A randomized controlled trial investigating the effect of liraglutide on self-reported liking and neural responses to food stimuli in participants with obesity.

BACKGROUND/OBJECTIVES: Obesity is a complex condition and the mechanisms involved in weight gain and loss are not fully understood. Liraglutide, a GLP-1 receptor agonist, has been demonstrated to successfully promote weight loss in patients with obesity (OB). Yet, it is unclear whether the observed weight loss is driven by an alteration of food liking. Here we investigated the effects of liraglutide on food liking and the cerebral correlates of liking in OB. SUBJECTS/METHODS: This study was a randomized, single-center, double-blind, placebo-controlled, parallel group, prospective clinical trial. 73 participants with OB and without diabetes following a multidisciplinary weight loss program, were randomly assigned (1:1) to receive liraglutide 3.0 mg (37.40 ± 11.18 years old, BMI = 35.89 ± 3.01 kg) or a placebo (40.04 ± 14.10 years old, BMI = 34.88 ± 2.87 kg) subcutaneously once daily for 16 weeks. INTERVENTIONS/METHODS: We investigated liking during food consumption. Participants reported their hedonic experience while consuming a high-calorie food (milkshake) and a tasteless solution. The solutions were administered inside the scanner with a Magnetic Resonance Imaging (MRI)-compatible gustometer to assess neural responses during consumption. The same procedure was repeated during the pre- and post-intervention sessions. RESULTS: None of the effects involving the intervention factor reached significance when comparing liking between the pre- and post-intervention sessions or groups. Liking during food reward consumption was associated with the activation of the ventromedial prefrontal cortex (vmPFC) and the amygdala. The liraglutide group lost more weight (BMI post-pre = -3.19 ± 1.28 kg/m2) than the placebo group (BMI post-pre = -0.60 ± 1.26 kg/m2). CONCLUSIONS: These results suggest that liraglutide leads to weight loss without self-report or neural evidence supporting a concomitant reduction of food liking in participants with OB.

[Evolution and effectiveness of therapeutic patient education for obesity and diabetes]. / Évolution et efficacité de l'éducation thérapeutique du patient pour l'obésité et le diabète.

Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease. Through a scientometric analysis of the literature, we identified the most influential bibliographic data related to TPE research that have strengthened the field and increased its effectiveness. These were studies from the fields of education, philosophy, psychology, anthropology and medical sociology. We have conducted a meta-analysis that has demonstrated the effectiveness of TPE for the management of obesity and diabetes on biological and psychological parameters. It allowed patients to improve their knowledge, their therapeutic adherence and their sense of self-efficacy.

L'éducation thérapeutique du patient (ETP) vise à aider les patients à acquérir ou maintenir les compétences dont ils ont besoin pour gérer au mieux leur vie avec une maladie chronique. À travers une analyse scientométrique de la littérature, nous avons identifié les données bibliographiques les plus influentes, relatives à la recherche en ETP, qui ont permis de renforcer le domaine et augmenter son efficacité. Ce sont des études issues des sciences de l'éducation, de la philosophie, de la psychologie, de l'anthropologie et de la sociologie médicale. Nous avons mené une méta-analyse qui a permis de démontrer l'efficacité de l'ETP pour la prise en charge de l'obésité et du diabète sur les paramètres biologiques et psychologiques. Elle a permis aux patients d'améliorer leurs connaissances, leur adhérence thérapeutique et le sentiment d'efficacité personnelle.

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. FINDINGS: We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

[A double pandemic : the impact of anti-Covid measures on obesity]. / Double pandémie : impact des mesures anti-Covid-19 sur l'obésité.

To deal with the COVID-19 pandemic, several restrictive measures have been put in place that cause significant disruption to lifestyle habits. We conducted a review of the literature to study the impact of these changes on the body weight of populations. We observed changes in eating habits (increase in the number of snacks and consumption of sugary products), a decrease in physical activity and an increase in stress that can exacerbate eating disorders. Increased efforts must be made to support patients during this difficult time, including public health measures to counteract these behaviours in order to prevent health complications.

Pour faire face à la pandémie de Covid-19, plusieurs mesures restrictives ont été mises en place, qui engendrent des perturbations importantes des habitudes de vie. Nous avons effectué une revue de la littérature pour étudier l'impact de ces changements sur le poids des populations. On observe des changements des habitudes alimentaires (augmentation du nombre de collations et de la consommation de produits sucrés), une baisse de l'activité physique et un accroissement du stress qui peut exacerber de troubles du comportement alimentaire. Des efforts accrus doivent être fournis pour soutenir les patients pendant cette période difficile, y compris des mesures de santé publique pour contrecarrer ces comportements afin de prévenir les complications de santé.

[The role of stress in obesity]. / Rôle du stress dans l'obésité.

Stress is known to favour weight gain. This can be explained by various physiopathological and behavioural mechanisms. Specifically, chronic stress induces a dysfunction of the sympathetic nervous system and of the hypothalamic-pituitary-adrenal axis which favours obesity, and the other way around. Furthermore, stress promotes eating disorders and a decrease in physical activity. Various studies using strategies that act specifically on stress have shown benefits in terms of weight loss. It is therefore important to evaluate stress in any patient suffering from obesity and to propose a treatment adapted to the patient's needs.

Le stress est connu comme un facteur favorisant la prise de poids. Cela s'explique par différents mécanismes physiopathologiques et comportementaux. Concrètement, le stress chronique induit un dysfonctionnement du système nerveux sympathique et de l'axe hypothalamo-hypophyso-surrénalien qui favorise l'obésité, et inversement. De plus, le stress favorise des troubles du comportement alimentaire et une baisse de l'activité physique. Diverses études utilisant des stratégies agissant spécifiquement sur le stress ont montré des bénéfices en termes de perte pondérale. Il est donc important d'évaluer le stress chez tout patient souffrant d'obésité et de proposer un traitement adapté en fonction des besoins du patient.

[Obesity†: eat less and move more†? Not so easy]. / Obésité†: manger moins et bouger plus†? Pas si simple.

Obesity is a chronic disease that requires a complex treatment. Establishing a balanced diet and regular physical activity is not always simple, especially in the long term. There are multiple factors (biological and psychological) favoring weight gain, often limiting the effectiveness of lifestyle approaches. Pharmacology offers us another therapeutic option with new molecules effective for weight loss. Bariatric surgery is also effective, but it is not without risks, especially if the patients have not been adequately prepared for this procedure. Furthermore, these approaches should always be proposed as complementary to lifestyle changes. This article summarizes the different treatments for obesity and highlights the importance of a multidisciplinary management and proper patient education.

L'obésité est une maladie chronique dont le traitement est complexe. L'instauration d'un équilibre alimentaire et d'une activité physique régulière n'est pas toujours simple, surtout à long terme. Les facteurs favorisant la prise de poids sont multifactoriels (biologiques et psychologiques), limitant souvent l'efficacité des approches hygiéno-diététiques. La pharmacologie nous offre une autre piste thérapeutique avec de nouvelles molécules efficaces pour perdre du poids. La chirurgie bariatrique est efficace, mais elle n'est pas sans risques, surtout si les patients n'ont pas eu une préparation adéquate. Ces traitements doivent toujours être proposés en complément de modifications d'hygiène de vie. Cet article résume les différents traitements de l'obésité et souligne l'importance de la prise en charge multidisciplinaire et de l'éducation thérapeutique du patient.

[Start to collaborate with partner patients†: an evidence?] / Entrer en collaboration avec des patients partenaires†: une évidence†?

The societal, political and institutional context is today favorable for the establishment of a partnership between patient and healthgivers. Despite the tangible benefits, the perception of partners ambivalent attitudes reinforces the importance of the construction for this collaboration. This article describes this collaborative approach born out of the transformation of a bariatric surgery preparation educational program. In this context, the implementation strategy is the founding stage to explore the needs of partners. This highlights the need to secure the healthgivers regarding power issues, as well as to question the skills required for patient partners. The definition of the partnership model by the partners provides answers.

Le contexte sociétal, politique et institutionnel est aujourd'hui favorable à la mise en place d'un partenariat entre patients et soignants. Malgré des bénéfices tangibles, la perception d'une ambivalence des partenaires renforce l'importance de la construction de cette collaboration. Cet article décrit cette démarche collaborative, née dans le contexte de la transformation d'un programme éducatif de préparation à la chirurgie bariatrique. Dans la stratégie d'implémentation, l'exploration contextuelle des besoins des partenaires constitue l'étape fondatrice. Elle met en lumière un besoin de sécurisation des soignants quant à des enjeux de pouvoir, et questionne sur les compétences requises des patients partenaires. La définition du modèle de partenariat par les partenaires apporte des réponses.

Cellular circadian period length inversely correlates with HbA1c levels in individuals with type 2 diabetes.

AIMS/HYPOTHESIS: The circadian system plays an essential role in regulating the timing of human metabolism. Indeed, circadian misalignment is strongly associated with high rates of metabolic disorders. The properties of the circadian oscillator can be measured in cells cultured in vitro and these cellular rhythms are highly informative of the physiological circadian rhythm in vivo. We aimed to discover whether molecular properties of the circadian oscillator are altered as a result of type 2 diabetes. METHODS: We assessed molecular clock properties in dermal fibroblasts established from skin biopsies taken from nine obese and eight non-obese individuals with type 2 diabetes and 11 non-diabetic control individuals. Following in vitro synchronisation, primary fibroblast cultures were subjected to continuous assessment of circadian bioluminescence profiles based on lentiviral luciferase reporters. RESULTS: We observed a significant inverse correlation (ρ = -0.592; p < 0.05) between HbA1c values and circadian period length within cells from the type 2 diabetes group. RNA sequencing analysis conducted on samples from this group revealed that ICAM1, encoding the endothelial adhesion protein, was differentially expressed in fibroblasts from individuals with poorly controlled vs well-controlled type 2 diabetes and its levels correlated with cellular period length. Consistent with this circadian link, the ICAM1 gene also displayed rhythmic binding of the circadian locomotor output cycles kaput (CLOCK) protein that correlated with gene expression. CONCLUSIONS/INTERPRETATION: We provide for the first time a potential molecular link between glycaemic control in individuals with type 2 diabetes and circadian clock machinery. This paves the way for further mechanistic understanding of circadian oscillator changes upon type 2 diabetes development in humans. DATA AVAILABILITY: RNA sequencing data and clinical phenotypic data have been deposited at the European Genome-phenome Archive (EGA), which is hosted by the European Bioinformatics Institute (EBI) and the Centre for Genomic Regulation (CRG), ega-box-1210, under accession no. EGAS00001003622.

Variable oxytocin levels in humans with different degrees of obesity and impact of gastric bypass surgery.

Exogenous oxytocin administration in obese mice, rats, and monkeys was shown to induce sustained weight loss, mostly due to a decrease in fat mass, accompanied by an improvement of glucose metabolism. A pilot study in obese humans confirmed the weight-reducing effect of oxytocin. Knowledge about circulating oxytocin levels in human obesity might help indicating which obese subjects could potentially benefit from an oxytocin treatment. Conclusive results on this topic are missing. The aim of this study was to measure circulating oxytocin levels in lean (n = 37) and obese (n = 72) individuals across a wide range of body mass index (BMI) values (18.5-60 kg/m2) and to determine the impact of pronounced body weight loss following gastric bypass surgery in 12 morbidly obese patients. We observed that oxytocin levels were unchanged in overweight and in class I and II obese subjects and only morbidly obese patients (obesity class III, BMI > 40 kg/m2) exhibited significantly higher levels than lean individuals, with no modification 1 year after gastric bypass surgery, despite substantial body weight loss. In conclusion, morbidly obese subjects present elevated oxytocin levels which were unaltered following pronounced weight loss.

Interventions targeting hypertension and diabetes mellitus at community and primary healthcare level in low- and middle-income countries:a scoping review.

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.

[To improve body image with dance therapy]. / Améliorer l'image du corps avec la danse-thérapie.

Body image is a multidimentional organisation which participates in the construction of the identity. It stems from the body schema and changes throughout life. Dance therapy creates a link between the psychic and the physical self. It works on the cognitive, social and personal aspect of the personality. During forteen years, the Service of Therapeutic Education for Chronic Diseases of the University Hospital of Geneva developed a dance therapy program for obese patients.The effect of a dance therapy treatment on body image has been evaluated and compared to control groups. Our results show a great improvement on quality of life, self esteem and body self esteem and mental representations of oneself.

L'image du corps est une organisation multidimensionnelle, subjective qui participe à la construction de l'identité. Elle est issue des représentations du schéma corporel et se modifie au cours des ans. La danse-thérapie crée un lien entre le corps psychique et physique de la personne. Elle agit sur le plan cognitif, affectif et social. Pendant 14 ans, le service d'enseignement thérapeutique pour maladies chroniques, aux Hôpitaux Universitaires de Genève, a développé un programme de danse-thérapie pour les personnes souffrant d'obésité. L'effet de la danse-thérapie sur l'image du corps a été évalué. La comparaison avec des groupes de contrôle montre que la danse-thérapie permet d'améliorer significativement la qualité de vie, l'estime de soi et l'estime corporelle et les représentations mentales.

[Information and communication technologies for weight loss]. / Technologies d'information et de communication pour la perte de poids.

The potential of information and communication technologies has quickly been identified for health and in particular to promote weight loss. Several types of technologies exist with varying degrees of efficiency. These include programs on the Internet, using text messages, smartphone applications or portable devices. All these technologies are based on a set of weight loss strategies known to be effective, such as self-monitoring, feedback and social support. Despite promising results, several important limitations must be addressed such as the quality of the information being disseminated, the risk of promoting eating disorders, the place of these tools in patient follow-up, as well as data confidentiality issues.

Le potentiel des technologies de l'information et de la communication a rapidement été identifié dans le domaine de la santé et en particulier dans la promotion de la perte de poids. Des programmes sur internet, l'utilisation de SMS, des applications sur smartphone ou encore des appareils portables connectés existent, avec des degrés variables d'efficacité. Toutes ces technologies reposent sur un ensemble de stratégies connues pour faciliter la perte de poids telles que l'autosurveillance, le feedback et le soutien social. Malgré des résultats prometteurs, plusieurs questions se posent, sur le plan de la fiabilité de ces outils, la qualité des messages diffusés, le risque de favoriser des troubles du comportement alimentaire, la place de ces outils dans le suivi ou encore les problèmes de confidentialité des données.

[Psychotropic drugs and weight]. / Psychotropes et poids.

Psychotropic drugs can induce weight gain and a metabolic syndrome, reducing the quality of life and the life expectancy of patients. Weight gain is also responsible for poor adherence to treatment and therefore relapses of mental illness. This weight gain and the metabolic syndrome are insufficiently treated for obese patients with mental disorders. Recommendations exist.

Les psychotropes peuvent faire prendre du poids et induire un syndrome métabolique réduisant ainsi la qualité de vie et l'espérance de vie des patients. La prise de poids est également responsable d'une mauvaise adhésion aux traitements et donc de rechutes des maladies psychiques. Cette prise de poids et le syndrome métabolique sont insuffisamment traités pour les patients obèses souffrant de troubles psychiques. Des recommandations existent.

[Do we have to treat the obese male with testosterone ?] / Faut-il traiter un homme obèse avec de la testostérone ?

Since a decade, we observe an expansion of the use of testosterone against different components of the metabolic syndrome in men. More particularly in the obese man, indications for the prescription of this hormone are not well defined because of the contradictory studies which do not allow the establishment of a clear consensus. This article proposes a diagnostic procedure for the detection of hypogonadism in obese men. It clarifies the indications of use of testosterone in this particular context but also the circumstances in which the specialist should be consulted.

Depuis une décennie, nous observons une expansion de l'utilisation de la testostérone chez l'homme surtout contre les différentes composantes du syndrome métabolique. Plus particulièrement, chez l'homme obèse, il n'existe pas d'indications bien définies pour la prescription de cette hormone en raison des études contradictoires qui ne permettent pas d'établir un consensus clair. Cet article propose une démarche diagnostique pour le dépistage de l'hypogonadisme chez l'homme obèse. Il clarifie les indications d'utilisation de la testostérone dans ce contexte particulier mais aussi les circonstances dans lesquelles le spécialiste devrait être consulté.

[Food reward circuitry in obese patients]. / Circuits de la récompense alimentaire chez les patients obèses.

Besides hormonal regulation of appetite and satiety, food intake depends on the activity of certain brain systems. Functional imaging studies are useful to better understand this central regulation of energy intake. Obesity is associated with increased brain responses to food stimuli at the level of the reward system. More specifically, studies have shown in obese individuals an increased motivation to obtain food reward as well as a decrease in pleasure during its actual consumption. Food consumption may be, in some instances, comparable to addiction, and be reflected by irresistible cravings for certain foods.

Hormis les mécanismes hormonaux de la régulation de l'appétit et de la satiété, la consommation alimentaire est également contrôlée par certains circuits cérébraux. Cette régulation centrale commence à être mieux étudiée grâce à l'imagerie fonctionnelle. L'obésité est associée à des réponses cérébrales accrues à des stimuli associés à de la nourriture au niveau du circuit de récompense. Plus spécifiquement, les études ont permis de mettre en évidence que les individus obèses avaient une motivation élevée pour obtenir une récompense alimentaire tout en ayant une diminution du plaisir lors de la consommation de celle-ci. De plus, la consommation alimentaire pourrait être, dans certains cas, comparable à l'addiction et se manifester par des envies irrésistibles de consommer certains aliments.

[What place for therapeutic education in nephrology ?] / Quelle place pour l'éducation thérapeutique en néphrologie ?

Chronic kidney disease (CKD) usually goes unrecognized for patients until late symptomatic stages. In preterminal CKD, extrarenal substitution methods are usually presented to patients. This is felt like a breakdown, implying major modifications of everyday life. Acquisition of health literacy is necessary for patients with CKD to become autonomous and increase their empowerment toward the disease. Therapeutic education in nephrology plays a major role in improving the care of CKD patients.

L'insuffisance rénale chronique (IRC) est une maladie silencieuse, évolutive, souvent asymptomatique dans ses stades précoces. Elle devient réelle lorsque les symptômes apparaissent, lors des stades avancés. Lorsque l'insuffisance rénale est préterminale, les différentes méthodes de substitutions extrarénales sont présentées au patient. Ceci raisonne souvent comme un choc, car elles impliquent des modifications majeures de la vie quotidienne. L'acquisition des compétences en santé devient une nécessité dans la maladie chronique afin de permettre au patient son empowerment (autonomisation et autodétermination, englobant la capacité de prendre des décisions et d'exercer un contrôle sur sa vie). L'éducation thérapeutique en néphrologie tient donc une place prépondérante dans la prise en charge des patients atteints d'IRC, afin d'améliorer leur autonomisation dans leur prise en charge et leur qualité de vie.

[Practical reading grids to better understand our hypertensive patients]. / Quelques grilles de lecture pour mieux comprendre son patient hypertendu.

Hypertension is well identified as the main factor of mortality, cardiovascular disease and renal damage worldwide. However, only half of hypertensive patients are diagnosed as hypertensive, and only a quarter of hypertensive patients has blood pressure values normalized by the medical treatment. The aim of this article is to propose a practical reading grid in order to get a better understanding of our patients, in the GP's office, and a comprehensive approach of problematics encountered by the patient with its own perception, to identify barriers, tools and patients' available ressources.

L'hypertension artérielle est bien identifiée comme l'un des principaux facteurs de mortalité et d'atteinte cardiovasculaire et rénale dans le monde. Pourtant, la moitié des sujets hypertendus ne sont pas diagnostiqués, et seul le quart des patients a des valeurs normalisées par le traitement. Cet article propose, à l'aide de courtes vignettes cliniques, des grilles de lecture pour mieux comprendre son patient, en se plaçant dans la relation d'un cabinet de consultation, ainsi qu'une lecture de la problématique du patient de son point de vue, afin de déceler les obstacles, outils et ressources disponibles pour améliorer la prise en charge de l'hypertension artérielle.

[Paradoxal decrease and metabolic effects of BNP in obese patient]. / Baisse paradoxale et effet métabolique du BNP chez les obèses.

Natriuretic peptides (NP), ANP and BNP, are produced by cardiomyocytes when there is stretching of the ventricular and auricular walls in heart failure (HF). Their vasodilatator and natriuretic effect oppose to volume and pressure overload occurring in HF. Several studies have observed decreased levels of NP in obese and diabetic people and in patients with insulin resistance. This decrease could contribute to hypertension, frequently observed in obesity. NP have also a lipolytic action. Low levels of NP could promote obesity. Therefore in obese patients normal BNP levels cannot a priori exclude HF. Normal values must be adjusted according to obesity degree and heart failure stage.

Les peptides natriurétiques (PN) ANP (atrial natriuretic peptide) et BNP (brain natriuretic peptide) sont synthétisés par les cardiomyocytes lors de mise sous tension des parois musculaires des ventricules et des oreillettes en cas d'insuffisance cardiaque (IC). Leur effet vasodilatateur et natriurétique s'oppose à la surcharge de volume et de pression qui survient lors d'IC. Plusieurs études ont montré que les taux de BNP sont diminués chez les patients obèses, diabétiques ou présentant une résistance à l'insuline. La baisse de BNP pourrait contribuer à l'hypertension observée chez les obèses. De plus les PN ont une action lipolytique. Des taux abaissés de PN pourraient favoriser l'obésité. En pratique, chez les obèses, des valeurs normales de BNP ne permettent pas d'exclure une IC. Les valeurs de BNP doivent être corrigées en fonction des degrés d'obésité et d'IC.

[Eating disorder and food addiction in a population candidates for a bariatric surgery]. / Troubles du comportement alimentaire, addiction à la nourriture et chirurgie bariatrique.

Non stabilized severe eating disorder is a contra-indication for bariatric surgery. Specific cares can stabilize this disorder, and therefore a surgery can be undertaken. In this respect, more and more attention is paid to the concept of food addiction even if its definition is still debated. Some authors, according to neurobiological data, consider food addiction as independent from eating disorder, but others see food addiction as a severe sub-type of eating disorder. To contribute to this debate, we performed a study in our department including 23 subjects candidates for a bariatric surgery and found a significant association between food addiction and eating disorder, independently of the body mass index. Clarification of the food addiction concept should permit to reconsider the specific cares needed by these obese patients.

Les troubles du comportement alimentaire (TCA) sévères non stabilisés sont une contre-indication à la chirurgie bariatrique. Une prise en charge spécifique peut permettre de stabiliser ces troubles et d'autoriser ainsi une chirurgie. Le concept d'addiction à la nourriture émerge de plus en plus même s'il reste encore débattu. Certains auteurs, en s'appuyant sur des bases neurobiologiques, le considèrent comme un trouble indépendant des TCA et d'autres l'envisagent plutôt comme un sous-type sévère. Une étude réalisée dans notre service chez 23 sujets candidats à la chirurgie bariatrique a montré une association significative entre les TCA et l'addiction à la nourriture, et ce indépendamment de l'indice de masse corporelle. Préciser le concept d'addiction à la nourriture permettrait de pouvoir repenser la prise en charge de ces patients.