorders. The most frequently observed in subjects with obesity are bulimia nervosa and binge-eating disorders, both of which are characterized by abnormal eating or weight-control behaviors. Various are the mechanisms overlying the interaction including environmental and individual ones, and different are the approaches to reduce the consequences. Evidence-based treatments for obesity and eating disorders in childhood include as first line approaches weight loss with nutritional management and lifestyle modification via behavioral psychotherapy, as well as treatment of psychiatric comorbidities if those are not a consequence of the eating disorder. Drugs and bariatric surgery need to be used in extreme cases. Future research is necessary for early detection of risk factors for prevention, more precise elucidation of the mechanisms that underpin these problems and, finally, in the cases requiring therapeutic intervention, to provide tailored and timely treatment. Collective efforts between the fields are crucial for reducing the factors of health disparity and improving public health.     

Obesity and Psychological Factors Associated with Weight Loss after Bariatric Surgery: A Longitudinal Study

Bariatric surgery is indicated for treatment of severely obese people and can lead to significant weight loss as well as reduction of comorbidities associated with obesity. The present study aims to investigate the relationship between different psychological factors (e.g., tendency to binge eating, impulsivity, alexithymia), adherence to the nutritional plan, and weight loss after bariatric surgery. Forty-five candidates for bariatric surgery accessing a center for the care of obesity were assessed at T0 (pre-surgery) and T1 (6 months post-surgery) through anthropometric and psychometric measures. Simple linear correlations and linear regressions were conducted to evaluate the relationship between the psychological variables, adherence to nutritional plan, and weight loss 6 months after bariatric surgery. Non-planning impulsivity was the principal factor that succeeded in explaining adherence to the diet plan among all the variables considered. Adherence to the nutritional plan and non-planning impulsivity were considered reliable short-term predictors of weight loss after bariatric surgery. This evidence explains the usefulness of promoting research on psychological predictors of outcome in bariatric surgery. Mid- and long-term weight maintenance and quality of life need to be investigated through further follow-up.     

Binge eating among African American and Caucasian bariatric surgery candidates

Bariatric surgery is an increasingly utilized treatment for severe obesity, especially among women. Although African American women have high rates of severe obesity, most research investigating psychological correlates of obesity has been conducted with Caucasians. This study examined the characteristics of African American women seeking bariatric surgery, and ethnic differences in BED rates and correlates of binge eating. Finally, we examined whether the association between psychological factors associated with binge eating was moderated by ethnicity. Results indicated that African American women had higher BMIs, higher self esteem, and less depression than Caucasians. There were no differences in rates of binge eating or BED. Both depression and self esteem accounted for unique variance in binge eating; however, these relationships were not moderated by ethnicity. These results further highlight African Americans' vulnerability to EDs, and suggest that depression and low self esteem are equally relevant to binge eating in African American and Caucasian women.     

Gastric surgery and restraint from food as triggering factors of eating disorders in morbid obesity

Obese patients may share some clinical features with anorexia nervosa patients because they risk developing an eating disorder when they diet. Methods and Results Some common etiological, psychological, and social factors have been proposed for both disorders. We present two cases of patients suffering from morbid obesity who, after weight loss, presented an intense fear of regaining weight and developed anorexic-like symptoms. In the first case, the symptoms appeared after gastric reduction surgery. In the second case, a strict diet was the triggering factor. DISCUSSION: This paper stresses the need for psychiatric evaluation of all patients with morbid obesity who seek treatment in clinical settings, in order to identify the factors that may lead to psychiatric complications.     

Psychosocial and behavioral aspects of bariatric surgery

Bariatric surgery has become an increasingly popular treatment option for individuals with extreme obesity (defined as a BMI > or = 40 kg/m2) or those with less severe obesity accompanied by significant comorbidities. Sustained postoperative weight loss and improvements in obesity-related health problems make bariatric surgery the most effective treatment for this population. Nevertheless, most experts agree that psychosocial and behavioral factors contribute to successful postoperative outcomes. This paper reviews the literature on the preoperative psychosocial status, eating behaviors, and quality of life of patients who seek bariatric surgery. In addition, the paper examines studies that investigated changes in these factors postoperatively. The review concludes with an agenda for future research in this area.     

Comportements alimentaires de l’enfant et attitudes parentales: le point de vue de la psychologie expérimentale

Children show a clear preference, throughout development, for high energy density foods, and particularly for sweet and/or fat products. Most parents disapprove of this behavior, in the present context of high obesity prevalence and widespread acceptance of thinness as a model. Children’s appetite for such foods has adaptive value, so far as the growing child has not lost his/her ability for energy adjustment. A few studies suggest that excessive control over children’s food choices contributes to a loss of the child’s capacity to energy adjustment. Education models that include both the teaching of rules and adjustments to the child’s requests seem to facilitate the acquisition of adequate eating behaviors, which favor a varied diet and body weight control.     

Promouvoir l’activité physique, lutter contre la sédentarité et prévenir le surpoids chez l’adolescent, c’est possible : les leçons d’ICAPS

Based on a socioecological approach, the Intervention Centered on Adolescents’ Physical activity and Sedentary behavior (ICAPS), a four-year randomized and controlled trial has shown that prevention of sedentariness and of obesity is feasible in youth thanks the mobilization of several partners including actors in the domains of health, education, physical activity, transport and of community agencies in charge of recreational areas and transportation infrastructures. In this article, we present a synthesis of the key data demonstrating the efficacy of ICAPS at the end of the four years of intervention as well as preliminary results of the six-year follow-up study, i.e. two years after the end of the intervention. We discuss a few tracks on elements that may explain the effectiveness of the strategy implemented.     

Effect of a multidisciplinary rehabilitation program for patients receiving weight management interventions on eating behaviours and health-related quality of life

The rapid rise in obesity prevalence is life-style related and tackling this problem requires a pro-active multi-faceted approach to management. A private health care provider in Melbourne, Australia, developed a multidisciplinary rehabilitation program for patients who had undergone bariatric surgery or receiving pharmacological weight loss treatments. The study aim was to assess the programs’ effect on patients’ quality of life, mental well-being, and eating behaviours.MethodsA prospective, observational, before and after study design was used. A total of 54 patients, 27 who had bariatric surgery and 27 receiving pharmacotherapy participated. Outcome measures were: change in weight and BMI, intuitive eating scale, impact of weight on quality of life scale and the depression, anxiety and stress scale.ResultsBoth medical and surgical patients reported improvements in their health-related quality of life and eating behaviours. Despite this, at program completion 71.4% of patients who had bariatric surgery reported severe anxiety and 52.4% severe stress levels.ConclusionParticipation in a rehabilitation program that provided patients with peer support and access to expert advice supported patients to make healthy eating choices and improved their quality of life. The high prevalence of stress and anxiety related symptoms highlights the need to provide individuals who have undergone bariatric surgery with ongoing mental health support.     

Which facets of mindfulness are related to problematic eating among patients seeking bariatric surgery?

There has been growing research indicating the potential positive benefits of mindfulness-based interventions for obesity, but few studies have examined the relationship of mindfulness processes to obesity-related behaviors, particularly among clinical populations such as bariatric surgery candidates. The current study examined the relationship of specific mindfulness facets to a variety of problematic eating behaviors assessed through diagnostic interviews in a clinical sample of 820 patients seeking bariatric surgery. Results indicated that greater mindfulness on specific facets, particularly acting with awareness, was related to less binge and emotional eating. Greater mindfulness was also related, though less consistently, to less habitual overeating and grazing. The observing facet was generally unrelated to problematic eating, but in a few cases being more observant related to having greater eating problems. The results of the study and future directions are discussed in relation to research on problematic eating in obesity and mindfulness-based interventions.     

Anorexia nervosa following gastroplasty in the male: Two cases

The first stage in the development of anorexia nervosa involves voluntary restriction of food intake, that is, diet. Marked weight loss, impairment in body image, and deterioration of health ensue. Anorexia nervosa is much more prevalent among women than men. Its etiology and presentation are mostly similar for both sexes. Certain features, such as greater premorbid obesity and sexual identity concerns, are thought to be more prevalent in male patients. We present 2 male patients who had undergone gastroplasty for morbid obesity and subsequently developed anorexia nervosa. Both evinced signs of identity confusion. Neither one of the patients underwent psychiatric evaluation before surgery. The cases described illustrate that anorexia nervosa may succeed acute and marked weight loss following gastroplasty. This emphasizes the need for a psychiatric assessment before bariatric surgery, and should alert clinicians to search for elements that may predispose vulnerable individuals to a risk of developing anorexia nervosa. © 1996 by John Wiley & Sons, Inc.     

La publicité, quel impact sur l’alimentation de l’enfant ?

Advertisements who target children pose a real problem in health and ethical terms given the current context of the rise of obesity levels. The solutions open to legislators are, however, far from clear as highlighted by the results of research undertaken in various countries. The options tested range from a total ban of the messages to a stiffer monitoring of their contents. This article tries to shed light on the current debate and emphasizes the role that food culture can play in this context.     

Do psychosocial variables predict weight loss or mental health after obesity surgery? A systematic review

OBJECTIVE: The objective of this study was to present a systematic review of psychological and psychosocial predictors of weight loss and mental health after bariatric surgery. This systematic review included all controlled and noncontrolled trials of the last 2 decades with either a retrospective or prospective design and a follow-up period of at least 1 year. RESEARCH METHODS AND PROCEDURES: The relevant literature was identified by a search of computerized databases. All articles published in English and German between 1980 and 2002 were reviewed. RESULTS: Using the above inclusion/exclusion criteria, 29 articles were identified focusing on psychosocial predictors of weight loss and mental health after obesity surgery. DISCUSSION: Personality traits have no predictive value for the postoperative course of weight or mental state. Apart from serious psychiatric disorders including personality disorders, psychiatric comorbidity seems to be of more predictive value for mental and physical well-being as two essential aspects of quality of life than for weight loss postsurgery. However, depressive and anxiety symptoms as correlates of psychological stress with regard to obesity seem to be positive predictors of weight loss postsurgery. The severity of the symptoms or the disorder is more relevant for the outcome of obesity surgery than the specificity of the symptoms. It is also not solely the consumption of distinct "forbidden" foods, such as sweets or soft drinks, but rather a general hypercaloric eating behavior, either as an expression of the patient's inadequate compliance or a dysregulation in energy balance, which is associated with a poor weight loss postsurgery.     

Practice guideline for the treatment of morbid obesity

The increasing prevalence of obesity and its related comorbidities represents an increasing burden for the Dutch health care and requires effective therapy. The primary treatment of obesity consists of lifestyle interventions directed at lifestyle change; in morbidly obese subjects only bariatric surgery is cost-effective in the long term, with respect to both weight loss and reduction in comorbidity. There is a new Dutch multidisciplinary practice guideline on the treatment of morbid obesity, in which the following aspects are covered: indications for surgery, pre-operative policy advice, considerations for the type of operation, and the short and long term follow-up after bariatric surgery. Patients between 18 and 65 years old are eligible for bariatric surgery if they have a BMI ≥ 40 kg/m2 or a BMI ≥ 35 kg/m2 in the presence of comorbidity. In adolescents under 18 bariatric surgery should only be performed in a research setting; in patients older than 65 years bariatric surgery can be performed exceptionally, preferably in a centre with large experience.     

Obésité : que nous dit l’épidémiologie ?

In most developed and developing countries, a regular increase of the prevalence of obesity has been documented during the last decade(s) of the xxth century. The last figure from the USA is for the first time discordant with this general trend by showing a clear slowing down since year 2000. In children likewise, a rapid increase in the prevalence of obesity took place in the second half of the xxth century but recent publications from France, Switzerland, UK, USA also report a stabilization of childhood overweight and obesity prevalences. The experience of developing countries clearly shows the impact of socioeconomic status improvement and urbanization on the prevalence of obesity. In developed countries like France, a striking element was the diffuse nature of the adult obesity epidemic observed from the 1990s. The general improvement of living conditions after the Second World War probably explains the diffuse nature of the epidemics. Specifically, the changes in the nutritional status of children that happened at that time have long lasting consequences for adult obesity epidemics. Indeed, a new current in epidemiology, lifecourse epidemiology, has prompted over the past decade a new approach of the pathophysiology of chronic diseases, including obesity. Lifecourse epidemiology considers factors affecting the susceptibility to diseases over the whole life with critical periods during developmental phases. Critical periods for the susceptibility to obesity have been documented in prenatal life, during the first 6 months of postnatal life and from 3 years on starting at the time of the adiposity rebound. Parental obesity is involved at each of the critical periods. The transgenerational transmission of obesity is explained by genetic factors, shared lifestyle but also epigenetics especially during the early developmental periods. The slowing down of the childhood obesity epidemics observed in several developed countries may signal that factors affecting the early susceptibility to obesity have recently changed.     

The Impact of the COVID-19 Epidemic on the Mood and Diet of Patients Undergoing Bariatric Surgery

Limited social contacts, lack of professional activities, economic insecurity, and a sense of threat, as well as boredom during the COVID-19 pandemic, contributed to tension and stress. All of these increase the risk of an inappropriate diet. The aim of this cross-sectional study was to assess the impact of the COVID-19 pandemic on the mood and nutrition of patients undergoing bariatric surgery. A group of 312 patients (both before and after bariatric surgery) completed a questionnaire about their diet and mood during COVID-19 lockdown. About 70% of all respondents reacted to the epidemiological situation: irritability, anxiety about their own health, and eating without being hungry. A total of 74% of all of the subjects snacked between meals (especially sweets). The respondents who believed that obesity and its complications had a negative impact on the prognosis of the coronavirus infection had a statistically significant higher prevalence of health anxiety, feeling that important life issues were out of control, irritability, need for psychological support, and need for dietary consultation. Patients after bariatric surgery had e.g., a statistically significant lower incidence of feeling hungry, eating after meals, and eating fatty foods. The COVID-19 pandemic has been shown to negatively affect the mood and diet of bariatric patients, which may affect their health status and worsen the prognosis of COVID-19.     

La consultation pré-anesthésique comme outil de dépistage nutritionnel préopératoire

Objective

In severely malnourished patients, preoperative nutritional support helps lessen the adverse impact of malnourishment on postoperative progress. An essential prerequisite is to identify this malnourishment. We wanted to find out whether pre-anaesthetic consultation (which is not compulsory in Belgium) was a tool that could be used to achieve these objectives of preoperative nutritional screening in patients undergoing abdominal surgery.

Method

Our working method comprised of three phases. Having conducted a study to determine our situation, we integrated the NRS 2002 into our computerised consultation protocol and created a procedure used to link our consultation with the dietetics consultation on the same day. We then analysed the effectiveness of our actions.

Results

We received 87.8% of patients undergoing elective abdominal surgery at the pre-anaesthetic consultation. Thanks to the computerisation of the NRS 2002, our nutritional screening rose from 60.8% to 86.1%. All patients at risk of malnutrition were referred to the dietetics service on the same day for a nutritional assessment and nutritional support if necessary. This procedure reduced the hospital re-admittance rate as much as possible. The average period of 13 to 15 days between the pre-anaesthetic consultation and the surgery was sufficient to put in place preoperative nutritional support.

Conclusion

Pre-anaesthetic consultation has therefore become a tool used for preoperative nutritional screening and care.