[When pain becomes complex, feedback from a pain team]. / Quand la douleur devient complexe, retour d'expérience d'une équipe douleur.

The main advantage of a pain team is its multidisciplinary nature. The different perspectives and roles of the members of this team (doctor, nurse and psychologist) make it possible to offer more appropriate support to the patient in pain. This is the case of 13-year-old Élio, whose journey and the specificities of pain management have proven to be complex.

[Psychological care for children with obesity: its means and purposes]. / Prise en charge psychologique des enfants en situation d'obésité : pourquoi et comment s'organise-t-elle ?

PSYCHOLOGICAL CARE FOR CHILDREN WITH OBESITY: ITS MEANS AND PURPOSES. Obesity among children, like any other chronic pathology, has noticeable consequences on the patient's body and on his overall quality of life. As psychologists, we aim to explore not only the child's family environnement but also the way he relates to food and perceives his own body. As it is often the case with any medical symptoms, weight gain paves the way to the patient's psyche and internal conflicts. A kind approach is fundamental, respectful of the family's intimacy as well as the child's temporality. It enables the patient to express a demand. This demand may not necessarily be weight loss but rather lead to self-acceptance of its own body as such.

PRISE EN CHARGE PSYCHOLOGIQUE DES ENFANTS EN SITUATION D'OBÉSITÉ : POURQUOI ET COMMENT S'ORGANISE-T-ELLE ? L'obésité chez les enfants, en tant que maladie chronique, a des répercussions visibles sur le corps des patients mais aussi sur leur qualité de vie globale ainsi que sur leur famille. Le contexte de vie, les rapports à l'alimentation et au corps sont à explorer car, comme tout symptôme en médecine, la prise de poids ouvre la porte sur la vie psychique du patient. Une approche bienveillante, respectant l'intimité des familles mais aussi la temporalité psychique des enfants, est fondamentale et permet l'émergence d'une demande, qui n'est pas nécessairement la perte de poids mais parfois davantage l'acceptation du corps tel qu'il est.

Bariatric procedures including Roux-en-Y gastric bypass in French adolescents.

INTRODUCTION: In France, approximately 100 obese adolescents undergo a bariatric procedure every year. To date, only data from laparoscopic adjustable gastric banding (LAGB) or sleeve gastrectomy (SG) have been published. Our objective was to report the outcomes of a series of French obese adolescents who underwent a Roux-en-Y gastric bypass (RYGB). METHODS: We included all obese adolescents aged 13-19 years who underwent RYGB in our department from 2008 with at least 2 years of follow-up after surgery. We analyzed the course of the anthropometric data, comorbidities, and subsequent adverse events. RESULTS: Starting in September 2008, out of 93 obese adolescents who requested bariatric surgery, 39 (35%) underwent a bariatric procedure. From these adolescents, 2-year follow-up data were available for 26 patients who had a RYGB. At the time of surgery, the mean patient age was 17.4 years (standard deviation [SD]=1.4) and the body mass index (BMI) was 52.0 kg/m² (SD=7.8). One patient was lost to follow-up. At 2 years after surgery,  the mean BMI was 35.7 kg/m² (SD=9.4) with a mean decrease in BMI of 31.9% (SD=11.6). Comorbidities improved for most of the patients: high blood pressure (2/2) and pseudotumor cerebri (1/1) were cured after surgery, and dyslipidemia improved globally. The complications observed were anemia, abdominal pain requiring celioscopy (n = 2), and oxalic nephrolithiasis. CONCLUSION: Only one third of the obese adolescents requesting bariatric surgery were operated on. Our series including exclusively obese adolescents who underwent an RYGB presents the results of this technique on weight loss and comorbidities; mechanical and nutritional complications remain uncommon. These results are similar to those obtained in studies of adult patients.

Mental health of adolescents after bariatric surgery: A textual analysis.

Mental health after bariatric surgery during adolescence has been little explored. This is a sensitive period in terms of self-image on which bariatric surgery could have negative effects because of the rapid and significant changes in morphology it induces. Previous studies have explored mental effects using questionnaires and only related to psychopathological disorders. The objective of our study was to complement these studies by exploring, via in-depth interviews, the adolescents' views on changes after bariatric surgery at psychological as well as socio-emotional levels. Fourteen adolescents with obesity were recruited in a French hospital 6-43 months after surgery. They participated in one-on-one interviews lasting an average of 45 minutes. A lexical analysis (using ALCESTE software© ) of their speech highlighted the most positive effects, particularly in terms of social relationships, physical activities, self-esteem and reduced stigma, along with less positive effects in terms of eating behaviour and skin. In terms of clinical implications, this study confirmed the value of bariatric surgery for adolescents at psychological and social levels and its contribution to their mental health. However, it also highlighted the importance of pre- and post-operative support.