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Although Roux-en-Y gastric bypass (RYGB) is widely performed worldwide, its efficacy in patients with a body mass index (BMI) greater than 50 kg/m2 remains controversial. The aim of the present paper was to assess long-term (10 years or more) weight loss and metabolic results of RYGB in patients with superobesity (SO; BMI > 50 kg/m2), compared with patients with morbid obesity (MO; BMI 35-50 kg/m2). This study involved retrospective analysis of a prospectively followed cohort of adult patients operated on for a primary RYGB between 1999 and 2008. Long-term weight loss and metabolic parameters were compared between SO and MO patients, with a sex-specific subgroup analysis in SO patients. Multiple logistic regression assessed independent predictors of poor long-term weight loss. Among the 957 included patients, 193 (20.2 per cent) were SO (mean BMI 55.3 kg/m2versus 43.3 kg/m2 in MO). Upon 10-year follow-up, which was complete in 86.3 per cent of patients, BMI remained higher in SO patients (mean 39.1 kg/m2versus 30.8 kg/m2, P < 0.001) although total bodyweight loss (per cent TBWL) was similar (28.3 per cent versus 28.8 per cent, P = 0.644). Male SO patients had a trend to higher 10-year per cent TBWL, while initial BMI greater than 50 kg/m2 and low 5-year per cent TBWL were independent predictors of long-term TBWL less than 20 per cent. Diabetes remission was observed in 39 per cent SO and 40.9 per cent MO patients (P = 0.335) at 10 years, and all patients had a significant lipid profile improvement. Substantial improvement in co-morbidities was observed in all patients 10 years after RYGB. Total weight loss was similar in SO and MO patients, leaving SO patients with higher BMI. Suboptimal TBWL 5 years after surgery in SO, especially female patients, may warrant prompt reassessment to improve long-term outcomes.

Background: One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). Methods: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. Results: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). Conclusion: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.

Obesity is a major health problem with a prevalence that has tripled since 1976, affecting a large portion of the population across all ages. Bariatric surgery is currently considered as the most efficient and durable treatment in terms of weight loss and remission of long-term co-morbidities. The objective of this article is to describe briefly the different surgical options for patients with severe obesity and to report their effectiveness, as well as to provide primary care physicians with simple instructions, regarding initial management and the appropriate guidance of their patients to a specialized service.

Democratization of the cannabis consumption and its derivatives incite patients to ask ever more for medical cannabinoid prescriptions, especially in the context of chronic pain. Its use is only validated in certain limited cases, in particular spasticity linked to multiple sclerosis and refractory epilepsies. All other prescriptions require a special request to the OFSP. Moreover, cannabinoid intake may produce several dose-dependent side effects that require a close monitoring with a slow and gradual initiation of its dosage. In the absence of clear medical evidence, many other mechanisms of action need to be investigated with ongoing and future studies to clarify their indication.

Bariatric and metabolic surgery is the only effective long-term treatment for morbid obesity. The three main practiced surgeries during the last 30 years are the Roux-en-Y gastric bypass (RYGB), the sleeve gastrectomy (SG) and the laparoscopic adjustable gastric banding (AGB). These surgeries can lead to long-term complications of a functional or of a surgical nature. Rapid management in a specialized setting where appropriate investigations can be done is essential. Abdominal pain after bariatric surgery are frequent, multiple and difficult to apprehend. They should not be trivialized because the risks of severe complications without an adequate and quick management are important.

Bariatric surgery, the most effective treatment for obesity, can lead to long-term complications. These may be of functional nature (dumping, hypoglycemia, reflux) or of surgical nature. Acute or chronic abdominal pain is not unusual after gastric bypass. Often unrelated to surgery, it can be caused by an acute surgical problem (internal hernia, obstruction, intussusception), which can lead to extensive bowel necrosis if not treated quickly. Other complications (candy cane, anastomotic ulcer, reflux) can also develop. An « obstructed sleeve » can develop early or late after sleeve gastrectomy. Rapid management of acute abdominal pain is essential and should, ideally, be done in a specialized setting where appropriate imaging and specific surgical skills are readily available.

Bariatric surgery is the most effective long-term therapy for the management of patients with obesity but all bariatric surgical procedures have the potential to cause clinically significant micronutrient deficiencies due to reduced food intake, decreased gastric acid and intrinsic factor secretion, poor food choices and food intolerance. For clinicians, the acquisition of special knowledge is required in order to deliver appropriate and effective care to the post-bariatric patient. In the present article, we summarize existing recommendations for monitoring and replacement of vitamins and minerals following bariatric surgery.

Adolescence is a stressful period where important biological, psychological and social changes occur. Adolescents are particularly vulnerable during this developmental period and can use various strategies to deal with daily stress, such as substance use or externalizing behaviors. In previous studies, stress in adolescents with externalizing behaviors was often linked to ineffective cognitive coping strategies (i.e., constructive thinking) and overlooking the biological aspects involved in stress management such as neuroendocrine regulation. Indeed, repeated activation of the hypothalamic-pituitary-adrenal (HPA) axis in chronic stress situations may have long-term effects on subsequent cortisol regulation and lead to psychological difficulties. It was also shown that basal cortisol levels are lower in adolescents with externalizing behaviors. This study aims to assess the links between constructive thinking and neuroendocrine regulation in adolescent offenders and their association with externalizing symptoms (e.g., aggression, delinquency, psychopathic traits, substance use). Identifying particular biopsychological patterns can help to better understand stress management in youth with externalizing behaviors and to improve clinical treatments. Sixteen adolescent males aged from 12 to 18 years were recruited in an institution for juvenile offenders. Exclusion criteria were insufficient reasoning abilities assessed using the Raven Matrices Test. Regarding psychological dimensions, constructive thinking was assessed through the Constructive thinking inventory (CTI), psychopathic traits through the Youth psychopathic traits inventory (YPI), externalizing behaviors through 30 items (out of 113) and 2 subscales (aggressive behavior and delinquency problems) from the Child behavior checklist-youth self-report (CBCL), and substance use through the Dep-ado. Regarding biological dimensions, cortisol daily secretion and regulation were assessed through saliva samples that were collected during 3 consecutive days (4 samples per day: directly after awakening, at 10 a.m., at 4 a.m., and before going to bed). Adolescent offenders presented maladaptative thinking styles and a particular neuroendocrine regulation in their daily management with stress. In particular, their level of cortisol in the morning was higher than those expected in a general population (20.34 nmol/L while the norm is around 10 nmol/L). They also showed more agressive and delinquent behaviors (CBCL) as well as more psychopathic traits (YPI) than the general population. Moreover, constructive thinking style was associated with personality and behavioral dimensions. Indeed, results indicated positive and significant correlations between categorical thinking style (CTI), psychopathic traits (YPI) (r=0.57, P=0.021) and externalizing behaviors (CBCL) (r=0.55, P=0.028). In other words, the more adolescent offenders used categorical thinking, the more they presented psychopathic traits and externalizing behaviors. With respect to the association between psychological and biological dimensions in stress management, we observed a significant and positive correlation between cortisol regulation and esoteric thinking (r=0.57, P=0.028) and a trend with superstitious thinking (r=0.47, P=0.075). The more adolescent offenders used esoteric and superstitious thinking, the poorer was their cortisol regulation. We also observed a trend between the life style scale of the YPI (i.e., impulsive, irresponsible) and the daily secretion of cortisol (r=0.51; P=0.052) as well as cortisol regulation (r=0.49, P=0.065). The more adolescent offenders presented psychopathic traits, the higher tended to be their daily secretion of cortisol and the poorer their cortisol regulation. Finally, cortisol regulation (r=0.54, P=0.038) and secretion (r=0.73, P=0.002) were significantly correlated with the DEP-Ado score. In other words, a poor cortisol regulation and a high secretion of cortisol seem to be associated with substance use. Adolescent offenders face an important amount of daily stress and do not always have the appropriate skills to deal with it. Indeed, we know from clinical experience that they often report a sense of hopelessness toward their lack of professional perspectives as well as familial conflicts which can be important stressors in addition to the incarceration in itself. Therefore, treatment aiming to improve psychic elaboration can help these adolescents to make their thinking styles more flexible and use more appropriate ways of coping with stress instead of externalizing behaviors and substance use. Moreover, considering the complex cases of these adolescents and the many changes of caregivers and institutions where they have lived, which can be important stressors as well, professionals working with these youth should be aware of their emotional reactions toward them and try to encourage continuity of care.

Bariatric and metabolic surgery (BMS) is currently the cornerstone of treatment for severe obesity. It produces significant and lasting weight loss in the vast majority of cases, which depends on the procedure performed, in any case much greater than that observed with non-surgical treatments. This weight loss along with direct metabolic effects of BMS, result in a substantial and lasting improvement in many obesity-related comorbidities, notably metabolic ones, sometimes with complete remission. This leads to a reduction in cardiovascular risk and mortality. Any BMS must be carried out by a multidisciplinary team, which will ensure lifelong follow-up in order to optimize results and prevent complications, including micronutrient deficiencies, by adequate supplementations.

Existing country image (CI) literature tends to focus on consumer behaviour. In contrast, this paper approaches CI from the point of view of the firm. In doing so, it seeks to identify the means by which international companies associate a brand with a specific country of origin in order to build brand values. In particular, it looks at the use of CI cues in brand strategies. The\ud paper is based on exploratory research comprising a case study of two contrasting companies from the cosmetics industry, Natura, a domestic company, and the French-owned L’Occitane, both of which draw on images of Brazil to build their brands. Specific elements of CI used in branding are identified, and the extent to which the use of these differs depending on the\ud origin of the owning company is explored. The cases suggest that CI can be exploited in different contexts. Through analysis of the elements used by both companies to build strong brands associated with the Brazilian CI—Natura Cosméticos and L’Occitane au Brésil—six tools are identified that can be combined by firms to deliver brand values, derived from any country, through the use of CI.