[Challenges of the transition for obese teenager towards adult care]. / Défis de la transition de l'adolescent obèse aux soins adultes.

The prevalence of overweight and obesity among young patients increases with age, and affects one out of five at secondary school level. Ensuring continuous care of these young patients during their growth into adulthood is a true challenge, and requires a close collaboration of pediatric and adult care teams. Each step of this transition is precarious and needs specific attentions and competencies to be successful, as teenagers and young adults are simultaneously undergoing multiple changes and challenges. As each of these young patients present with their own individual development and life experiences, individualized care transitional care plans are necessary.

La prévalence des jeunes en surpoids ou obèses augmente avec l'âge, et atteint la proportion d'un écolier sur cinq au niveau secondaire. Assurer la continuité des soins de ces jeunes patients à l'âge adulte représente un véritable challenge et demande la collaboration étroite des équipes pédiatriques et adultes. Chaque étape de la transition de soins est délicate et nécessite des attentions et des compétences particulières. Les phases d'adolescence et d'adulte émergent sont caractérisées par de multiples changements rendant la transition d'autant plus difficile. Chaque jeune patient a un développement et un vécu qui lui sont propres, ce qui implique que la transition doit être individualisée et adaptée.

[Pregnancy after bariatric surgery]. / Grossesse après chirurgie bariatrique.

Bariatric surgery interventions are rapidly growing and most are performed on female patients. Thus, pregnancies after bariatric surgery are increasingly common. Awareness of the consequences and risks of bariatric surgery on subsequent pregnancies is important. Literature data report a reduction of the usual pregnancy risks of pregnancies in obese patients, but also an increased risk of small-for-gestational-age infants, possibly related to nutritional deficiencies. A careful screening for micronutrient deficiencies is therefore already advised before conception. Nutritional follow-up and serious evaluation of any abdominal complaints are recommended as well during pregnancy.

[How to facilitate protein consumption after gastric bypass?]. / Comment faciliter la consommation de protéines après un bypass gastrique?

After a gastric bypass, covering protein needs is impossible. This deficit is co-responsible for several postoperative complications so it is essential to inform, prepare and train every patient candidate for such an intervention. To increase protein intake, it is important to work on two different aspects: on the one hand on food sources, targeting the richest food and, on the other hand, on food tolerance so that these foods can be consumed. In fact, gastric bypass induces not only a reduction in gastric volume, but also reduces the passage from the stomach to the intestine. Changes in feeding behavior are much needed to improve food tolerance.

[When the obese patient can't lose any weight or keeps putting some on]. / Lorsque le patient obèse ne perd pas de poids ou continue a en prendre....

The traditional obesity treatments have proven to be ineffective in the long-term. The presence of eating disorders frequently explains this phenomena. Eating educational and behavioral aspects must be addressed in a practical way so that patients could gradually become aware of their behavior towards food as well as internal sensations associated with hunger, satiety, craving and pleasure. Finally, the link between emotions and compulsive eating behaviors during and between meals is an essential aspect that the general practitioner can help the patient to understand. A specialized psychological treatment can then be considered when the patient shows sufficient motivation and consciousness.

[Light food and beverages: what to think about?]. / Aliments et boissons allégés: qu'en penser?

Light food and beverages are increasing on the market for many years, first for economic reasons and, more and more for aesthetisme, however without aimed a defined population. The interest of these products is not evident, reason why it is difficult to get a clear and objective opinion without being influenced by marketing messages. Under what circumstances can they be a solution? Can we advise them? Do they have an influence in the loss or weight control? This article offers some thoughts and suggestions on the use of these specific products.

[Sweeteners: between myth and reality]. / Edulcorants: entre mythe et réalité.

As the prevalence of obesity and diabetes are continually increasing, the use of "false sugars" otherwise known as sweeteners, and their associated health issues are being more and more discussed. A higher sugared power, less calories as well as a moderated or non-existent effect on blood sugar would lead to believe that sweeteners are helpful. However, we CANNOT say that they are THE solution as they can contain calories, may have some undesired effects, and moreover they ease the conscience without actually allowing a weight loss with their sole use. They are to be used with judgment, wittingly and especially when comparing sweetened products. The sweetener myth is often far from reality. It is therefore important to give our patients the means to analyze their dietary intake with regard to their sweeteners ingestion.

[Fruit and vegetable beverages: advantages and disadvantages]. / Shots de fruits et légumes: avantages et inconvénients.

In Switzerland, fruits and vegetables recommendations are of 600 gr per day. In reality, the average intake is about 60% of these recommendations, it means 380 gr per day. The use of products like fruits and vegetables shots could reduce the gap by making drinking easier. However, they cannot replace one hundred percent fresh food for their content in fibers and vitamin C are lower and they interfere with the physiology of the food intake (satiety). These products can have their importance in a various supply by taking the place of one fruit or vegetable portion. Another non negligible aspect is the price as if we consume these products over one week instead of fresh food, the difference would be of about CHF 30.- more.

Energy and macronutrient intake after gastric bypass for morbid obesity: a 3-y observational study focused on protein consumption.

BACKGROUND: The effect of a Roux-en-Y gastric bypass (RYGB) on body weight has been amply documented, but few studies have simultaneously assessed the evolution of energy and macronutrient intakes, energy expenditure, and changes in body composition over time after an RYGB. OBJECTIVE: We evaluated energy and macronutrient intakes, body composition, and the basal metabolic rate (BMR) in obese female patients during the initial 3 y after an RYGB. METHODS: Sixteen women with a mean ± SEM body mass index (in kg/m(2)) of 44.1 ± 1.6 were included in this prospective observational study. The women were studied on 6 different occasions as follows: before and 1, 3, 6, 12 (n = 16), and 36 (n = 8) mo after surgery. On each occasion, food intake was evaluated from 4- or 7-d dietary records, body composition was assessed with the use of bio-impedancemetry, and energy expenditure was measured with the use of indirect calorimetry. RESULTS: Body weight evolution showed the typical pattern reported after an RYGB. Total energy intake was 2072 ± 108 kcal/d at baseline and decreased to 681 ± 58 kcal/d at 1 mo after surgery (P < 0.05 compared with at baseline). Total energy intake progressively increased to reach 1240 ± 87 kcal/d at 12 mo after surgery (P < 0.05 compared with at 1 mo after surgery) and 1448 ± 57 kcal/d at 36 mo after surgery (P < 0.05 compared with at 12 mo after surgery). Protein intake was 87 ± 4 g/d at baseline and ± 2 g/d 1 mo after surgery (P < 0.05 compared with at baseline) and increased progressively thereafter to reach 57 ± 3 g/d at 36 mo after surgery (P < 0.05 compared with at 1 mo after surgery). Carbohydrate and fat intakes over time showed similar patterns. Protein intake from meat and cheese were significantly reduced early at 1 mo after surgery but increased thereafter (P < 0.05). The BMR decreased from 1.12 ± 0.04 kcal/min at baseline to 0.93 ± 0.03, 0.86 ± 0.03, and 0.85 ± 0.04 kcal/min at 3, 12, and 36 mo after surgery, respectively (all P < 0.05 compared with at baseline). CONCLUSIONS: Total energy, carbohydrate, fat, and protein intakes decreased markedly during the initial 1-3 mo after an RYGB, whereas the BMR moderately decreased. The reduction in protein intake was particularly severe at 1 mo after surgery, and protein intake increased gradually after 3-6 mo after surgery. This trial was registered at clinicaltrials.gov as NCT01891591.