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L'accompagnement de patients vivant avec l'obésité nécessite une cohérence d'approche des professionnels de santé. La formation à cet accompagnement thérapeutique est une des missions des Centres Spécialisés Obésité (CSO). Un dispositif numérique a été expérimenté par le CSO des Hospices Civils de Lyon (HCL) afin d'en évaluer la pertinence pour la formation de son réseau de professionnels entre septembre et décembre 2022. Deux e-parcours ont ainsi été testés : « nutrition obésité » (38 ateliers) et « chirurgie bariatrique » (23 ateliers) par des professionnels de santé volontaires (n = 282) et par un groupe d'experts (n = 8). Trois grandes catégories de données ont été recueillies pour cette expérimentation afin d'évaluer l'usage, la satisfaction et la pertinence de la plateforme à l'aide d'échelle de Likert sur 10 et de liste de mots à choisir. Les taux de réalisation de la totalité des parcours pour les professionnels de santé sont de 32,8 % (nutrition obésité) et 65,2 % (chirurgie bariatrique). Plus de 90 % des utilisateurs recommandent l'usage de l'outil pour les patients et les professionnels de santé. Le groupe d'experts a évalué l'intérêt de l'outil dans le cadre de la formation des professionnels de santé à 9,3 ± 0,7 sur 10. Le numérique permet aujourd'hui d'enrichir les parcours de soins avec l'usage de dispositifs digitaux sous réserve que ces derniers conservent une cohérence d'approche et de contenus. Cette expérimentation démontre ici que ce dispositif numérique, initialement conçu pour l'éducation thérapeutique des patients, a toute sa place au sein des futurs parcours de formation des soignants. Supporting patients living with obesity requires a consistent approach from healthcare professionals. Training in this therapeutic support is one of the missions of the Specialized Obesity Centers (CSO). A digital device was tested by the CSO of the Hospices Civils de Lyon (HCL) in order to assess its relevance for the training of its network of professionals between September and December 2022. Two e-courses were tested: "obesity nutrition" (38 workshops) and "bariatric surgery" (23 workshops) by volunteer healthcare professionals (n = 282) and by a group of experts (n = 8). Three main categories of data were collected for this experiment in order to assess the use, satisfaction and relevance of the platform using a Likert scale out of 10 and a list of words to choose from. The completion rates for all courses for healthcare professionals are 32.8% (nutrition obesity) and 65.2% (bariatric surgery). More than 90% of users recommend the use of the tool for patients and healthcare professionals. The expert group assessed the interest of the tool in the context of training healthcare professionals at 9.3 ± 0.7 out of 10. Digital technology now makes it possible to enrich care pathways with the use of digital devices provided that the latter maintain a consistency of approach and content. This experiment demonstrates here that this digital device, initially designed for the therapeutic education of patients, has its place in the future training pathways of caregivers. [ABSTRACT FROM AUTHOR]

Introduction: The current obesity epidemic is accompanied by an increasing use of obesity surgery. However, the French health care system struggles to ensure long-term follow-up of these patients, for which the general practitioner plays a crucial role. Objective: Based on a literature review, to develop a monitoring tool in order to improve patient follow-up care after obesity surgery, by optimizing the coordination between general practitioner and the referral Obesity center team. Methods: Methodology of the French National Authority for Health to develop a memo sheet, supported by a systematic review, validated by the expertise of a task group. Results: Obesity surgery, yet effective on severe obesity and its comorbidities, can expose to the risk of severe postoperative complications, adverse psychosocial impact, or weight regain, which is feared. Nutritional deficiencies are frequent, and a lifelong micronutrient supplementation is essential (multivitamin and mineral complex, vitamin D-calcium, iron, vitamin B12); otherwise, the deficiency could lead to complications (e.g. hematological, neurological, musculoskeletal). Their prevention-screening-treatment are part of a global interdisciplinary postoperative management, including medical and biochemical monitoring, behavior change strategies in eating and exercise habits, and psychological support. The learned societies recommend to strengthen the collaboration between general practitioners and surgical teams. The "BARIA Check" sheet has synthesized these key data in order to guide the general practitioner to ensure this mission, in coordination with the referral obesity centre. Conclusion: Complications after obesity surgery need to be prevented to ensure its long-term safety and effectiveness. General practitioners supported by "BARIA Check" will contribute to this achievement. [ABSTRACT FROM AUTHOR]

À l'heure actuelle, l'évaluation psychologique préopératoire fait partie des éléments incontournables pour toute personne souhaitant bénéficier d'une chirurgie bariatrique. Toutefois, il aura fallu attendre la fin du XIXe siècle pour que la prise en charge de l'obésité s'inscrive dans une approche pluridisciplinaire, posant ainsi les bases de l'évaluation psychologique dans ce domaine. En étant intégrée comme un traitement possible, la chirurgie va renforcer l'intérêt d'une telle perspective, notamment en s'appuyant sur ce type d'évaluation qui a pour fonction d'établir l'existence éventuelle de contre-indications. Celles-ci sont définies selon les pays par différentes instances comme l' American Society for Bariatric and Metabolic Surgery ou la Haute Autorité de santé. Bien qu'il n'existe pas d'outil spécifique pour ce type de bilan, certains font figure de référence depuis l'émergence de cette discipline dont l'Inventaire Multiphasique de la Personnalité du Minnesota. Depuis sa création, il est utilisé dans l'univers de la chirurgie bariatrique, démontrant sa validité et ses qualités psychométriques au fil du temps. Par ailleurs, la littérature continue à s'enrichir de travaux de recherche concernant sa capacité prédictive des suites d'une chirurgie renforçant la pertinence et l'intérêt de son utilisation dans cette pratique. At present, the preoperative psychological assessment is one of the essential elements for anyone wishing to undergo bariatric surgery. However, it was not until the end of the 19th century that the management of obesity became part of a multidisciplinary approach, thus laying the foundations for psychological assessment in this area. By being integrated as a possible treatment, surgery will reinforce the interest of such a perspective, in particular by relying on this type of assessment, which has the function of establishing the possible existence of contraindications. These are defined in different countries by different bodies such as the American Society for Bariatric and Metabolic Surgery or the Haute Autorité de santé. Although there is no specific tool for this type of assessment, some have been used as a benchmark since the emergence of this discipline, including the Minnesota Multiphase Personality Inventory. Since its inception, it has been used in the world of bariatric surgery demonstrating its validity and psychometric qualities over time. In addition, the literature continues to be enriched by research work concerning its predictive capacity for the aftermath of surgery, reinforcing the relevance and interest of its use in this practice. [ABSTRACT FROM AUTHOR]

The objective of this qualitative study was to characterize the functions of significant social networks of patients who experienced obesity recurrence after bariatric surgery. For data collection, semi-structured interviews and application of the Network Map were used. The analysis of the data of the 12 participants was based on Grounded Theory and was supported by the Atlas-ti software. Family members were the most mentioned people playing, predominantly the role of emotional support. Noteworthy were the functions of emotional support, cognitive guidance and material help offered by the health team, as well as unmet expectations of help. It is sustained that knowing the relational dimension that surrounds bariatric patients allows us to highlight resources to face challenging moments inherent to the postoperative period, such as the recurrence of obesity. [ABSTRACT FROM AUTHOR]

Après une perte de poids massive, le thorax chez les hommes peut présenter des déformations importantes. Le traitement chirurgical de la gynécomastie après un amaigrissement massif reste une chirurgie difficile et partiellement incomprise en raison de 4 facteurs principaux : un excès cutané complexe en hauteur et largeur et qui peut parfois se poursuivre en axillaire ou en dorsal, une composante graisseuse prédominante plutôt que glandulaire, la malposition de la plaque aréolo-mamelonnaire (PAM) qui est souvent élargie et un sillon sous mammaire (SSM) souvent marqué. Les techniques actuellement décrites sont soit insuffisantes, soit elles entraînent des complications fréquentes et/ou importantes. Les auteurs décrivent une nouvelle approche qui dissocie le traitement du volume et de la peau avec une résection « sur mesure » qui est simple, reproductible et sécure. Notre objectif est d'améliorer la satisfaction des patients tout en réduisant les taux de complications. Dix-sept patients présentant une adipomastie avec excès cutané après amaigrissement massif ont été opérés selon la technique de lipoaspiration et redrapage cutané sur mesure après pose d'agrafes. Les auteurs décrivent la technique, les indications et contre-indications de la procédure et analysent les résultats. L'âge moyen des patients est de 39 ans. L'indice de masse corporelle (IMC) moyen avant la perte de poids est de 42,7 kg/m2, la perte moyenne de poids avant la correction corporelle est de 49 kg, avec un delta moyen de perte de BMI de 15,34 kg/m2. Le séjour moyen à l'hôpital est de 1,3 nuits. Aucun patient n'a présenté de complications majeures (hématome, hémorragie, nécrose, thrombophlébite, reprise chirurgicale immédiate pour traiter des complications). Les complications mineures incluant les déhiscences cicatricielles, les infections, les stéatonécroses, les corrections cicatricielles à distance, ont été rapportées pour 2 patients, soit 11 %. La torsoplastie assistée par liposuccion et désépidermisation sur mesure est moins invasive que les techniques décrites antérieurement. Les résultats sont reproductibles et les taux de complications sont faibles. Ses avantages sont multiples : absence d'espace de décollement et donc aucun drain n'est nécessaire, le respect des vaisseaux, nerfs et lymphatiques, peu de douleur et une courte durée d'hospitalisation. Cette technique est simple, rapide, facile à apprendre et reproductible. Cependant, elle n'est applicable que dans l'adipomastie pure. Une technique différente doit être utilisée en présence de tissu glandulaire ferme. 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. 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. The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7 kg/m2, the average weight loss before body correction is 49 kg, with an average delta of BMI loss of 15,34 kg/m2. 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%. 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. [ABSTRACT FROM AUTHOR]

L'objectif de ce travail a été de rechercher les principaux facteurs prédictifs de complication post opératoire, autres que le tabac, après abdominoplastie ou bodylift dans le cadre de séquelles d'amaigrissement post-bariatrique. Une étude monocentrique rétrospective, incluant des abdominoplasties ou bodylift, après chirurgie bariatrique a été réalisée, entre le 01/01/2016 et le 31/12/2019. Ont été exclus : les tabagiques actifs, les patients non bariatriques et/ou ayant déjà eu une abdominoplastie ou bodylift et/ou ayant bénéficié d'une chirurgie combinée. 105 patients ont été inclus (73 bodylifts, 32 abdominoplasties). 68 % ont présenté au moins une complication. La majorité d'entre elles n'entrainaient qu'un prolongement des soins locaux. Le taux de complication grave était de 2,9 %. Les facteurs de risque de complication étaient : un sujet jeune (p = 0,014), une perte de poids plus importante (p = 0,03), un délai entre la chirurgie bariatrique et l'intervention de chirurgie plastique plus important (p = 0,0002), la réalisation d'un bodylift versus une abdominoplastie (p < 0,01), l'anneau gastrique (p = 0,029). À l'inverse le bypass est apparu comme un facteur limitant les complications post séquelles d'amaigrissement (p = 0,041). Le model prédictif de complication issu de l'étude multivariée conclue au rôle prépondérant du type de chirurgie plastique et de l'IMC pré-opératoire. La chirurgie de séquelles abdominales d'amaigrissement présentent des complications fréquentes mais généralement bénignes. L'information du patient en pré-opératoire doit donc être adaptée en fonction de l'obésité initiale, et de l'importance de la perte de poids. 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. 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. 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. 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. [ABSTRACT FROM AUTHOR]

La prévalence de la NALFD et donc de la NASH est en constante augmentation dans le monde, et en fait l'une des principales cause de morbi-mortalité hépatique. À ce jour, aucun traitement pharmacologique n'est recommandé. La perte de poids et son maintien dans le temps est l'un des éléments clé de la prise en charge de la NASH. En ce sens, la chirurgie bariatrique apparaît comme une option thérapeutique de choix, d'autant plus qu'elle permet la résolution histologique de la NASH à cinq ans dans près de 80 % des cas avec une amélioration de la fibrose. L'amélioration histologique postopératoire s'accompagne d'une diminution de la morbi-mortalité hépatique. L'ensemble des effets bénéfiques de la chirurgie sur la survie, les évènements cardiovasculaires, hépatiques et néoplasique imposent de l'intégrer dans l'élaboration du projet thérapeutique des patients NASH. Toutefois, sa réussite est conditionnée par une préparation préopératoire intense de 6 à 12 mois et d'un suivi postopératoire rigoureux. En conséquence, la chirurgie bariatrique apparaît de plus en plus comme une chirurgie métabolique plutôt qu'un traitement de l'obésité morbide. Actuellement, ses indications s'étendent aux IMC entre 30 et 35 kg/m2 en cas de diabète sévère. Son indication pour le traitement de la NASH avec une fibrose sévère chez patients avec des IMC inférieurs à 35 est actuellement à l'étude. The prevalence of NALFD and NASH is constantly increasing worldwide, making it one of the main causes of liver morbidity and mortality. To date, no pharmacological treatment is recommended. Weight loss and its maintenance over time is one of the key elements in the management of NASH. In this sense, bariatric surgery appears to be an optimal therapeutic option. In addition, cohort studies have shown that bariatric surgery allows the histological resolution of NASH at five years in nearly 80% of cases with fibrosis improvement. Postoperative histological improvement also is accompanied by a decrease in liver morbidity and mortality. Thus, the overall beneficial effects of surgery on survival, cardiovascular, hepatic and neoplastic events make it necessary to integrate it into the therapeutic plan of NASH patients. However, its success is conditioned by an intense preoperative preparation of 6 to 12 months and a rigorous postoperative follow-up. As a result, bariatric surgery appears more and more as a metabolic surgery rather than a treatment of morbid obesity. Currently, its indications extend to BMI between 30 and 35 kg/m2 in case of severe diabetes. Its indication for the treatment of NASH with severe fibrosis in patients with BMIs below 35 is currently under investigation. [ABSTRACT FROM AUTHOR]

Le tissu adipeux est modifié en quantité et qualité au cours de l'obésité : hypertrophie des adipocytes, diminution de leur expansibilité et fibrose, productions de cytokines et adipokines proinflammatoires, infiltration inflammatoire par des macrophages pro-inflammatoires M1, des lymphocytes T. Ainsi, l'excès de tissu adipeux et l'obésité sont associés à une inflammation de bas grade qui peut aggraver les pathologies inflammatoires chroniques, impacter l'effet des traitements, l'apparition des comorbidités et le développement de la maladie à sa phase préclinique. L'obésité augmente le risque de développer une polyarthrite rhumatoïde (PR), un psoriasis, un rhumatisme psoriasique avec un effet dose dépendant du poids. C'est aussi un facteur de moins bonne réponse aux traitements en particulier aux anti-TNF. La perte de poids induite par la chirurgie bariatrique diminue le risque de psoriasis et de rhumatisme psoriasique, et améliore l'activité de la maladie et la rémission sous traitement dans la PR. Une perte de poids d'au moins 5 % avec un régime hypocalorique améliore la réponse thérapeutique aux traitements anti-TNF dans le rhumatisme psoriasique avec un effet dose dépendant de la perte de poids. Dans la PR, l'effet bénéfique de la perte de poids au cours d'un régime hypocalorique sur l'activité de la maladie est rapporté dans quelques études observationnelles mais n'a pas été démontré dans un essai randomisé contrôlé. Le dépistage et la prise en charge de l'obésité font partie des recommandations de la SFR sur l'alimentation des patients ayant un rhumatisme inflammatoire chronique et doivent bien sûr être associés aux autres facteurs modifiables, arrêt du tabac, qualité de l'alimentation, activité physique et lutte contre la sédentarité. Adipose tissue is altered in quantity and quality during obesity: hypertrophy of adipocytes, decrease in expandability and fibrosis, production of proinflammatory cytokines and adipokines, inflammatory infiltration by pro inflammatory macrophages M1, T lymphocytes. Thus, excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease the treatment efficacy, the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight dose effect. It is also predictor of poorer response to treatments, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis, and improves disease activity and remission in RA. A weight loss of at least 5% with a hypocaloric diet improves the response to TNF inhibitor in psoriatic arthritis with a dose-dependent effect of weight loss. In RA, the beneficial effect of weight loss during a hypocaloric diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases and should of course be associated with others modifiable lifestyle factors such as smoking, quality of food, physical activity and sedentary lifestyle. [ABSTRACT FROM AUTHOR]

Les auteurs, cliniciens et chercheurs en psychopathologie, développent un phénomène psychique transtructurel rencontré chez des patients obèses opérés d’une chirurgie bariatrique: des fantasmes et des délires de morcellement corporel. C’est à partir d’un cas clinique de névrose et un autre de psychose, que l’impact psychique de la chirurgie bariatrique sera étudié, avec la mise en lumière d’une altération de l’image du corps et de ses sensations qui serait à l’origine de ce phénomène de morcellement.

Non-alcoholic fatty liver disease (NAFLD) has been recently termed metabolic dysfunction-associated fatty liver disease (MAFLD) to address the strong association with the metabolic syndrome. The prevalence of MAFLD is significantly increased in obese individuals and treatment of obesity is currently the cornerstone of management of MAFLD. Bariatric and metabolic surgery nowadays emerges as a key therapeutic strategy for the treatment of the MAFLD. This review aims to provide an update on the novel studies reporting the outcomes of bariatric surgery on the spectrum of MAFLD, from hepatic steatosis to cirrhosis. [ABSTRACT FROM AUTHOR]

This paper presents some psychological considerations to consider when surgically treating obesity with bariatric surgery; it incorporates a comprehension of the body according to the three orders that Jacques Lacan formalized: real, symbolic, and imaginary. It analyzes the procedure in the pre- and post-operative stages and recognizes the importance of adding the notion "symbolic body" and examining the treatment by integrating the aforementioned orders. Such a proposal can be defined as a "supplementary complement" regarding the current therapeutic alternatives; it complements the approaches available but in a supplementary way by allowing the various forms of comprehending the phenomenon and encouraging the use of new therapeutic possibilities. The paper also presents some current problems due to not including the psychoanalytic notion "symbolic body" in the medical-surgical treatment. It finally presents some ideas to advance the comprehension of "morbid obesity" by incorporating the three body dimensions previously mentioned. [ABSTRACT FROM AUTHOR]

• La chirurgie bariatrique est associée à un risque 21 à 44 % plus élevé de fracture de tous types. • Une perte osseuse rapide est associée à des altérations de la microarchitecture. • Le diagnostic d'ostéoporose et l'évaluation du risque de fracture lié à l'ostéoporose devraient inclure une mesure de la DMO par DXA. • Si un traitement anti-ostéoporotique est indiqué, l'acide zolédronique est recommandé en première instance. • Les connaissances restent insuffisantes concernant le traitement de l'ostéoporose chez les patients qui bénéficient d'une chirurgie bariatrique. Cet article présente les recommandations initiales du Groupe de Recherche et d'Information sur les Ostéoporoses (GRIO) et de la Société française de rhumatologie (SFR) concernant la prévention et le traitement de l'ostéoporose secondaire à la chirurgie bariatrique. Les recommandations ont été établies par un groupe de travail constitué de quatre rhumatologues experts, trois nutritionnistes, deux chirurgiens de l'obésité, un spécialiste de l'activité physique et un représentant d'une association de patients. Les recommandations générales suivantes s'appliquent à tous les patients ayant une indication de chirurgie bariatrique ou ayant déjà bénéficié d'une chirurgie de l'obésité : normaliser les apports en calcium et en protéines, atteindre une concentration de 25(OH) vitamine D comprise entre 30 et 60 ng/ml, prévenir le risque de chute et instaurer un programme d'activité physique adapté. Une évaluation initiale du risque de fracture devrait être effectuée de manière systématique, de préférence avant la première intervention bariatrique, (i) en cas de Roux-en-Y bypass gastrique et de dérivation biliopancréatique, quel que soit l'âge, (ii) chez les patients à risque élevé de fracture, quel que soit leur âge et (iii) chez toutes les femmes ménopausées et tous les hommes ≥ 50 ans, quel que soit le type d'intervention bariatrique. L'évaluation du risque de fracture s'appuie sur la détermination des facteurs de risque d'ostéoporose et la mesure de la densité minérale osseuse. Les traitements anti-ostéoporotiques, l'acide zolédronique en première ligne, sont indiqués chez les femmes ménopausées et les hommes ≥ 50 ans (i) ayant déjà subi une fracture sévère, quel que soit le T-score, (ii) ayant déjà subi une fracture non sévère et ayant un T-score ≤ -1 et (iii) n'ayant jamais subi de fracture et ayant un score T-score ≤ -2. Le risque de fracture augmente après une chirurgie bariatrique. Les cliniciens devraient attacher une attention particulière aux patients à haut risque de fracture, comme les femmes ménopausées et les hommes de plus de 50 ans. Des recherches supplémentaires sont nécessaires pour orienter et étayer les recommandations. [ABSTRACT FROM AUTHOR]

Vitamin B12 deficiency is frequent after obesity surgery. The goal of this study was to establish the current practices in specialized obesity centers in terms of dosage, supplementation, and management of B12 deficiency after obesity surgery. In 2021, a survey has been sent to the 37 French specialized obesity centers to perform an assessment of the physician professional practices relating to B12 supplementation after obesity surgery. Forty-one responses were collected from 29 centers, representing a response rate of 78%. All physicians routinely monitored plasma B12 in the postoperative period. The first intent route of B12 supplementation after obesity surgery was mainly: oral, then intramuscular, then subcutaneous, with respectively 38 (93%), 9 (22%), and 3 responses (7%). The preferred prescription for prevention of B12 deficiency, used as long-term maintenance therapy, was 1 mg per week, orally (n = 21; 51%). The other schemes used for that purpose were rare and specific to a single center. In case of B12 deficiency, the two most used therapeutic schemes were 1 mg per day orally for 15 days (n = 8; 20%) and 1 mg intramuscular per week for 1 month (n = 4; 10%). This assessment of the current physician professional practices revealed a diversity in the practices of B12 supplementation after obesity surgery, with a trend to favor the oral route. This is due to the lack of evidence and clear-cut recommendations. A comparative randomized study would help to identify the best route and posology for B12 supplementation after obesity surgery. [ABSTRACT FROM AUTHOR]

Beyond somatic consequences, excess weight affects quality of life. In the literature this has markedly improved in the first 6 months, but has decreased later. The originality of our work in that is based on the comparison of two groups of patients, surgical and non-surgical ones, monitored by a multi-professional team for 3 years. The sample is comprised of 32 subjects divided into two groups: 17 subjects from the non-surgical pathway and 15 from the surgical one. The Quality of Life, Obesity, and Dietetics questionnaire (QOLOD), the Hospital Anxiety and Depression Scale (HADS) and the Dutch Eating Behaviour Questionnaire (DEBQ), age, BMI, and sex were recorded. At baseline, age was significantly different between two groups (surgery vs. non-surgery). BMI and QOLOD improvement were significantly more important in surgical group (−13.6 kg [−19.2; −10.8] vs. 0.0 kg [−2.8; 3.0] P < 0.001 and 16.9 [8.5; 32.2 vs. 2.1 [−9.4; 16.2], P = 0.004). The progression of the QOLOD score correlated negatively with the progression of BMI (r = −0.5, P = 0.005) There is a link between post-surgery weight loss and improved quality of life at 36 months. We suggest a qualitative follow-up survey for surgical and non-surgical obese patients. [ABSTRACT FROM AUTHOR]

Résumé: L'obésité est un problème majeur de santé publique. Son incidence et celle des MICI augmentent. Par conséquent, un grand nombre de patients MICI pourraient être évalués pour une chirurgie bariatrique. L'obésité apparaît comme un facteur péjoratif dans les MICI avec un effet probablement proinflammatoire. La pharmacocinétique des traitements est également impactée. Les complications post-opératoires ne sont pas augmentées dans les MICI, on note cependant un changement du microbiote en post-chirurgie avec un impact sur la calprotectine. Obesity is a major healthcare problem worldwide. Incidence of IBD is rising in parallel with overweight and obesity. As a consequence, a great number of IBD patients could be evaluated for a bariatric surgery. It appears that obesity has a negative impact on IBD, with pro inflammatory effects. Treatment pharmacokinetic is impacted. Bariatric surgery is feasible with no increase of post operative complications. A change in microbiote and an effect on fecal calprotectin is described. [ABSTRACT FROM AUTHOR]

Introduction: Bariatric surgery is the only treatment for severe obesity (BMI>35kg/m 2 ) currently recognized as effective both in achieving tangible and lasting weight loss, and in improving obesity-related comorbidities such as type 2 diabetes, hypertension, and cardiovascular complications. Bariatric surgery, like any other surgery of the digestive tract, can have an impact on nutrient absorption, as well as on drug absorption. The literature on drug management in bariatric surgery patients concerned mainly of case reports and retrospective studies involving a small number of patients. No official guidelines are available., Methods: We conducted a literature search on the consequences of bariatric surgery in terms of drug bioavailability and/or effect. The Medline® (PubMed) database was searched using the following keywords: "bariatric surgery", "bioavailability", "gastric bypass", and "obesity". We completed this review with an analysis of reports of adverse drug reactions (ADRs) in post-bariatric surgery patients for obesity registered in the National pharmacovigilance database (PVDB). We selected all cases with the mention of "bariatric surgery and/or gastrectomy" as "medical history". After reading the cases, we excluded those in which the patient had undergone surgery for an indication other than obesity, where the route of administration was other than oral, and cases in which ADRs resulted from voluntary overdose, attempted suicide, allergy, switch to Levothyrox® new formulation, meningioma under progestative drugs, inefficacy related to generic substitution and medication error., Results: The literature search identified mainly "case report" about the impact of bariatric surgery on so-called "narrow therapeutic window" drugs. We identified 66 informative cases out of a total of 565 cases selected (11%) in the PVDB. Nevertheless, the information does not allow a clear relationship between the occurrence of the ADR and the influence of bariatric surgery., Conclusion: There is a lack of official information and/or recommendations on medication use in subjects who have undergone bariatric surgery. Apart from under-reporting, ADRs reports remain largely uninformative. Health professional and patients would be awareness for improving, quantitatively and qualitatively the reporting of ADRs in this population., (Copyright © 2024 Société française de pharmacologie et de thérapeutique. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The health crisis linked to COVID-19 led to the containment of the general population in order to limit the spread of the virus. With the emergence of this new disease, it was necessary to mobilise in order to limit the transmission of the virus to our obese population, at risk of developing a severe form of COVID-19. To do this, we proposed to carry out our TPE workshops by videoconference to all patients included in the TPE "bariatric surgery" programme. Objectives: The aim of this study is to identify the benefits and drawbacks of this group distance TVE format, their efficiency in terms of learning and behavioural changes, and the different resources of the programme that facilitate their learning for the pre- and post-surgery course. Methods: This is a two-phase mixed-methods study. The first phase of the study consisted of an exploratory qualitative study using semi-directive interviews with 18 patients who had followed the distance TPE from March 2020 to May 2020, to explore their experiences of the different educational sessions. In a second phase, the exploratory study made it possible to draw up a questionnaire to gather the views of all the patients educated from March 2020 to May 2021. The analysis of the answers mobilised the theory of capabilities to identify the positive or negative conversion factors of the programme for the patients' learning. Results: Of the 70 patients included, 43 responded to the questionnaire... This video conferencing TPE enabled the scheduling of surgical procedures to be maintained. Patients reported time savings due to the absence of travel. Patients with low digital literacy were able to access this programme. Participants stressed the importance of continuity of connection with caregivers. Patients reported self-care skills acquired through this distance learning and an average weight loss of 7 kg. Both positive and negative learning factors were identified. Discussion: The results of this study demonstrate the interest in developing e-TPE programmes for several reasons: the difficulties in bringing these patients to the hospital, the geographical inequalities in access to TPE, the absence of reimbursement for transport tickets and the lack of dedicated spaces available. It therefore seems important to train professionals and patients in the digital tool. Conclusion: This study of a population of obese patients who participated in a TVE programme by videoconference during a pandemic and a period of confinement shows the perceived quality of this distance education. In view of the different programmes transposed into distance format, it would be interesting to promote research crossing the experiences of patients and professionals to propose the best educational format to the health authorities. [ABSTRACT FROM AUTHOR]

Obesity is defined as excess body fat with adverse health consequences and is a chronic disease often associated with co-morbidities when it persists into adulthood. It is therefore important to support adolescents with obesity during the transition to adulthood in order to avoid a medical worsening. This risk is particularly important in the case of monogenic or syndromic obesity, especially as it is also a period of fragility with an important psychosocial dimension. Dedicated organizations have emerged since few years, such as transition platforms, to facilitate coordination between health professionals and help young people to integrate their dedicated care pathway as adult. [ABSTRACT FROM AUTHOR]

The authors, clinicians, and researchers in psychopath ology, developed a trans-structural psychic phenomenon found in obese patients who have undergone bariatric surgery: fantasies and delusions of body fragmentation. The psychic impact of bariatric surgery was studied based on a clinical case of neurosis and another one of psychosis, highlighting an alteration of body image and its sensations which would be at the origin of this phenomenon of fragmentation. [ABSTRACT FROM AUTHOR]

Bariatric surgery is the most efficient treatment for obesity and associated diseases. Basic knowledge about the indications, common procedures, follow-up and possible complications has become essential for primary care practice. This article explains the current standards of care in Switzerland with a focus on relevant information for the practice: nutritional aspects after bariatric surgery, necessary clinical and laboratory examinations, early detection of complications. Only intense interdisciplinary and interprofessional collaboration leads to a treatment success in morbid obesity. [ABSTRACT FROM AUTHOR]

Les auteurs s'intéressent à la problématique de l'obésité sévère, notamment au fonctionnement psychique sous-jacent des patients en demande de chirurgie bariatrique. Ils proposent une comparaison interculturelle entre la France et la Turquie en questionnant l'implication de la culture dans la psychogénèse de cette maladie chronique. Ils présentent les résultats d'un premier volet exploratoire qualitatif, par l'analyse comparée de deux cas cliniques, représentatifs de chacun des deux pays. Cette analyse s'appuie sur des entretiens cliniques, des autoquestionnaires et sur le test de Rorschach. Cette comparaison culturelle montre que les deux cas cliniques représentatifs ont des antécédents de vie difficiles et traumatiques, souvent d'origine infantile. Ces événements conduisent à des difficultés de mentalisation des affects, constatés lors des entretiens cliniques, des autoquestionnaires et de la passation du test de Rorschach. Ainsi, l'impossibilité de ce travail de transformation psychique conduit à des Troubles des Conduites Alimentaires (TCA). Ces premiers résultats invitent à poursuivre la construction et la validation d'un modèle transculturel de l'obésité sévère, permettant dans l'avenir de proposer des recommandations internationales pour la prise en charge psychologique de cette maladie chronique, particulièrement lors d'une chirurgie bariatrique. The authors are interested in the problematic of severe obesity, particularly in the underlying psychic function of patients who seek bariatric surgery. They propose an intercultural comparison between France and Turkey by questioning the implication of culture in the psychogenesis of this chronic disease. They represent the results of a first qualitative exploratory section, by the comparative analysis of two clinical cases which are representatives of each of the two countries. This analysis is based on clinical interviews, self-questionnaires and Rorschach Test. This cultural comparison shows that two representative clinical cases have antecedents with difficult and traumatic life experiences, mostly based on infancy background. These incidents lead to difficulties of mentalization of affects as it is occurred during the clinical interviews, the self-questionnaires and the process of Rorschach Test. Therefore, the impossibility of this work of psychic transformation leads to Eating Disorders. These initial results call for further construction and validation of a cross-cultural model of severe obesity, allowing in the future to propose international recommendations for the psychological treatment of this chronic disease, especially during bariatric surgery. [ABSTRACT FROM AUTHOR]

Résumé: La chirurgie bariatrique connaît un développement croissant en France depuis plus de dix ans, comme dans les autres pays occidentaux. Concernant les complications de la chirurgie bariatrique, elles varient en fonction de la technique chirurgicale, du volume d'activité du centre, de l'expérience de l'opérateur, et du terrain du patient (comorbidités, super-obésité). Les techniques de chirurgie bariatrique sont multiples, mais en pratique trois interventions sont couramment pratiquées, essentiellement par cœlioscopie : l'anneau gastrique, la sleeve gastrectomie (techniques restrictives), le bypass gastrique avec anse en Y (ou RYGB, technique mixte, restrictive et malabsorptive). La prise en charge des complications reste complexe et doit être multidisciplinaire : médico-chirurgicale, radiologique et, si nécessaire, réanimatoire. Les complications rencontrées sont multiples (ulcère anastomotique, fistules/désunion anastomotique, sténose luminale) et font appel à diverses techniques endoscopiques, souvent discutées en première intention. La prise en charge endoscopique reste encore peu codifiée, en l'absence de recommandations internationales ou nationales récentes. Bariatric surgery has been growing in France for more than ten years, as in other Western countries. Complications of bariatric surgery vary according to the surgical technique, the volume of activity of the center, the experience of the surgeon, and the patient's condition (comorbidities, superobesity). There are many different bariatric surgery techniques, but in practice, three procedures are commonly performed, essentially by laparoscopy: gastric banding, sleeve gastrectomy (restrictive techniques), and gastric bypass with Roux-en-Y gastric bypass (or RYGB, a mixed technique, restrictive and malabsorptive). The management of these procedures is complex and requires a multidisciplinary approach: Medical and surgical, radiological, and if necessary, intensive care. Complications are multiple (anastomotic ulcer, fistulas/anastomotic disunion, Luminal stenosis) and call for various endoscopic techniques, often discussed in first intention. Endoscopic management is still poorly codified, in the absence of recent international or national recommendations. [ABSTRACT FROM AUTHOR]

We assessed the psychotherapeutic process based on a Kleinian psychoanalytic approach as a contribution to improve the health of patients undergoing bariatric surgery. To that end, we performed a case study based on the analysis of a clinical vignette accompanied by a literature review. We analyzed excerpts of conversations of the psychotherapeutic process of a very obese 53-year-old woman who sought an institution dedicated to the surgical treatment of severe obesity relying on a multidisciplinary approach. After a diagnosis of morbid obesity, an initial psychological evaluation was performed. As an extension, a psychotherapeutic process based on a psychoanalytical approach took place once a week and then later twice a week. Two months after the first meeting, the patient underwent bariatric surgery. To date, the psychotherapeutic process has lasted for three years. As a result, the patient managed to get in touch with her feeling of helplessness associated with a destructiveness factor, which appears in narrative scenes of revenge, envy and jealousy. We conclude that the psychoanalytic process proved to be effective: the patient was able to preserve her constituent affective networks and became less vulnerable to anxiety and impulsivity, favoring reduction of obesity and avoiding situations of suffering such as alcoholism. Our observations confirm some references already mentioned in the literature. [ABSTRACT FROM AUTHOR]

Le recours à la chirurgie bariatrique est en plein essor. Le bypass gastrique est une des techniques les plus utilisées en France, non dénuée de complications à long terme. Une femme de 55 ans était hospitalisée pour un ralentissement psychomoteur, des œdèmes des membres inférieurs et une éruption psoriasiforme évoluant depuis 3 mois. L'évolution a rapidement été marquée par l'apparition d'une pancytopénie, d'une encéphalopathie et d'une défaillance circulatoire menant à une défaillance multiviscérale. Rétrospectivement, on documentera une encéphalopathie pellagreuse, une acrodermatite, une transformation gélatineuse de la moelle d'origine multicarentielle et une probable cardiomyopathie sur carence en vitamine B1. Une origine carentielle doit être évoquée et traitée précocement devant tout nouveau symptôme chez un patient avec antécédent de chirurgie bariatrique. Une carence en sélénium doit être évoquée devant toute insuffisance cardiaque dans ce contexte. Supplémentation préventive et suivi spécialisé sont essentiels. Bariatric surgery is a very effective treatment for obesity. After gastric bypass, micronutrient deficiencies frequently occur which can have dramatic consequences. We report the case of a 55-year-old woman who was admitted for psychomotor retardation, bilateral leg pitting edema and psoriasis-like rash that had been ongoing for 3 months. Pancytopenia, encephalopathy and heart failure rapidly occurred leading to multiorgan dysfunction syndrome and death. We retrospectively identified severe selenium deficiency with possible secondary cardiomyopathy, niacin deficiency resulting in pellagrous encephalopathy with skin lesions and gelatinous transformation of bone marrow. Micronutrient deficiency should systematically be assessed when new symptoms occur in a patient with a history of bariatric surgery. Selenium deficiency should be considered in the presence of any heart failure in this context. [ABSTRACT FROM AUTHOR]

Résumé: Les deux interventions chirurgicales bariatriques les plus pratiquées en France, la sleeve gastrectomy et le bypass en Y selon Roux, ont d'indéniable bénéfice sur la santé en termes de qualité et d'allongement de la durée de vie. Cependant, les complications sont nombreuses : immédiates, tardives, mécaniques ou métaboliques, elles peuvent être d'ordre fonctionnelles, ou mettre en jeu le pronostic vital - et ce même à distance de la chirurgie. Ce cas clinique de complications en cascade sur une longue échelle de temps, illustre trois règles intangibles : la sélection précise pré-opératoire des malades, leur information, et leur surveillance à vie, après la chirurgie. The two most commonly performed bariatric surgical procedures in France, sleeve gastrectomy and the Roux Y-bypass, have undeniable health benefits in terms of quality of life and life extension. However, complications are numerous: immediate, late, mechanical or metabolic, they can be functional or life threatening - even at a distance from the surgery. This clinical case of cascading complications over a long period of time illustrates three intangible rules: precise preoperative selection of patients, their information, and their lifelong monitoring after surgery. [ABSTRACT FROM AUTHOR]

Polycystic ovarian syndrome (PCOS), the most common endocrine disorder in women, is worsened by obesity; lifestyle modifications, the first line therapy, is however insufficient in severely obese women. Bariatric surgery is an effective weight loss treatment proposed to women with a Body mass index (BMI) greater than 40 kg/m² but neither PCOS nor infertility are considered as comorbidities justifying to lower this threshold to 35 kg/m². PCOS incidence after bariatric surgery decreases from 45.6% to 6.8%, as well as menstrual disorders (56.2% irregular cycles before surgery vs 7.1% after). Androgens levels are significantly reduced and SHBG increases, leading to a subsequent decrease in testosterone levels. All studies show an improvement in hirsutism symptoms and metabolic troubles resolve one year after the surgery for almost all patients. 22% of PCOS patients become pregnant spontaneously after bariatric procedure. In In Vitro Fertilization, the cumulative live birth rates after bariatric surgery are comparable to those of patients without any history of surgery, and higher than those of obese patients (respectively 22.9%, 25.9% and 12%). The BMI appears to be an independent predictive factor of live birth: 1-unit lower BMI increases chances of live birth by 9%. The dramatic weight loss induced by bariatric surgery reduces obstetrical and neonatal risks in obese women; however, pregnancies after bariatric surgery are at risk of low birthweight and micronutrients deficiencies. It is thus recommended to delay the pregnancy by 12 months after the surgical procedure and a multidisciplinary care is needed during these pregnancies. [ABSTRACT FROM AUTHOR]

L'obésité, définie par un excès de masse grasse, représente un problème majeur de santé publique. Sa prévalence a fortement augmenté à l'échelle mondiale depuis la seconde moitié du XXe siècle, à tel point que l'on parle « d'épidémie » d'obésité ou encore de « globésité ». Au vu des résultats souvent insuffisamment probants des mesures physiques et nutritionnelles, l'indication de chirurgie bariatrique peut être posée dès l'adolescence pour des cas d'obésité sévère, après échec d'autres stratégies thérapeutiques. L'indication de cette chirurgie pour les patients mineurs est encadrée en France par les recommandations de la Haute Autorité de Santé publiées en 2016. Elle a pu montrer pour cette population son efficacité à court terme sur la réduction de l'Indice de Masse Corporelle, le traitement des comorbidités et une amélioration de la qualité de vie. Cependant la réussite à la chirurgie n'est pas systématique et des données de l'évolution à plus long terme de ces adolescents sont requises pour appréhender au mieux cette chirurgie. Il est primordial de repérer et renforcer des éléments de motivation interne et de capacités d'adaptation du jeune, afin d'affiner la demande et d'améliorer l'efficacité de la chirurgie. Elle s'intègre dans une prise en charge pluridisciplinaire indispensable. The prevalence of severe and morbid obesity in children and adolescents is sharply increasing. Severe obesity is defined by a body mass index > 120% of BMI IOTF-30 cut off and morbid obesity by a BMI > 140% of BMI IOTF-30 cut off. It concerns 5 to 10% of French obese adolescents. This condition is simple to diagnose but complex to manage. Somatic complications can be found in about half of these patients, and psychiatric symptoms such as depression and anxiety are common. These comorbidities have a real impact on the quality of life of these patients. In case of severe obesity, bariatric surgery can be indicated for adolescents once other therapeutic strategies have failed. It is an effective option when lifestyle interventions – such as nutritional, physical and behavioural care – turn out to be inefficient. The three techniques used are gastric banding, gastric bypass and sleeve gastrectomy. It has shown short-term effeciency in adolescents with severe and morbid obesity regarding weight loss, treatment of comorbidities and improvement of quality of life. However, success in surgery is not systematic and side effects can occur. Sometimes, patients require another surgery. Also, obesity in adolescence is associated with a context of psychological vulnerability. It seems wise to identify and reinforce elements of internal motivation and adaptive capacities of the young person in order to refine the demand and improve the efficiency of surgery. When a psychiatric disorder is identified, it is essential to take it into account and propose a fitting psychiatric care. Medical care has to be performed in specialized multidisciplinary centers. Multidisciplinary follow-up must be standardized and continued even into adulthood. Data regarding middle-term and long-term evolution are sparse, thus it is primordial to pursue this follow-up in order to improve knowledge of the clinical evolution of these patients and to maintain a sustainable efficacy. It is also essential to identify the factors that could be responsible of failure of bariatric surgery so that effectiveness can be improved. French recommendations regarding bariatric surgery indications and specialized multidisciplinary care have been published by the French National Health Authority (Haute Autorité de Santé) in 2016. [ABSTRACT FROM AUTHOR]

We describe the process by which items of a belief scale in obesity and bariatric surgery were generated using mixed methods. Participants were 22 Ecuadorian bariatric patients between 22 and 50 years old (M = 37.5, SD= 8.91). A semi-structured interview was constructed, validated, and conducted. The information was analyzed using directed content analysis, guided by the Health Belief Model. The beliefs varied according to sociodemographic and clinical characteristics, particularly age, sex, surgical technique, and postoperative evolution. The level of susceptibility, severity and benefits were mainly associated with the consequences of the loss of psychological well-being and social acceptance. Meanwhile, a greater perception of barriers was found in women, people who experienced negative emotions and those with less social support. [ABSTRACT FROM AUTHOR]

Si les personnes avec une insuffisance rénale chronique terminale et vivant en situation d'obésité ont un pronostic considérablement amélioré par la transplantation rénale, elles sont encore confrontées à de nombreux freins à l'accès à la greffe. L'effet de l'obésité sur la survie du greffon et la survie toutes causes est de moins en moins démontré. Les questions sur la gestion des immunosuppresseurs, des diabètes post transplantation et des syndromes d'hyperfiltration glomérulaire restent, cependant, toujours un enjeu. Néanmoins, la barrière principale est celle du geste chirurgical. Les complications opératoires restent un frein à l'inscription sur liste. Parallèlement, les programmes d'amaigrissement en dialyse avant inscription se confrontent à la surmortalité des cohortes. La question de la chirurgie bariatrique pour les personnes avec les IMC les plus importants peut être une solution qui doit encore être consolidée. Les programmes de réentraînement physique en dialyse sont aussi des pistes de recherche clinique dont l'exploration doit se poursuivre. Enfin, L'arrivée du robot pour la chirurgie pourrait permettre de lever certaines barrières. Ces notions chirurgicales nous amènent, par ailleurs, à nous demander si l'IMC est le bon indicateur. Le tour de taille, reflet du tablier abdominal, n'est-il finalement pas l'élément bloquant du chirurgien ? Quoi qu'il en soit, la Haute Autorité de Santé ne fixe, aujourd'hui, une limite à la transplantation rénale que pour des IMC au-dessus de 50 kg/m2. Cette règle est encore loin d'être une réalité pour les personnes vivant en situation d'obésité en France et dans le monde. While patients with an end-stage renal disease and living with obesity have a significantly improved prognosis with kidney transplantation, they still face many barriers to access to it. Obesity effect on graft survival and all-cause survival is less and less established. However, questions about immunosuppressive drugs management, post-transplant diabetes and glomerular hyperfiltration syndromes remain an issue. Nevertheless, surgical gesture remains the main barrier. Complications from surgery still restrain registration. At the same time, pre-registration weight-loss programs under dialysis face an excess of mortality. Bariatric surgery issue for people with the highest BMIs might be a solution that still needs more research. Exercise rehabilitation during dialysis programs are also major avenues that need further explorations. Finally, robot-assisted surgery arrival could remove many restrictions. These surgical notions also lead us to wonder whether BMI is the right indicator. Isn't the waist circumference, a direct reflection of the abdominal apron, the blocking element for surgery? In any case, the French National Authority for Health currently only sets a limitation on kidney transplantation for BMIs above 50 kg/m2. This rule is still far from being a reality for people living with obesity in France and around the world. [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.)

Résumé: 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 événements 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, diététicien, psychologue, spécialiste en activité physique et incluant le médecin traitant. The benefits of bariatric surgery for class II and III obese patients are well established, with effects on type 2 diabetes and insulin resistance dyslipidemia. This literature review suggests that this so-called metabolic surgery induces a reduction in the incidence of hypertension, heart failure and atrial fibrillation, as well as an improvement in heart failure and a reduction in cardiovascular events, both fatal and non-fatal. Indications for bariatric surgery are class III obesity without metabolic co-morbidity or class II obesity associated with hypertension, type 2 diabetes, sleep apnea syndrome or dysmetabolic steatosis. Because of the risk of nutritional and psychological complications, surgery must be preceded and followed by multidisciplinary care involving a nutritionist, dietician, psychologist, physical activity specialist and attending physician. [ABSTRACT FROM AUTHOR]

La nécessité de séquences chirurgicales itératives, la proximité géographique de deux gestes, l'association d'une chirurgie esthétique à une chirurgie prise en charge par l'assurance maladie ont motivé les auteurs à proposer un geste combiné des bras et des seins en chirurgie post-bariatrique. Un schéma cicatriciel continu reliant les faces internes de bras aux sillons sous-mammaires propose de traiter l'excès cutané latérothoracique, soit par résection, soit par intégration au volume mammaire. Une série rétrospective menée de 2010 à 2017 présente 12 patients de 42 ans d'âge moyen [31 ; 56], opérés en un temps d'une brachioplastie prolongée en latérothoracique et combinée selon une cicatrice continue à une chirurgie mammaire : amputation-greffe (2 hommes), cure de ptôse avec résection latérothoracique (8 cas) ou avec intégration des tissus latérothoraciques pour augmentation mammaire (par LICAP 2 cas). Les patients présentaient un indice de masse corporelle moyen de 28 kg/m2 [23 ; 32] avec un amaigrissement moyen de 56 kg [14 ; 112] secondaire à un régime (3 cas), pose d'un anneau gastrique (1 cas), d'un by-pass (6 cas), d'une sleeve (2 cas). La durée moyenne d'intervention était de 4 heures [3 heures ; 6 heures], la durée moyenne d'hospitalisation de 4 jours [2 jours ; 9 jours]. Les suites ont été marquées par la survenue d'une complication majeure (hématome) et d'une complication mineure (désunion cicatricielle). Le résultat morphologique et cicatriciel est satisfaisant à un recul moyen est de 21 mois [15 jours ; 84 mois]. Ce schéma cicatriciel permet d'intégrer un redrapage latéro-mammaire dans les deux axes très adaptatif avec une cicatrice facilement dissimulable. Cette technique offre une solution élégante à l'excès cutané latéral gênant qui persistait après les chirurgies séparées des bras et des seins. The need of iterative surgeries, the proximity of two anatomical areas, the combination of an aesthetic surgery with a surgery covered by health insurance are the reasons which motivated the authors to provide a simultaneous procedure on arms and breast in patients achieving massive weight loss. We propose a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision to treat the excess skin and subcutaneous tissue of the lateral chest wall, either by resection, or by increasing the breast with the patients own autologous tissue. Between 2010 and 2017, twelve patients aged between 31 and 56 years, with 42 being the average, have undergone a technique that utilises a vertical continuation of the lateral mastopexy incision superiorly, in continuity with a simultaneous brachioplasty incision: transverse skin incisions and free nipple transplantation for correction of extreme gynaecomastia (2 cases), mastopexy with resection of the excess tissue of the lateral chest wall (8 cases), autologous breast augmentation by the use of intercostal artery perforator flaps (2 cases). Mean body mass index (BMI) was 24 kg/m2 [23; 32] after average weight loss of 56 kg [14; 112] following diet (3 cases) or bariatric surgery (9 cases). Mean operative time was 4 hours [3: 6], mean length of hospital stay was 4 days [2; 9]. We observed one major complication (hematoma) and one minor complication (wound dehiscence). At a mean follow-up of 21 months (ranged from 15 days to 84 months), the lateral flank scarring was well tolerated, with the additional benefit of reducing flank fullness. The extended lateral flank scar allows reducing the excess skin and subcutaneous tissue of the lateral chest wall, while being easily concealable. This technique offers an elegant solution to this excess that used to persist after multistage surgeries. [ABSTRACT FROM AUTHOR]

Une équipe pluridisciplinaire intervenant dans le service de chirurgie viscérale de l'Hôpital d'Instruction des Armées Robert Picqué (HIARP) et de la Maison de Santé Protestante Bagatelle (MSPB) a mis en place un programme d'éducation thérapeutique pour des patients obèses candidats à une chirurgie bariatrique. Les interventions du psychologue au cours du parcours médico-chirurgical des patients se font en trois temps : évaluation clinique préopératoire, animation d'ateliers psychoéducatifs et accompagnement psychologique postopératoire de soutien ou à visée psychothérapeutique. Dans cet entretien, le psychologue Laurent Brulin et la diététicienne Hélène Lordon développent les deux premiers axes et rendent compte des bénéfices des ateliers psychoéducatifs observés chez les patients. A multidisciplinary team working in the visceral surgery department of the Robert Picqué Army Training Hospital (HIARP) and the Bagatelle Protestant Health Center (MSPB) has set up a therapeutic education program for patients obese candidates for bariatric surgery. The intervention of the psychologist during the medical and surgical course of the patients are done in three stages: pre-operative clinical evaluation, animation of psycho-educational workshops and post-operative psychological support in support or for psychotherapeutic aim. In this interview, psychologist Laurent Brulin and dietician Hélène Lordon develop the first two axes and report on the benefits of the psycho-educational workshops observed in patients. The medico-psychological course of the patient candidate for bariatric surgery is marked by the recommendations of the Authority for Health (HAS), punctuated by medical, psychological and paramedical consultations. Post-operative psychological consultations seek to creat a therapeutic alliance, to reveal the subjective etiology of obesity in connection with traumatic life events, to assess the psychological, social and family repercussions linked to weight loss, to identify the motivations for change, as well as the correct application of medical and dietetic recommendations aimed at maintaining a healthy life style. Among the obese population, eating disorders, of which there are several clinical descriptions, are frequent. They question the primary or secondary nature of a mood disorder and refer to attachment bond problems characterized by emotional and affective or addictive disorders. The therapeutic education program participates in the process for the surgical project, promotes understanding of the disease and develops self-care or psychological skills. Educational workshops with a psychological component promote the psychic maturation of the bariatric surgery project thought individual and collective speaking times. The group's cohesion contrasts with the feeling of isolation, stigma and social discrimination felt. On a psychological level, the psychologist's interventions in three specific works hop aims at differentiating between self-esteem and body image, then putting patients' expectations regarding the effects of bariatric surgery. Emotional expression, introspection, psychic elaboration, inter-subjective sharing of personal experiences are favored. After the intervention, the obese patient benefits from long-term support by the dietician and the surgeon, as well as psychological consultations at his request, promoting psychic rearrangements linked to the modification of the body image and tending to strength then the self esteem. [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.)

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.)

En 2014, la Cour européenne de justice reconnaît, pour la première fois, que l'obésité sévère puisse être considérée comme une situation de handicap au travail. Cette reconnaissance, pas encore appliquée en France, émerge dans un contexte où l'obésité comme maladie à soigner semble faire consensus. Le développement de la chirurgie de l'obésité et ses résultats médicaux renforcent actuellement cette perspective. L'absence de débats publics, en France, concernant cette potentielle reconnaissance d'handicap de l'obésité, et simultanément l'utilisation fréquente du terme handicap ou « déshandicap » par les personnes opérées pour évoquer les effets de cette chirurgie sont les deux constats à l'origine de l'article. Dans une démarche ethnographique, il est proposé de rendre compte de la façon dont les personnes, expérimentant cette transformation corporelle, participent à redéfinir l'obésité, la chirurgie bariatrique et le handicap, en amont des débats et décisions politiques que pourrait déclencher cette reconnaissance de handicap. À partir du néologisme émique « se déshandicaper », fil conducteur de l'article, il est analysé l'idée de sortie du handicap et d'entrée dans une normalité, en montrant que ces situations confrontent les personnes opérées à de nouvelles injonctions sociales et interrogent de façon originale la relation handicap et normalité. In 2014, the European Court of Justice recognized, for the first time, that severe obesity could be considered as a disability at work. This recognition, not yet applied in France, emerges in a context where obesity as a disease to treat seems to be consensus. The development of obesity surgery and its medical results are reinforcing this perspective. The lack of public debate in France on this potential handicap recognition of obesity, and simultaneously the frequent use of the term disability or "de-disability" by people operated to discuss the effects of this surgery are two findings at the origin of the article. In an ethnographic approach, it is proposed to give an account of the way in which people, experimenting this corporal transformation, participate in redefining obesity, bariatric surgery and disability, before the debates and political decisions that could trigger this recognition of disability. Starting from the emic neologism "de-disability", the thread of the article, it is questioned the idea of exit from disability and entry into normality, showing that these situations confront the people operated with new social injunctions and examine the relationship between disability and normality in an original way. [ABSTRACT FROM AUTHOR]

Obesity impacts at multiple levels on the female reproductive functions. Weight loss is associated with improved ovulation and pregnancy rate after assisted reproductive technique (ART). Bariatric surgery allows for greater weight loss than with lifestyle modifications. It is associated with a reduction in the prevalence of polycystic ovarian syndrome, as well as an increase in the rate of spontaneous pregnancies. To date, no data shows an improvement of ART pregnancy rates after bariatric surgery, and the decrease in AMH levels observed postoperatively implies for caution for women whose infertility is not related to a polycystic ovarian syndrome. Bariatric surgery could thus be interesting in obese infertile women by allowing the weight loss necessary to restore spontaneous ovulation, allow access to AMP and limit maternal comorbidities during pregnancy. The objectives nutritional care should be discussed early in the process, taking into account the age of the patients who play a predominant role after 35 years, and the time between bariatric surgery and pregnancy. [ABSTRACT FROM AUTHOR]

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Ces dernières années, une attention croissante a été portée au microbiote intestinal (MI) en raison de son rôle dans les maladies métaboliques, la santé cardiovasculaire, les troubles gastro-intestinaux et les cancers. Chez les individus atteints d'obésité, une diminution de la richesse, de la diversité et de la composition du MI a souvent été observée, et cela a été associé aux traits métaboliques et à l'inflammation systémique de bas grade. Un moyen de réduire les risques cardiométaboliques est la chirurgie de l'obésité. Le nombre de chirurgies bariatriques a augmenté en parallèle avec la prévalence croissante de l'obésité sévère ces dernières années. La chirurgie métabolique, telle que le by pass gastrique Roux-en-Y (RYGB) ou la sleeve gastrectomie (SG), a en effet démontré des résultats prometteurs en termes de perte de poids à long terme, d'amélioration de l'état métabolique et même de rémission des comorbidités. Cependant, ces résultats positifs ne peuvent être attribués uniquement à la restriction de l'apport alimentaire ou à la malabsorption. Des données suggèrent que la chirurgie bariatrique entraîne des modifications significatives dans le microbiome intestinal, ce qui pourrait contribuer aux effets bénéfiques observés sur les complications liées à l'obésité. Ces changements pourraient jouer un rôle crucial dans la réduction des maladies cardiovasculaires. Par conséquent, l'objectif principal de cette revue est de mieux comprendre les liens entre la composition du MI après une chirurgie bariatrique et l'amélioration de la santé cardiovasculaire. En explorant cette relation complexe, les équipes dans le domaine espèrent éclairer les mécanismes sous-jacents et ouvrir la voie à de nouvelles stratégies thérapeutiques pour améliorer la santé cardiovasculaire chez les patients ayant subi une chirurgie bariatrique. © 2023 Société francophone nutrition clinique et métabolisme (SFNCM). Publié par Elsevier Masson SAS. Tous droits réservés. In recent years, increasing attention has been given to the gut microbiota because of its role in metabolic diseases, cardiovascular health, gastrointestinal disorders, and cancers. In individuals suffering from obesity, a reduction in the richness, diversity, and composition of the intestinal microbiota has often been observed, and this has been associated with metabolic traits and low-grade systemic inflammation. Bariatric surgery has emerged as a valuable approach for reducing cardiometabolic risk. Recently, the number of bariatric surgeries has increased in parallel with the growing prevalence of severe obesity. Metabolic surgery, such as Roux-en-Y gastric bypass or Sleeve Gastrectomy, has shown promising results in terms of long-term weight loss, improved metabolic status, and even remission of comorbidities. However, it is important to note that these positive results cannot be attributed solely to food intake restriction or malabsorption. Emerging evidence suggests that bariatric surgery leads to significant changes in the intestinal microbiome, which may contribute to the beneficial effects observed on obesity-related complications. These changes could play a crucial role in reducing cardiovascular disease. Therefore, the main objective of this review is to better understand the links between the composition of the gut microbiota after bariatric surgery and improved cardiovascular health. By exploring this complex relationship, research teams aim to shed light on the underlying mechanisms and pave the way for novel therapeutic strategies to improve cardiovascular health in patients who have undergone bariatric surgery. © 2023 Société francophone nutrition clinique et métabolisme (SFNCM). Published by Elsevier Masson SAS. All rights reserved. [ABSTRACT FROM AUTHOR]

L'issue des grossesses après chirurgie bariatrique semble favorable associant réduction de l'incidence du diabète gestationnel, des troubles hypertensifs et de la macrosomie. Néanmoins une augmentation de l'incidence des nouveaux nés de petit poids pour l'âge gestationnel et de la prématurité est constatée dans plusieurs études. Des carences nutritionnelles de sévérité variable pour la mère et le nouveau-né set des complications chirurgicales avec un pronostic conditionné par les difficultés diagnostiques sont également observées. Notre groupe de travail multidisciplinaire propose une série de recommandations élaborées selon la méthodologie de la HAS et concernent les questions suivantes: quel délai entre la chirurgie et la grossesse ? Quelle contraception ? Quel type de chirurgie pour les femmes en âge de procréer ? Quel support nutritionnel et quelle gestion des carences nutritionnelles ? Quel dépistage et quelle gestion du diabète gestationnel ? Quelle prise de poids optimale ? Comment gérer l'anneau gastrique au cours de la grossesse ? Comment prendre en charge les urgences chirurgicales, la prise en charge obstétricale et les soins spécifiques pendant la période post-partum et pour les nouveau-nés ? The outcome of pregnancies after bariatric surgery seems favorable with a reduction in the incidence of gestational diabetes, hypertensive disorders and macrosomia. However, an increase in newborns of low weight for gestational age and prematurity are observed. Nutritional deficiencies of varying severity for the mother and the newborn are reported, as well as surgical complications with a prognosis conditioned by the diagnostic difficulties during pregnancy. Our multidisciplinary working group proposes clinical practical guidelines developed according to the methodology of the HAS and covering the timing between surgery and pregnancy, contraception, preferred type of surgery for women of childbearing age, systematic nutritional support and management of nutritional deficiencies, screening and management of gestational diabetes, weight gain during pregnancy, gastric banding management, surgical emergencies, obstetrical management, and specific care in the postpartum period and for newborns. [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.)

Introduction: The current collective preparation program for obesity surgery is performed by an interdisciplinary team over four non-consecutive days. In order to optimize the delays of the program and to improve the educational offer a temporal condensation of this service in the proximity of the intervention was decided. The objective of this study is to describe the creation process of the new obesity surgery preparation program based on the needs of partner patients. Materials and methods: We conducted semi-structured focus groups with 50 patients over 3 successive stages of the surgical journey: at the beginning and end of the collective preparation and then 2 to 14 months after the surgery. The analysis crosses by theme the needs identified. Results and discussion: Our study allowed to authenticate a central need of sharing with witnesses, a need for information (medical, dietary, behavioral), and a need for longer-term projection (transformations, investment axes to support weight loss). Conclusion: The preparatory needs identified by the partner patients served as a guide for the transformation of the existing program. This experiment paves the way for a partnership with patients established and recognized by the institution of care in the evaluation process of this program. [ABSTRACT FROM AUTHOR]