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The origins of obesity tan be traced back at least 25000 years. In the Stone Age, in the Middle Ages, and in the 17th century overweight indicated prosperty, power, and fertility, but already Hippocrates described obesity as a disease in the Antique. The first academic papers dealing with adiposity were published in the times of the Industrial Revolution. In the 19th century a pharmaceutical treatment boom against overweight emerged- people had to deal with quackery and dangerous remedies like amphetamines that flooded the market. Bariatric surgery was introduced in the 20th century- todays goldstandard is the RYGB operation. Dealing with morbid obesity and its comorbidities is nowadays one of the serious problems in the field of public health. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery is the treatment of choice for morbid obesity, however all patients do not achieve the same weight loss post surgery, for reasons that might be partially psychological. Objective: The goals of our study were (1) to evaluate changes in psychological factors three years post gastric bypass and (2) to explore the predictive value of psychological factors on weight loss three years post surgery. Method: Ninety-eight patients filled in self-report questionnaires on psychological health (HAD for anxiety and depression) and eating disorders (EDI-2) before bariatric surgery and were contacted to fill in them again three years postoperatively. Fifty-nine percent (N = 58) of patients accepted to participate. Results: There were no differences between people who accepted to participate and those who did not. Overall, three years after surgery, mean Body Mass Index (BMI) significantly decreased from 46.6 kg/m2 (SD = 9.0) to 31.0 kg/m2 (SD = 7.8). Eating disorder dimensions, such as bulimia or body dissatisfaction, and symptoms of depression improved. Higher BMI at baseline and greater symptoms of depression were related to a poorer excess weight loss (EWL). Discussion: A confirmation of the relationship between the depression subscale of the self-report questionnaire HAD and EWL would facilitate the detection of patients in need of a careful follow up post surgery. Conclusion: Results argue in favour of a careful psychological evaluation of patients before bariatric surgery with specific attention to patients showing symptoms of depression. A complex psycho-pedagogical preparation should be proposed before bariatric surgery but also after. [ABSTRACT FROM AUTHOR]

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Abstract: Objectives: The objective of this study is to describe how appear, in severely obese patients waiting for bariatric surgery, the self representation and psychic representations of own body and of bodily space. The aim is not here to identify psychological factors of severe obesity, but to describe which somatopsychic conditions are involved in the life situation of these patients. Authors propose theoretical discussions about body image to give understanding of how body is lived in severe obesity. Arguments give explanations of emotions and mental representations that severely obese patients construct. It is so useful to understand how those mental states and body image can be transformed by way of bariatric surgery. Materials and methods: The methodology exploring the subjective self is based on a double approach: a quantitative external evaluation (clinical scales: obesity, anxiety, depression), and a qualitative internal evaluation of subjective state (Rorschach test). Quantitative evaluation uses both the Dutch Eating Behavior Questionnaire (DEBQ) to assess behaviors and motivations giving troubles in eating and obesity, and the Hospital Anxiety and Depression Scale (HADS) to assess emotions in people arriving in hospitalization. Qualitative evaluation uses Rorschach ink blot test (RCH) to describe body image as it is lived by patients, RCH gives information about mentalization and psychic process. Seven criterions are used to describe body image and work of mentalization, 766 Rorschach''s response are analyzed with those seven criterions, RCH''s data are associated with the two clinical scales’ data to discuss how patients appear to psychiatrist/psychologist in time of waiting bariatric surgery. Subjects of our study are 43 severely obese patients (BMI: 45; male 19%, mean age 39; female 81%, mean age 41). Every patient has been assessed during hospitalization before bariatric surgery by psychologist in single case analysis. Results: Results show two elements. First, scales bring only little information, whereas projective method (Rorschach) indicates somatopsychic troubles in psychological functioning. Then, the subjective self in obese patients presents an atypic mood of bodily space, which defines an atypic self representation, identity is affected. Mentalization is disturbed for each patient, no psychiatric diagnosis can be held but personality is about to be pathological. HADS and DEBQ give little information about psychic life and can’t screen affective disturbance when RCH reveals both hidden body image troubles and psychic suffers. All criterions used to describe body image and emotions related to own body are pathological. Psychological health is in weakness, identity is disturbed and it could be understood as risk factor for failed surgery treatment. Actually, if body image and body experiences are disturbed before surgery it is not surprising to verify that body image and body experiences can be although disturbed after surgery and fast weight-loss. Fast weight-loss can be a risk factor of deep disturbance of psychic functioning, psychopathological disease can be induced. Literature considers that 18% of patient after bariatric surgery are in check and severe obesity has set in again, part of them are probably individuals with psychological complications. Our results suggest that psychic modification and identity modification are too difficult for patients if somatopsychic criterions in time of waiting surgery are already disturbed. Conclusions: In these conditions, the question of fast weight-loss after surgery can be asked, because causing deep disturbances, forcing to fast global identity reorganization, while somatopsychic functioning before surgery is already often affected. Research perspectives and clinical indication are led. Authors propose that each patient waiting for bariatric surgery should have a clinical assessment of the self representation and psychic representations of own body and of bodily space, this clinical setting could reveals psychic risk factor, and each patients should have then a clinical assessment 12 month after surgery. If somatic complications appear they could be better understood in term of psychic disturbance. [Copyright &y& Elsevier]

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Abstract: The prevalence of obesity has been steadily increasing worldwide. In this context, we observe an increase in obesity surgery (or bariatric surgery). This type of surgery leads to complications related to the intervention in an obese patient, but also specific nutritional complications. The three major types of bariatric surgery are as follows: restrictive procedures; restrictive malabsorptive procedures and both. The metabolic changes associated with obesity can be further exacerbated by illness. Main aims of nutritionnal assistance are limiting the process of protein malnutrition and hypercatabolism. This surgery has the feature to apply to obese patients with a perioperative risk, to initiate severe metabolic changes and induce deficiencies in vitamins and trace elements. The nutritional management is a challenge for multidisciplinary teams responsible for these patients. [Copyright &y& Elsevier]

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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.)

Backgrounds: Gastric bypass surgery for morbid obesity has gained an increasing popularity because of the high prevalence of obesity in the western culture. As any other major surgery, bariatric surgery involves the potential for a number of adverse events, including neuropsychiatric disorders. Among neuro-psychiatric complications, Wernicke's encephalopathy (WE) has been most frequently reported in the literature. This syndrome is mainly characterized by ataxia, ophthalmoplegia and confusion. We report a patient with negative history of psychiatric illnesses, who presented with symptoms of psychosis, behavioral alterations and cognitive decline. Neurological, psychiatric and biochemical evaluations revealed findings suggestive for Wernicke's encephalopathy and other findings indicating a possible fronto-temporal dementia. At one year follow up there was evidence for stabilization of symptoms. Short-term memory impairment was however a persistent subjective complaint. Method: Observational case report. Setting: A specialist hospital. Conclusion: This case report illustrates that some of the atypical presentations of Wernicke's encephalopathy can develop years after the procedure. Patients with WE can show a sub-acute and insidious presentation. In these cases, the diagnosis WE demands a careful clinical approach and thorough neurological and psychiatric assessments. This case report also emphasizes the importance of a prompt follow up of CNS and metabolic function during the first years after gastric bypass surgery in order to detect early signs of deterioration in cognitive, motor and sensory functions and to initiate the appropriate treatment to prevent further disabilities on the long term. [ABSTRACT FROM AUTHOR]

Copyright of Néphrologie & Thérapeutique is the property of John Libbey Eurotext Ltd. 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.)

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Abstract: Recommendations for perioperative nutrition in obese subjects require considering the following evidences. Obesity has long been falsely considered a risk factor for poor outcomes from a variety of surgical procedures, yet recent studies of critically and chronically ill patients suggest that overweight and obese patients may paradoxically have better outcomes than normal weight patients. Preoperative weight loss should be considered as a risk factor of postoperative complications in obese subjects as in normal weight patients. Obese patients could be malnourished because of vitamin deficiencies and of sarcopenia. The prevalence of vitamin deficiencies in the morbidly obese population prior to surgery is high, especially for vitamins B1, B12, B9, A, C, D and E. Standard of care should include perioperative thiamine replacement, especially in case of prolonged vomiting. Vitamin B12 deficiency could appear fast after gastric or ileal surgery, and iron deficiency is more frequent. Low caloric diet is not recommended in obese subjects before surgery, especially for the elderly, because of the frequent sarcopenia in this population. Energy and protein recommendations are not easy to be determined in obese subjects. Recommended allowance for protein should be defined according of the fat free mass, which is not easy to evaluate in clinical practice. So it is recommended to use a normalized weigh for a theoretic BMI between 25 and 30kg/m2. The loss of muscle mass can be very fast in the postoperative period in these subjects. The nutritional objective of care is to preserve skeletal muscle mass and to enhance the protein balance. [Copyright &y& Elsevier]

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This study aims at understanding the alteration of the eating impulse arising after bariatric surgery. Hunger is transformed after surgery, with satiety being quickly achieved, but not the sensation of satiation. There is an evident misunderstanding between hunger as non-satiety and as dissatisfaction, with anguish emerging as the resulting affect, which surgery does not correct. In-depth psychological treatment is crucial as the surgery creates new emotional demands for the patient. [ABSTRACT FROM AUTHOR]

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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.)

Abstract: In the last decade, the number of patients suffering from obesity is multiplied by seven. Bariatric surgery is indicated only for morbid obesity (body mass index>40kg/m2, or >35kg/m2 with comorbidity). French recommendations suggest that psychiatric assessment is required before and after the surgery. Before the surgery, the psychiatrist assesses the psychiatric status of each patient, as well as the well understanding, the motivation and the capacity to manage with the treatment and the following. After surgery, psychiatric consultations are particularly important for patients who suffered from eating disorder or depression before the treatment. Because of the multidisciplinary, this activity is a model of consultation-liaison psychiatry. [Copyright &y& Elsevier]

Diabetes mellitus type 2 is a chronic disease with increasing prevalence in western society. Obesity represents a well established risk factor for the development of diabetes mellitus type 2. Several studies on surgical procedures for the treatment of obesity have shown a postoperative reduction of obesity-related co-morbidities. Thus, diabetes mellitus type 2 was shown to resolve or improve in more than 75% of morbidly obese patients (BMI >35) after bariatric surgery. These insights paved the way for the advent of metabolic surgery -- a novel field with the goal to improve glucose metabolism in patients with a BMI of less than 35. Encouraging results from mostly observational studies have sparked the interest in the surgical management of diabetes mellitus type 2. [ABSTRACT FROM AUTHOR]

Résumé La chirurgie bariatrique améliore de façon spectaculaire certaines comorbidités liées à l’obésité, en particulier le diabète et l’hypertension artérielle. Cette chirurgie diminue aussi l’uricémie. Sur le plan locomoteur, elle a des effets bénéfiques indiscutables chez les patients souffrants d’arthrose et de lombalgie. En revanche, elle semble induire une diminution des chiffres de densité minérale osseuse, avec la réserve d’une interprétation délicate de ces chiffres chez les patients obèses. Les résultats des rares études ayant évalué le risque fracturaire au décours de cette chirurgie sont divergents. Les effets secondaires de cette chirurgie et que l’on pourra rencontrer en rhumatologie sont de rares syndromes canalaires, des ostéomalacies carentielles, ainsi que des accès aigus goutteux survenant en début de réduction pondérale. Bariatric surgery improves major comorbidities related to obesity, such as diabetes and hypertension. In addition, it decreases the serum urate level. Bariatric surgery also benefits patients with osteoarthritis and low back pain. By contrast, it might decrease the bone mineral density in obese patients. Whether bariatric surgery can increase or not the risk of peripheral or vertebral fracture is controversial. Side effects of this surgery which can be encountered in rheumatology are nerve compression, in particular peroneal neuropathy, osteomalacia, and acute attacks of gout which occur most often shortly after the surgery. [ABSTRACT FROM AUTHOR]

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Copyright of Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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 Diabetes & Metabolism is the property of Masson Editeur 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.)

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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.)

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.)

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.)