Search

Résumé: Le dumping syndrome est une des complications devant être dépistées par tout praticien après une chirurgie bariatrique en raison de sa fréquence, de ses conséquences potentielles et de l'accessibilité des mesures hygiéno-diététiques à mettre en place. Le dumping syndrome précoce est la conséquence de l'accélération de la vidange gastrique et de l'hyperosmolarité du bol alimentaire. Des modifications complexes du métabolisme du glucose peuvent également favoriser l'apparition de pics hyperglycémiques chez des sujets non diabétiques. Une sécrétion insulinique excessive médiée par les incrétines en réponse à ces pics hyperglycémiques participe à son tour à la survenue d'hypoglycémies, pouvant être sévères dans certains cas. Le diagnostic est clinique à l'interrogatoire, paraclinique avec la réalisation d'HGPO et de mises en place de dispositifs de mesure continue du glucose en centre spécialisé. Le fractionnement de l'alimentation, la réduction des quantités ingérées, le respect du délai entre les prises hydriques et les repas d'au moins trente minutes, la diminution voire l'élimination des aliments riches en glucides et à index glycémiques élevés sont les premiers messages à délivrer au patient. Des traitements médicamenteux hors AMM existent, l'acarbose étant à ce jour la molécule la plus simple d'utilisation en cas d'échec des mesures hygiéno-diététiques. The dumping syndrome is one of the complications to be detected by any practitioner after a bariatric surgery because of its frequency, its potential consequences and the accessibility of dietary and hygiene measures to put in place. The early dumping syndrome is the consequence of the acceleration of gastric emptying and the hyperosmolarity of the bolus. Complex changes in glucose metabolism may also promote hyperglycemic peaks in non-diabetic subjects. Excessive insulin secretion mediated by incretins in response to these hyperglycemic peaks in turn contributes to the occurrence of hypoglycemia, which may be severe in some cases. Diagnosis is clinical at the interrogatory, paraclinical with the realization of OGTT and implementation of devices of continuous measurement of the glucose in specialized center. The fractionation of the diet, the reduction of the quantities ingested, the respect of the delay between water intake and the meals of at least thirty minutes, the reduction or even the elimination of the foods rich in carbohydrates and with glycemic indexes are the first ones messages to deliver to the patient. Off-label medicinal products exist, acarbose being the simplest molecule of use to date in the event of failure of dietary and hygiene measures. [ABSTRACT FROM AUTHOR]

Bariatric surgery, combined with nutritional and psychological care and physical activity, is currently the most effective treatment for morbid obesity. The multidisciplinary team at the Caen Normandy obesity center explains the prerequisites of this therapeutic approach, and the monitoring and vigilance to be developed in partnership with the patient., (Copyright © 2023 Elsevier Masson SAS. All rights reserved.)

Résumé Objectifs de l'étude Évaluer les effets de la chirurgie bariatrique sur les paramètres anthropométriques et métaboliques chez des sujets tunisiens obèses morbides. Méthodes Il s'agit d'une étude rétrospective qui a inclus 47 sujets ayant une obésité morbide et qui ont bénéficié d'une chirurgie bariatrique entre 2004 et 2012. L'âge moyen était de 36,5 ± 8,9 ans et le sex-ratio de 0,08. Les données cliniques et paracliniques pré et post-opératoires ont été relevées à partir des dossiers médicaux des patients. Résultats La perte moyenne de l'excédent pondéral (PEP) était de 50,6 % [17,9–99,8]. Le taux d'échec (PEP < 25 %) était de 21,3 %. Le by-pass gastrique était l'intervention qui a permis d'obtenir les meilleurs résultats en termes de perte de poids (PEP de 63,4 %), suivi de la pose d'un anneau gastrique (PEP = 54,5 %) et de la sleeve gastrectomie (PEP = 40,8 %). Les taux de rémission de l'hypertension artérielle, du diabète de type 2, de l'hypercholestérolémie, de l'hypertriglycéridémie et de l'hyperuricémie étaient respectivement de 40 %, de 75 %, de 17 %, de 75 % et de 68 %. Conclusion Notre étude a prouvé l'efficacité de la chirurgie bariatrique chez nos patients obèses morbides dans l'obtention d'une PEP significative et dans la rémission des comorbidités. Abstract Aims of the study To investigate the effect of bariatric surgery on anthropometric and metabolic parameters in morbidly obese Tunisian subjects. Methods It is a retrospective study including 47 morbidly obese patients who have had a bariatric surgery between 2004 and 2012. The mean age was 36.5 ± 8.9 years and the sex ratio 0.08. Pre- and post-operative clinical and paraclinical parameters were collected from patients' medical records. Results Mean excess weight loss (EWL) was 50.6% [17.9–99.8]. Failure rate (EWL < 25%) was 21.3%. Gastric bypass surgery was the intervention which led to the best weight loss rate (EWL of 63.4%), followed by gastric banding (EWL = 54.5%) and sleeve gastrectomy (EWL = 40.8%). The remission rates from hypertension, type 2 diabetes mellitus, hypercholesterolemia, hypertriglyceridemia and hyperuricemia were 40%, 75%, 17%, 75% and 68% respectively. Conclusion This study has proven the efficiency of bariatric surgery in morbidly obese Tunisian patients in achieving a significant EWL and in the remission of the comorbidities. [ABSTRACT FROM AUTHOR]

Obesity and one of its corollaries, type 2 diabetes, are real public health problems. The failure of "traditional" medical treatments has favored the development of surgery, recognized as one of the most effective long-term treatments. Metabolic surgery (a term that replaces that of bariatric surgery) is a real therapeutic alternative for patients with type 2 diabetes. The latest recommendations advocate early integration among the therapeutic options to be considered, particularly in patients with severe obesity or with insufficiently controlled diabetes. Surgical treatment is a last resort and is conceived in the continuity of a coordinated care path, with a follow-up of the patient before and after the surgery. HAS recommends the establishment of a therapeutic education program to optimize its effectiveness and tolerance. But the current craze for bariatric surgery should not overshadow its evaluation with little data on the long term. [ABSTRACT FROM AUTHOR]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Les bénéfices de la chirurgie bariatrique pour les patients atteints d'obésité de classe II et III sont bien établis, et s'exercent via des effets sur le diabète de type 2 et sur la dyslipidémie liée à l'insulinorésistance. Cette revue de littérature suggère que cette chirurgie, dite métabolique, induit également une réduction de l'incidence de l'hypertension artérielle, de l'insuffisance cardiaque et de la fibrillation auriculaire, ainsi qu'une amélioration de l'insuffisance cardiaque et une réduction des évènements cardiovasculaires, fatals et non fatals. Les indications pour la chirurgie bariatrique sont une obésité de classe III sans comorbidité métabolique ou une obésité de classe II associée à une hypertension artérielle, à un diabète de type 2, à un syndrome d'apnées du sommeil ou à une stéatose dysmétabolique. Du fait du risque de complications nutritionnelles et psychologiques, une chirurgie doit être précédée et suivie d'une prise en charge pluridisciplinaire associant médecin nutritionniste, diététiciens, psychologue, spécialistes en activité physique et incluant le médecin traitant. [ABSTRACT FROM AUTHOR]

Résumé Objectifs Il s’agit dans cet article d’interroger les nouvelles pratiques de chirurgie bariatrique dans la clinique de l’obésité puisque les effets qu’elles produisent peuvent s’avérer mystérieux sur le plan organique, parfois problématiques, jusqu’à mettre en échec la démarche thérapeutique initiale. Chez une majorité de patients opérés, l’apparition de modifications olfactives et gustatives à la suite de l’intervention met en lumière le fait que la transformation du corps réel par la chirurgie provoque des effets de remaniements non seulement organiques mais aussi psychiques. Ce bouleversement de l’organisation pulsionnelle et des investissements libidinaux, soutenu par les modifications corporelles, prendrait sa source dans l’actualisation du mécanisme du refoulement « organique » chez le patient opéré. Convoqué par la clinique, ce concept freudien oublié permettrait de tirer des pistes de réflexion pour la compréhension théorique et l’amélioration de la prise en charge psychique des sujets en situation d’obésité et opérés d’une chirurgie bariatrique. Méthode Les patients rencontrés ont été opérés d’une chirurgie bariatrique de type Sleeve gastrectomie ou de type Bypass gastrique . Il a été proposé aux patients de parler de leur expérience de la chirurgie bariatrique et du retentissement des modifications corporelles sur leur comportement alimentaire, sur leur rapport au corps et sur leur rapport à l’autre. Résultats Les modifications psychosensorielles post-chirurgicales attesteraient de l’actualisation du processus de refoulement « organique » et du remaniement de l’organisation pulsionnelle qui lui est connexe. La coupure du corps réel provoquée par ce type d’intervention va avoir des incidences sur le refoulement « organique » qui va s’actualiser et se renforcer chez le sujet opéré. Les représentations qui, avant l’intervention, amenaient le sujet vers un plaisir organique et psychique auto-érotique vont être ainsi réprimées du champ de la conscience car les conditions d’accès à ce plaisir érogène ont été modifiées. Les objets, notamment alimentaires, qui se liaient par association à ces représentations refoulées, seront perçus consciemment par le sujet comme vecteurs de déplaisir. Ces objets, auparavant source d’un certain plaisir érogène pour le sujet, vont ainsi devenir objets de dégoût et de répulsion après la survenue des changements corporels. Discussion Les changements olfactifs et gustatifs dans la perception des aliments représenteraient non seulement l’impact de la chirurgie sur la vie psychique du sujet opéré, mais signaleraient paradoxalement que derrière les aliments qui « refoulent » et qui sont maintenant mis à distance par le sujet se cacherait en réalité ce qui a été refoulé psychiquement lors de l’actualisation du refoulement « organique ». Ces modifications psychosensorielles sélectives et les relations alimentaires particulières qui sont visées par ces changements semblent être régulièrement mises en lien par les patients eux-mêmes avec certains aspects de leur histoire personnelle et intime, avec des souvenirs ou des représentations d’évènements dans lesquels la sexualité infantile s’est retrouvée dans l’écueil, parfois traumatique, du rapport à l’autre. La verbalisation de ces souvenirs-écrans, convoqués depuis ces changements perceptifs sélectifs issus de l’actualisation du refoulement « organique », ouvrirait ainsi une nouvelle voie d’accès vers l’élaboration d’une vérité subjective inconsciente pouvant, par ailleurs, être en lien avec l’édification de la construction symptomatique de l’obésité. Conclusion Cette étude souligne l’importance du refoulement « organique » pour penser ces modifications psychosensorielles sélectives après la chirurgie bariatrique et pour comprendre le réaménagement psychique conduisant à ces changements du comportement alimentaire. Il conviendrait de prendre en considération l’impact des éléments spécifiques présents dans la construction symptomatique de l’obésité (oralité, image du corps, structuration familiale), en fonction de leurs différentes modalités d’expression pour chaque sujet, sur le refoulement « organique » après la modification chirurgicale du corps. Mais il s’agirait également de cerner, dans la construction symptomatique propre à chaque sujet, les formes prises originairement par le refoulement « organique » avant même son actualisation par les effets de la chirurgie bariatrique. Ces deux étapes (pré et post-opératoire) sont essentielles pour la compréhension des éléments psychiques conduisant à un échec thérapeutique dans le traitement chirurgical de l’obésité, afin d’améliorer les soins et de limiter une rechute de la maladie. Objectives This study aimed to investigate the new practices of bariatric surgery in the clinical treatment of obesity, since the effects produced by these procedures are organically enigmatic, sometimes problematic, and may cause treatment failure. Thus, in many operated patients, the psycho-sensory changes following surgery, such as olfactory and taste mutations (from “pleasure” to “displeasure”), show that these technical transformations of the body cause organic, and also psychic reorganizations. These disturbances in instinctual organization and in libidinal investments, underpinned by profound bodily changes, seem to originate from the updating of the mechanism of “organic” repression in the patient. Derived from clinical practice, this forgotten Freudian concept raises points of interest for the theoretical understanding and improvement of the psychic management of patients with obesity undergoing bariatric surgery. Method The patients investigated were treated with bariatric surgery, including Sleeve gastrectomy or Roux-en-Y Bypass . They were asked to comment on their experience of bariatric surgery and on the impact of the body changes on their eating behaviours, their relationship with the body and with the others. Results In most of the patients, bariatric surgery brought about olfactory and taste changes. These psycho-sensory changes seem to attest to an updating of the process of “organic” repression and to a restructuring of the associated instinctual organization. In these patients, cutting into the reality of the body appears to have an impact on “organic” repression, which is reshaped, updated and reinforced for most of the operated subjects. Consequently, the representations that, before surgery, brought the subject organic, psychic, self-erotic pleasure appear to be repressed from the field of consciousness because the conditions underpinning access to this erotic pleasure have been altered. Therefore objects, in particular food items, which are bound by association to these repressed representations, could be consciously perceived by the operated subject as vectors of displeasure. These objects, previously providing erogenous pleasure, will thus become sources of disgust and repulsion following the bodily changes. Discussion The olfactory and gustatory modifications in the perceptions of food observed after bariatric surgery underline the impact of this procedure on the psychic life of these patients. Behind the “disgusting” foods now pushed away could lie what was repressed when the “organic” repression was updated. These selective psycho-sensory changes and the dietary relationships affected by these changes seem to be regularly linked by the patients themselves to certain aspects of their personal and intimate history, including memories or representations of events in which infantile sexuality was confronted with the pitfalls of relationships with the others. The verbalization of these screen-memories, appearing after these selective perceptive changes and resulting from the updating of “organic” repression, could thus open a new way of access to the elaboration of an unconscious subjective truth, which may be linked to the elaboration of the symptomatic construction of obesity. Conclusion This study underlines the importance of the notion of “organic” repression to approach these psycho-sensory changes after bariatric surgery and to understand the psychic reorganization leading to these changes in eating behaviour. It is important to consider the impact on the process of “organic” repression of the specific elements present in the symptomatic construction of obesity (orality, body image, family structure), according to their different modes of expression for each subject, following surgical modification of the body. In addition, it is important to understand the forms originally taken on by “organic” repression, before its reshaping or updating by the effects of bariatric surgery, in the light of the specificity of the symptomatic construction of each subject. These two pre- and post-operative steps are essential in the understanding of the psychic elements leading to therapeutic failure in the surgical treatment of obesity, in order to improve quality of care and to limit relapses. [ABSTRACT FROM AUTHOR]

Résumé Actualités La chirurgie bariatrique a pris une place importante dans le traitement de l’obésité mais son efficacité à long terme est compromise dans 20–30 % des cas par des reprises de poids. L’activité physique pourrait être une stratégie préventive et/ou curative de ces échecs secondaires. Nous présentons une revue générale des études portant sur l’activité physique après chirurgie bariatrique. Pour cela, nous avons sélectionné 11 articles ayant étudié l’effet d’un protocole d’activité physique postopératoire. De manière globale, l’activité physique a des effets positifs sur le système cardiovasculaire, le maintien de la capacité fonctionnelle et musculaire, l’insulino-sensibilité et le métabolisme des lipides. Les effets sur le poids sont un peu discordants mais les protocoles réalisés après la phase initiale de perte de poids rapide et sur une durée suffisante retrouvent perte de poids supérieure à celle qu’induit la chirurgie bariatrique seule. Cet effet renforçant celui de la chirurgie sur la perte de poids est observé avec l’activité en endurance à faible intensité et notamment celle qui est ciblée au LIPOXmax, et n’est pas retrouvée avec l’endurance à plus haute intensité ou la résistance. Conclusion En résumé, l’ensemble des articles présentés montrent des effets bénéfiques sur les comorbidités et complications de l’obésité. Cependant, les protocoles d’entraînement sont hétérogènes entre les études. Des études complémentaires sont nécessaires afin de mieux préciser les stratégies les plus adaptées. Summary News Bariatric surgery has taken a large place in the modern treatment of obesity but its long-term effectiveness is compromised in 20–30% of cases by weight regain. Physical activity could be a preventive and/or curative strategy for these secondary failures. We present a general review of physical activity studies after bariatric surgery. For this purpose, we selected 11 articles that studied the effect of a postoperative physical activity protocol. Globally, physical activity has positive effects on the cardiovascular system, maintenance of functional and muscular capacity, insulin sensitivity and lipid metabolism. The effects on weight are somewhat discordant but the protocols carried out after the initial phase of rapid weight loss and for a sufficient length of time find more weight loss than that induced bariatric surgery alone. This effect reinforcing that of surgery on weight loss is observed with low intensity endurance activity and especially exercise training targeted at the LIPOXmax, while is not clearly evidenced with protocols using higher intensity endurance or resistance training. Conclusion in summary, all the articles analyzed here show beneficial effects on comorbidities and complications of obesity. However, training protocols are heterogeneous. Further studies are needed to better define the most appropriate exercise strategies. [ABSTRACT FROM AUTHOR]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé La chirurgie bariatrique est reconnue comme une modalité à part entière du traitement de l’obésité sévère mais aussi de ses comorbidités. De nombreux centres de chirurgie bariatrique encouragent, voire imposent à leurs patients, une perte de poids durant la période pré-opératoire. Le but de cet article est de faire le point sur cette question et de proposer une attitude pratique dans l’attente de données concluantes. L’analyse de la littérature actuelle ne permet pas de conclure de façon univoque concernant l’intérêt de la perte de poids pré-opératoire dans le cadre de la chirurgie bariatrique. Il n’y a donc actuellement pas d’argument suffisant pour considérer que la perte de poids est un prérequis systématique à la chirurgie bariatrique. Le seul bénéfice démontré est la réduction de la taille du foie. Il reste cependant à démontrer par des études prospectives randomisées que la réduction du volume hépatique engendrée par la perte de poids pré-opératoire est accompagnée d’une réduction des complications per- et postopératoires sans risque de dénutrition. Bariatric surgery is recognized as a modality in its own right for the treatment of severe obesity but also of its comorbidities. Many centers of bariatric surgery encourage or even impose on their patients a weight loss before surgery. The purpose of this paper is to review the rationale of this practice and to propose a practical attitude in the expectation of conclusive data. The analysis of the current literature does not make it possible to conclude unequivocally about the value of preoperative weight loss in the context of bariatric surgery. There is thus currently no sufficient argument to consider that weight loss is a systematic prerequisite for bariatric surgery. The only benefit demonstrated is the reduction in liver size. It remains however to be demonstrated by randomized prospective studies that the reduction in hepatic volume caused by preoperative weight loss is accompanied by a reduction in per- and postoperative complications without any risk of undernutrition. [ABSTRACT FROM AUTHOR]

Résumé L’exemple de la prise en charge du patient en chirurgie de l’obésité permet de définir le rôle du pharmacien d’officine au sein d’une équipe pluridisciplinaire dans le cadre d’une évolution professionnelle. Il y met en œuvre ses qualités d’écoute et d’empathie, établit un lien entre le malade et les professionnels de santé et, grâce à sa spécialisation en micronutrition, intervient à toutes les étapes de l’accompagnement. Retour d’expérience. Summary The example of the treatment of a patient through bariatric surgery helps to define the role of the community pharmacist within a multidisciplinary team in the framework of professional development. He demonstrates his empathy and effective listening skills, establishes a connection between the patient and the health professionals and, thanks to his specialisation in micronutrition, provides guidance and support to the patient at every stage of the care. [ABSTRACT FROM AUTHOR]

Résumé La dénutrition chez le patient obèse, à l’instar du patient non obèse, expose à de nombreuses conséquences cliniques et aboutit à un accroissement de la morbi-mortalité mais reste fortement sous-estimée. Il est donc impératif de la prévenir, de la dépister et de la prendre en charge le plus tôt possible surtout chez les patients à risque ou fragilisés par une maladie chronique. Cependant, la définition et les critères de diagnostic de la dénutrition destinés aux sujets adultes non obèses sont mis en défaut en raison des particularités cliniques, morphologiques et biologiques liées à l’adiposité excessive. Dans un domaine où il n’existe pas de consensus, cette synthèse a pour objectif de souligner les difficultés d’appréciation de la dénutrition dans cette circonstance et d’apporter des éclaircissements sur les paramètres de l’évaluation de la dénutrition et leurs limites en situation d’obésité. Undernutrition in the obese patient, like the non-obese patient, has numerous clinical consequences and leads to an increase in morbidity and mortality, but it is still underestimated. It is therefore imperative to prevent, detect and manage it as early as possible especially in patients at risk or weakened by a chronic disease. However, the definition and diagnostic criteria for undernutrition in non-obese adult subjects are flawed due to the clinical, morphological and biological characteristics associated with excessive adiposity. In an area where there is no consensus, the aim of this review is to highlight the difficulties in assessing undernutrition in this circumstance and to clarify the parameters of undernutrition assessment and their limits in the situation of obesity. [ABSTRACT FROM AUTHOR]

Résumé Après une chirurgie bariatrique, le risque de carence nutritionnelle dépend de l’importance de la perte de poids et du type de chirurgie ; les techniques purement restrictives (anneau gastrique) peuvent induire des troubles digestifs, une intolérance pour certains aliments et des comportements alimentaires mal adaptés en rapport avec des troubles du comportement alimentaire pré- ou postopératoires. Les apports en micronutriments, très réduits pendant la phase d’amaigrissement, justifient une supplémentation systématique en multivitamines comportant des éléments traces. Le « gastric bypass » entraîne une malabsorption de certains micronutriments. La « sleeve gastrectomy » semble entraîner un risque de carence moindre qu’après « gastric bypass » mais néanmoins significative à court terme, justifiant un dépistage régulier et souvent une supplémentation. La carence en fer est fréquente après les trois types d’intervention et concerne particulièrement les femmes non ménopausées. Le « gastric bypass » augmente le risque de carences en fer. La supplémentation n’est pas systématique mais pourrait se discuter chez les femmes avant la ménopause. Après cette intervention, la malabsorption du calcium et de la vitamine D entraîne un risque d’ostéoporose accéléré, notamment chez les femmes au moment de la ménopause. Le risque de carence en vitamine B12 est extrêmement élevé après « gastric bypass » et justifie d’une supplémentation systématique. L’encéphalopathie de Gayet-Wernicke n’est pas rare, notamment en cas d’intolérance alimentaire et de vomissements prolongés. Quelle que soit la technique chirurgicale, la surveillance nutritionnelle, la prescription de suppléments appropriés et la surveillance de l’adhésion des patients à ces mesures s’imposent. Ces patients doivent donc être suivis régulièrement et au long cours. Obese patient is at risk of undernutrition, due to specific deficiencies or sarcopenia. After bariatric surgery, the risk of nutritional deficiency depends on the weight loss and the type of surgery; restrictive procedures (as gastric banding) can induce digestive disorders, food intolerance and inappropriate dietary behaviors related to pre- or postoperative eating disorders. Low micronutrient intake during weight loss justifies a systematic supplementation with multivitamins with trace elements. Gastric bypass causes micronutrients. Sleeve gastrectomy leads to a lower risk of deficiency than gastric bypass but significant in the short term, justifying regular screening and supplementation. Iron deficiency is frequent after these three interventions and especially in non-menopausal women. Gastric bypass increases the risk of iron deficiency. Supplementation is not systematic but may be discussed in women before menopause. After gastric bypass, the malabsorption of calcium and vitamin D leads to a risk of accelerated osteoporosis, especially in women at the time of menopause. The risk of vitamin B12 deficiency is extremely high after gastric bypass and justifies systematic supplementation. Gayet-Wernicke encephalopathy is not uncommon, particularly in cases of food intolerance and prolonged vomiting. Regardless of the surgical technique, nutritional monitoring, appropriate supplementation and monitoring of patient adherence to these measures are required. These patients should therefore be monitored regularly and over the long term. [ABSTRACT FROM AUTHOR]

Résumé L’obésité infantile, caractérisée par un excès de masse grasse, est devenue ces dernières années un véritable problème de santé publique en raison de l’augmentation régulière de sa prévalence depuis trente ans et de ses complications à long terme si elle persiste à l’âge adulte. Si la dénutrition à proprement parler est rare chez l’enfant obèse, cette population est à risque de carences. L’hypovitaminose D concerne plus d’un enfant sur trois et nécessite une supplémentation systématique par 100000 UI de vitamine D tous les trois mois. La carence martiale est fréquente comme décrit dans la population pédiatrique et doit être dépistée. Certains déficits en vitamines du groupe B sont aussi décrits, mais sont plus rares. De plus, l’émergence de la chirurgie bariatrique chez les moins de 18 ans avec réalisation de manchon gastrique, voire de by-pass augmente ce risque de dénutrition à moyen et long terme, en particulier, en cas de mauvaise compliance aux supplémentations à l’instar de ce qui est observé chez l’adulte. Recently, childhood obesity, defined by an excessive fat mass, has become a major public health problem due to its steady increased prevalence over the last thirty years and its long-term complications if it persists during adulthood. Although malnutrition is rare in obese children, this population is at risk for iron and vitamin deficiencies. Hypovitaminosis D affects more than one in three children and requires systematic supplementation per 100,000 IU of vitamin D every three months. Iron deficiency is common as described in the pediatric population and must be detected. Specific vitamin of group B deficiencies is also described but is more rare. In addition, with the emergence of bariatric surgery in teenagers with sleeve gastrectomy or gastric by-pass, the risk of malnutrition will increase throughout life, especially in the case of poor compliance with vitaminic supplements as observed in adults. [ABSTRACT FROM AUTHOR]

Copyright of Revue d'Orthopédie Dento-Faciale is the property of Parresia and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé La thiamine (vitamine B1) est une vitamine hydrosoluble présente dans la levure de bière, la pulpe des fruits crus, les germes de céréales et les produits d’origine animale. Après absorption, elle est phosphorylée dans le foie et est un cofacteur d’enzymes intervenant dans le métabolisme énergétique et de l’alcool. Le magnésium est un cofacteur impliqué dans son métabolisme et son déficit est un facteur de résistance à la supplémentation. Les réserves sont quasi inexistantes. En dehors de l’alcoolisme, le déficit est lié à une carence d’apport, secondaire à vomissements ou diarrhée, à une malabsorption ou à une alimentation riche en glucide et carencée en vitamine B1 ou certains médicaments. Une forte susceptibilité génétique est en cause. Son dosage sanguin est faiblement contributif, ne représentant qu’un faible proportion du stock de l’organisme. Au niveau clinique, la forme « sèche » neurologique est l’encéphalopathie de Gayet-Wernicke, associée ou non à un syndrome de Korsakoff et la polynévrite résultant de carences multiples. La forme dite « humide » est une insuffisance cardiaque. La prévention de cette carence doit être systématique chez tout patient qui présente des troubles digestifs et une carence d’apport et chez tout patient à risque de syndrome de renutrition inappropriée. En cas de signes neurologiques évocateurs, le traitement doit être mis en route sans attendre les résultats du dosage et associé à une supplémentation en magnésium. Il faut prévenir et traiter de façon empirique tout patient suspect de carences, sans se préoccuper des résultats des dosages plasmatiques. Thiamine (vitamin B1) is a water-soluble vitamin. The richest natural sources are brewer's yeast, raw fruits (in the pulp) and cereal germs, but also animal products. It is absorbed by active and saturable transport in the proximal small intestine and phosphorylated in the liver (into an active form). It is an essential cofactor of enzymes involved in energy and alcohol metabolism. Magnesium is a major cofactor involved in the metabolism of thiamine and a factor of resistance to supplementation. Thiamine flows in the formed elements of the blood and stocks are virtually nil, so signs of deficiency can appear quickly. The causes of deficiency are often multifactorial. Apart from alcoholism, insufficient intake is due to digestive symptoms (vomiting, diarrhea) or malabsorption, or a carbohydrate rich diet and poor in thiamine. Some medications may also worsen the deficit. A high genetic susceptibility may explain the variability of clinical presentations, i.e. dry vs. wet B1 deficiency. The testing of blood vitamin B1 is weakly contributory, since it only represents a very small proportion of the body's stock. Two clinical presentations are conventionally described: the “dry” is the neurological one: Wernicke encephalopathy, sometimes associated with a Korsakoff syndrome, and a polyneuropathy, resulting mainly from nutritional disorders including deficiencies in all group B vitamins; its prevalence is largely underestimated; the “wet” one mainly includes cardiac insufficiency. The prevention of these clinical deficiencies must be systematic in all patients with digestive disorders, including prolonged vomiting and diarrhea, and in any patient at risk of refeeding syndrome, a situation also described after digestive surgery, especially obesity surgery, using oral or parenteral supplementation. In case of evocative neurological symptoms, B1 supplementation must be initiated without delay, combined with a magnesium supplementation, and without waiting for the blood test results. The absence of B1 toxicity, even with large doses, and the imperfection of biological markers encourage the preventive and empirical treatment of all patients suspected of thiamine deficiency, without worrying about blood level. [ABSTRACT FROM AUTHOR]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Obesity is a chronic disease with alarming prevalence and consequences. In France, some healthcare organizations were set to offer care for obese patients on the whole territory. As any other healthcare professionnal, the pharmacist, especially in the community setting, should play a role in the obese care pathway. The aim of our project was to survey the knowledge of pharmacists about obese pharmaceutical care before and after bariatric surgery and to identify pharmaceutical care expectations from obese patients from the community pharmacist. A questionnaire was set and sent to community pharmacist to determine their knowledge and role for obese patients. In parralel, we carried out semi-directed interviews and one focus groupe among obese patients to determine their feelings about their disease and observations about pharmaceutical care received. Ninety four per cent of pharmacist responders monthly met at least one patient obese patient. Their knowledge was satisfaisant for the disease definitions. However, there were some lack of knowledge about surgery techniques and physiologic particularities of obese patient after surgery. Patient interviews showed that patient were expecting feedback and counseling from their pharmacist and so far admited that pharmacist were lacking of knowledge about obese pharmaceutical care. Currently, the pharmacist is not really commited into the obese patient care pathway which explains why its role is limited. The obese patients wished their pharmacist would be able to detect obesity, refer them to dedicated obese structure and offer them some appropiate pharmaceutical care. Finally, some education and information tools were designed to contribute to the pharmacist training. [ABSTRACT FROM AUTHOR]

Résumé Le pharmacien d’officine joue un rôle indispensable dans le suivi des patients obèses dont la prise en charge thérapeutique est pluridisciplinaire. Le respect des règles hygiéno-diététiques est indispensable avant d’envisager une chirurgie bariatrique et/ou un traitement médicamenteux. Summary The community pharmacist plays an essential role in the follow-up of obese patients whose treatment is multi-disciplinary. Following specific lifestyle and dietary advice is essential before envisaging bariatric surgery and/or pharmacological treatment. [ABSTRACT FROM AUTHOR]

Cholelithiasis is a common complication of obesity and its treatment. Obesity triples the risk of gallstones in women and doubles it in men, in adults and in adolescents. Therapeutic weight loss (medical or surgical) increases the risk of cholelithiasis especially when fast (more than 1.5 kg/week), and in the first 6 months. Stones are usually made of cholesterol. Obesity increases the hepatic secretion of cholesterol, which leads to cholesterol supersaturation of bile. A decreased gallbladder motility and intestinal transit also play an important role. It is unclear whether obesity modifies cholesterol nucleation. Rapid weight loss further increases the saturation of bile (by mobilization of peripheral cholesterol and decreased synthesis of bile acids and phospholipids), increases the nucleation, and decreases gallbladder emptying. The risk of symptoms and complications increases in parallel to that of stone formation, and could be increased with age and the magnitude of weight loss. The morbidity and mortality of biliary acute pancreatitis are increased in obesity. To prevent gallstone formation, restrictive diets should not go below 1,000 kCal/day. Sufficient fat intake should be maintained to stimulate gallbladder contraction. Cholecystectomy before weight loss (including prior to bariatric surgery) is only indicated in cases of symptomatic or complicated stones, because it increases the morbidity and mortality of bariatric surgery when done for asymptomatic gallstones. The administration of ursodeoxycholic acid for 6 months at a dose of 500-600 mg/day significantly reduces the risk of cholelithiasis after dietary weight loss (from a mean of 19% to 3.5%) or bariatric surgery (from 29% to 9%), with a parallel decrease in the risk of symptomatic disease. [ABSTRACT FROM AUTHOR]

Background: After massive weight loss (MWL), the chest in men may show significant deformities. The surgical treatment of gynecomastia after MWL remains a difficult and partially misunderstood surgery due to 4 main factors: a complex excess of skin in height and width that sometimes continues in the axilla or dorsal region, a predominantly fatty rather than glandular component, the malposition of the nipple-areola complex (NAC) that is often enlarged and an inframammary fold (IMF) that is often marked. The techniques currently described are either insufficient or lead to frequent and/or significant complications. The authors describe a new approach that dissociates the treatment of the volume and the skin with a customized resection that is simple, reproducible and safe. Our goal is to improve patient satisfaction while reducing complication rates., Methods: Seventeen patients with adipomastia with excess skin after massive weight loss were operated on using liposuction and skin redraping technique. The authors describe the technique, indications and contraindications of the procedure and analyze the results., Results: The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7kg/m 2 , the average weight loss before body correction is 49kg, with an average delta of BMI loss of 15,34kg/m 2. The average stay in hospital is 1,3 nights. No patient had major complications (hematoma, hemorrhage, necrosis, thrombophlebitis, immediate surgical revision to treat complications). Minor complications including scar dehiscence, infection, steatonecrosis, and distant scar correction were reported in 2 patients, i.e. 11%., Conclusion: Liposuction assisted and desepidermization torsoplasty is a new technique for correction of pseudogynecomastia in MWL patients. The results are reproductible and the complication rates are low. There is no dead space and therefore no drains are needed. There is little pain and a short hospital stay. This technique is simple, quick and easy to learn. However, it is only applicable in adipomastia. A different technique should be used in the presence of firm glandular tissue., (Copyright © 2023. Published by Elsevier Masson SAS.)

The goal of this work was to find the main predictive factors of postoperative complications, other than smoking, after abdominoplasty or bodylift concerning sequelae of post-bariatric weight loss., Patients and Method: A retrospective monocentric study, including abdominoplasties or bodylift, after bariatric surgery was carried out between 01/01/2016 and 12/31/2019. The following were excluded: active smokers, non-bariatric patients and/or patients who had already had an abdominoplasty or body lift and/or who had undergone combined surgery., Results: 105 patients were included (73 bodylifts, 32 abdominoplasties). 68% presented at least one complication. The majority of them only resulted in an extension of local care. The serious complication rate was 2.9%. The risk factors for complications were: a young subject (P=0.014), greater weight loss (P=0.03), longer delay between bariatric surgery and plastic surgery (P=0.0002), performing a bodylift versus an abdominoplasty (P<0.01), gastric banding (P=0.029). Conversely, the bypass appeared to be a factor limiting post-sequelae complications of weight loss (P=0.041). The predictive complication model from the multivariate study concludes that the type of plastic surgery and preoperative BMI play a major role in the risk of complications., Conclusion: Surgery for abdominal weight loss sequelae presents frequent but generally benign complications. Preoperative patient information must therefore be adapted according to initial obesity and the extent of weight loss., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Anal incontinence (AI) prevalence in general population is estimate to range from 1.4 to 19.5% (Wexner ≥ 1). Obesity could be an AI risk factor. However, AI prevalence in patients with obesity is not clearly established. The main objective of this study was to assess the prevalence of AI in patients with extreme obesity prior to bariatric surgery and to identify specific AI risk factors in this subset of patients., Material: A cross-sectional study, in a tertiary referral center in obesity was performed during one year. Patients who presented criteria for bariatric surgery (BMI>40 or BMI > 35 with co-morbidities) were asked to fill in preoperative self-questionnaires. A Wexner score ≥ 3 was used to define AI to identified patients who had a clinic impact of AI, by frequency of symptoms or alteration of quality of life., Results: Two hundred and fifty patients were included. Corresponded to, 196 women (78.4%) and 54 men (21.6%). Median BMI was 44.53kg/m 2 . AI was diagnosed in 41 patients (prevalence 16.4%, 95CI 0.59). Constipation, urinary incontinence and the history of pregnancy (P = 0.03, OR 2.79; P = 0.01, OR 3.53 and P=0.02, OR 4.71, respectively) were significantly associated with AI., Conclusion: AI is frequently observed in patients with extreme obesity scheduled for bariatric surgery and should be routinely evaluated. Modifiable risk factors as constipation should be manage before surgery as well as the specific management of AI, to prevent AI exacerbation after surgery. The choice of bariatric surgical procedure should be discussed and evaluated for the treatment of patients with obesity and AI., Level of Evidence: Moderate., (Copyright © 2022 Elsevier Masson SAS. All rights reserved.)

Résumé L’obésité atteint des proportions pandémiques et la chirurgie bariatrique est de plus en plus fréquente. Des complications neurologiques de cette chirurgie sont rapportées et les praticiens devront apprendre à les reconnaître et à les prendre en charge. Ces complications peuvent résulter de mécanismes immuns, inflammatoires, mais surtout de déficits nutritionnels. Les déficits en vitamine B12, folates, thiamine, vitamine D, et vitamine E sont les plus fréquemment rencontrés. Différents tableaux peuvent être observés selon le délai de survenue après la chirurgie. À la phase précoce, les lésions nerveuses périphériques immédiates, l’encéphalopathie de Gayet-Wernicke et les polyradiculonévrites aiguës sont observées. Les complications tardives peuvent apparaître après plusieurs années et comprennent les neuropathies optiques, les myélopathies, les neuropathies périphériques et les myopathies. Les patients de chirurgie bariatrique doivent bénéficier d’un suivi nutritionnel attentif avec monitoring des micronutriments tous les 6 mois après la chirurgie et supplémentation multi-vitaminique à vie en cas de chirurgie malabsorptive. The number of bariatric surgery procedures is increasing. Neurological complications of such procedures are being more and more reported. They may result from mechanical, inflammatory mechanisms, but mainly from nutritional deficiencies. Vitamin B12, folate, thiamine, vitamin D and vitamin E are the most frequent deficiencies. At an early stage, immediate peripherical nerve injury, Wernicke encephalopathy, and polyradiculoneuropathy are the more frequent. Late complications include optic neuropathy, myelopathy, peripherical neuropathy, and myopathy. [ABSTRACT FROM AUTHOR]

Copyright of Obésité is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Résumé La lombalgie et l’obésité sont deux problèmes banals et importants de santé publique. Ces deux entités complexes sont associées par des phénomènes biopsychosociaux. Il est maintenant admis que la lombalgie est fréquemment associée à l’obésité mais les mécanismes de cette association restent peu clairs. La perte pondérale sous surveillance médicale améliore différents types de douleurs musculo-squelettiques chez les patients obèses. Toutefois, à ce jour, la chirurgie bariatrique permet une perte pondérale plus rapide que la restriction calorique alimentaire associée à la pratique d’une activité physique quotidienne. Par la chirurgie bariatrique, associée à un programme d’éducation pré- et post-chirurgical, différentes études ont clairement montré qu’une perte de poids importante était suivie d’une diminution de la lombalgie, et, en parallèle, d’une diminution des incapacités et d’une augmentation de la qualité de vie. Toutefois, différents aspects restent non résolus : par quels mécanismes ces améliorations sont-elles obtenues ? Y a-t-il une relation entre la réduction pondérale, les modifications de la composition corporelle et les différentes anomalies structurelles et fonctionnelles observées chez les patients souffrant de lombalgie et obèses. Low back pain and obesity are two important common and public health problems. These two complex entities are associated to biopsychosocial phenomena. It is now admitted that low back pain is frequently associated to obesity but the mechanisms of this association remain unclear. Medically supervised nonsurgical weight loss improved different types of musculoskeletal pain in obese patients. Though, to day, bariatric surgery allows a more rapid weight loss than a caloric diet restriction in association with a daily physical activity. By a bariatric surgery, associated with a pre- and post-surgery educational program, different studies have clearly shown that such a large weight loss is followed by a decrease of the pain intensity and, in parallel, by a rapid decrease of disabilities and an increase of the quality of life. Though, different aspects remain unresolved: by which mechanisms these improvements are obtained? Is there a relationship between the weight reduction, the body composition and different structural and functional abnormalities observed in low back pain and obese patients? [ABSTRACT FROM AUTHOR]