[From morbid obesity to complex obesity: somato-psychic issues]. / De l'obésité morbide à l'obésité complexe : des enjeux somato-psychiques.

Complex obesity is a chronic, multifactorial pathology. These repercussions (respiratory insufficiency, hypoventilation syndrome, cardiac insufficiency, loss of functional autonomy and mobility with a tendency to grabatization, depression, behavioral disorders) directly sustain the disease. Access to care is virtually impossible for them outside specialized obesity centers (CSO) and specialized medical and rehabilitation care (SMR). We need to support healthcare teams by analyzing their practices, including those of expert patients, to ensure that complex obesity is treated with the humanity it requires.

[Psychological support for weight loss]. / L'accompagnement psychologique de la perte de poids.

Psychological support for obese people as part of their health care process seems to be a matter of course. However, it is one of the most poorly relayed components in the field. Exploring and assessing are necessary operations in order to develop an integrative approach to psychological support, involving body-mediated approaches and an optimal helping alliance.

[Obesity, a multifactorial, chronic disease]. / L'obésité, une maladie multifactorielle et chronique.

A pathology of modernity, obesity is developing rapidly in the population, linked to multiple risk factors and somatopsychic disturbances. The healthcare system's responses have been enriched by specialized programs and centers, but we mustn't forget basic clinical pragmatism.

[Self-directed learning: A framework for understanding therapeutic patient education through online health forums]. / L'autoformation, cadre d'analyse de l'apprentissage des patients sur les forums de santé.

INTRODUCTION: Online Health Forums (OHFs) allow patient learning and therapeutic patient education (TPE). To reinforce the pedagogical dimension of these tools, it is necessary to understand the learning processes and conditions involved in OHFs. A potential framework for the analysis of this phenomenon is self-directed learning (SDL). OBJECTIVE: The objective is to propose a framework for the analysis of learning and TPE in OHFs, based on existing SDL theories. This could allow to identify the learning characteristics of OHFs and to identify potential implications for TPE. METHOD: A narrative review was conducted on the basis of 40 publications whose analysis through three categories (elements of SDL's definition, learner role and environmental impact) allowed to identify the explanatory theories of SDL. RESULTS: The main result is a proposition for an analytical framework to examine OHFs according to their self-formative characteristics and, then, discuss their links with TPE programs. Indeed, similar principles between SDL and TPE are emerging such as the identification of needs, the autonomy of patients/learners, and the place of Self Efficacy. These similarities highlight the potential complementarity between OHFs and SDL. CONCLUSION: SDL allows us to understand how Internet users learn on OHFs. Although links between SDL, OHFs and TPE are identified, a better understanding of the learning modes used in OHFs and their functioning according to the user profile could clarify their learning potential and their empowering effect.

Telephone support oriented by accelerometric measurements enhances adherence to physical activity recommendations in noncompliant patients after a cardiac rehabilitation program.

OBJECTIVE: To assess the efficacy of a strategy, based on telephone support oriented by accelerometer measurements, on the adherence to physical activity (PA) recommendations in cardiac patients not achieving PA recommendations. DESIGN: Prospective and randomized study. SETTING: A cardiac rehabilitation program (CRP) at a clinic. PARTICIPANTS: Stable, noncompliant cardiac (coronary artery disease, heart failure, post-cardiovascular surgery) patients (weekly moderate-intensity PA <150 min) were randomly assigned to an intervention group (n=19) or a control group (n=10). INTERVENTIONS: The intervention group wore an accelerometer for 8 weeks. Every 15 days, feedback and support were provided by telephone. The control group wore the accelerometer during the 8th week of the intervention only. MAIN OUTCOME MEASURES: Active energy expenditure (EE) (in kilocalories) and the time spent doing light, moderate, or intense PA (minutes per week). RESULTS: In the intervention group, the time spent at moderate-intensity PA increased from 95.6±80.7 to 137.2±87.5 min/wk between the 1st and 8th week (P=.002), with 36.8% of the sample achieving the target amount of moderate-intensity PA. During the 8th week, the EE averaged 543.7±144.1 kcal and 266.7±107.4 kcal in the intervention group and control group, respectively (P=.004). CONCLUSIONS: Telephone support based on accelerometer recordings appeared to be an effective strategy to improve adherence to PA in noncompliant patients. This intervention could be implemented after a CRP as an inexpensive, modern, and easy-to-use strategy.

[The place for nutrition rehabiliation in bariatric surgery pathway]. / Place des soins de suite et réadaptation dans le parcours de soins en chirurgie bariatrique.

THE PLACE FOR NUTRITION REHABILIATION IN BARIATRIC SURGERY pathwaythe place for nutrition rehabilitation in bariatric surgery is well identified and complements the multi-professional support of the patient suffering from obesity either before, during or after the surgery. Mainly through therapeutic education the patient becomes an actor in his health and participates in improving his health by modifying his behavior concerning food, physical activity and if necessary in conjunction with the psychologist.

PLACE DES SOINS DE SUITE ET RÉADAPTATION DANS LE PARCOURS DE SOINS EN CHIRURGIE bariatriquela place des soins de suite et de réadaptation (SSR) dans le parcours de soins en chirurgie bariatrique est bien identifiée. Elle complète l'accompagnement luriprofessionnel du patient souffrant d'obésité soit en amont, soit en per- ou postopératoire. À travers principalement l'éducation thérapeutique, le patient devient acteur de sa santé et participe à son amélioration, en modifiant son comportement alimentaire et son activité physique, si nécessaire en lien avec la/le psychologue.

Effect of weight reduction on quality of life and eating behaviors in obese women.

OBJECTIVE: To examine the impact of a 3-week weight-reducing program on body composition, physical condition, health-related quality of life, and eating behaviors of sedentary, obese (body mass index, 29-35 kg/m) women, according to menopausal status and menopause duration (<5, >or=5, and >or=10 y). DESIGN: Thirteen premenopausal and 27 postmenopausal women received a dietary plan of 1,400 +/- 200 kcal/day and completed 110-minute endurance exercise 6 days per week. Body mass index, fat mass, lean mass, distance walked in the Six-Minute Walk Test, health-related quality of life estimated by the 36-item Short Form Health Survey (SF-36), and eating behaviors (restriction, disinhibition, and susceptibility to hunger) assessed by the Three-Factor Eating Questionnaire were determined before and after weight reduction. RESULTS: Body mass index and fat mass decreased (P < 0.0001), whereas distance walked increased in both groups after weight reduction (P < 0.001). Although the SF-36 mental component score increased after weight loss in both groups (P < 0.0001), the SF-36 physical component score increased in postmenopausal women only (P < 0.001). Restriction increased (P < 0.0001), whereas disinhibition and susceptibility to hunger decreased after weight reduction (P < 0.001 and P < 0.01, respectively) in both groups. Distance walked and SF-36 physical component score after weight loss were higher in women whose menopause ranged between 5 and 9 years and exceeded 10 years, respectively (P < 0.01). CONCLUSIONS: Our study shows that a short-term weight-reducing program combining caloric restriction and physical activity has a favorable impact on women's body composition, physical condition, health-related quality of life, and eating behaviors irrespective of their menopausal status.

Whole-body strength training with Huber Motion Lab and traditional strength training in cardiac rehabilitation: A randomized controlled study.

BACKGROUND: Isometric strengthening has been rarely studied in patients with coronary heart disease (CHD), mainly because of possible potential side effects and lack of appropriate and reliable devices. OBJECTIVE: We aimed to compare 2 different modes of resistance training, an isometric mode with the Huber Motion Lab (HML) and traditional strength training (TST), in CHD patients undergoing a cardiac rehabilitation program. DESIGN: We randomly assigned 50 patients to HML or TST. Patients underwent complete blinded evaluation before and after the rehabilitation program, including testing for cardiopulmonary exercise, maximal isometric voluntary contraction, endothelial function and body composition. RESULTS: After 4 weeks of training (16 sessions), the groups did not differ in body composition, anthropometric characteristics, or endothelial function. With HML, peak power output (P=0.035), maximal heart rate (P<0.01) and gain of force measured in the chest press position (P<0.02) were greater after versus before training. CONCLUSION: Both protocols appeared to be well tolerated, safe and feasible for these CHD patients. A training protocol involving 6s phases of isometric contractions with 10s of passive recovery on an HML device could be safely implemented in rehabilitation programs for patients with CHD and improve functional outcomes.

Caloric restriction and aerobic exercise in sarcopenic and non-sarcopenic obese women: an observational and retrospective study.

BACKGROUND: Sarcopenic obese (SO) individuals are a unique subset of subjects that combines obesity and sarcopenia. Traditional weight loss programmes including aerobic exercises may worsen their condition by further reducing their lean mass. The objective of this observational and retrospective study was to verify the effect of a mixed weight loss programme combining caloric restriction and exercise on body composition, and lipid-lipoprotein profile of obese women according to their sarcopenic status. METHODS: One hundred and forty-six obese women (body mass index ≥ 30 kg/m(2) and fat mass ≥ 40%) participated to the 3 week usual and institutionalized weight-reducing programme combining a dietary plan (1400 ± 200 kcal/day) and aerobic exercise (1 h/day, 6 days/week) of a specialized medical institution. The lean body mass index (LMI; lean mass/height(2)) was calculated, and women in the lowest tertile of LMI were considered SO. RESULTS: At baseline, SO women were older, and their body weight and LMI were lower than non-sarcopenic obese (N-SO) women (p < 0.05). N-SO and SO women similarly lost fat mass and improved their lipid-lipoprotein profile (p < 0.05), while differences in LMI between groups persisted at the end of the weight-reducing programme. Indeed, N-SO women lost lean mass (p < 0.05) while SO did not. CONCLUSIONS: These findings suggest that a short weight loss programme combining caloric restriction and aerobic exercise may significantly reduce fat mass and improve lipid-lipoprotein profile in obese women, independently of their sarcopenic status. Such programmes may have deleterious effects on lean mass in N-SO subjects, only.

Impact of weight reduction on eating behaviors and quality of life: Influence of the obesity degree.

BACKGROUND: To examine the effects of a short-term weight reducing program on body composition, eating behaviors, and health-related quality of life (HRQL) of sedentary obese women characterized by different obesity degrees. METHODS: 44 women with a BMI under 34.9 kg/m(2) and 39 women with a BMI above 35 kg/m(2) were studied. Fat mass and lean mass (electrical bioimpedance), eating behaviors (Three-Factor Eating Questionnaire), and HRQL (36-item short form, SF-36, questionnaire) were determined before and after weight loss. RESULTS: Disinhibition and hunger scores and their subscales decreased after weight loss in both groups (0.0001 < p < 0.04). Restriction increased after weight reduction in all women (p = 0.02). Among the five restriction subscales, flexible restriction increased in women with a BMI above 35 kg/m(2) (p = 0.008), whereas rigid restraint and avoidance of fattening foods increased in both groups (0.006 < p < 0.02). SF-36 Mental Component Score increased after weight loss in all women (p < 0.0001). CONCLUSION: A 3week weight reducing program changes selected eating behaviors and components of HRQL, irrespective of women's obesity degree. Data suggest that women with a BMI above 35 kg/m(2) could have a better weight control in the long term because of their higher flexible restriction after weight loss when compared to those whose BMI was under 34.9 kg/m(2).

What is the influence of menopausal status on metabolic profile, eating behaviors, and perceived health of obese women after weight reduction?

The duration of the numerous weight-loss studies that combine physical activity and diet varies from 3 to 14 months, and these studies have often considered pre- and postmenopausal women separately. The purpose of this study was to compare the effects of a 3-week weight-reducing program that combines caloric restriction and exercise on the metabolic profile, eating behaviors, and perceived health of sedentary obese pre- and postmenopausal women, after adjustment for age. In 10 pre- and 22 postmenopausal women, before and after weight loss, body composition, fasting lipid-lipoprotein profile, glucose and insulin levels, eating behaviors, and perceived health state were assessed. Body mass index, fat mass, and waist girth decreased after weight reduction in both groups (p < 0.0001). Reductions in fasting serum cholesterol and low-density lipoprotein-cholesterol levels were greater in pre- than in postmenopausal women (p < 0.0001), whereas triacylglycerol, glucose, and high-density lipoprotein-cholesterol levels decreased similarly in both groups (p < 0.05). Neither fasting insulin nor free fatty-acid concentrations were modified after weight loss in either group. Disinhibition (p < 0.005) and hunger scores on the three-factor eating questionnaire (TFEQ) (p < 0.05) and the state-anxiety score on the state-trait anxiety inventory (STAI) questionnaire (p < 0.0005) decreased in both groups, but restriction (TFEQ) increased (p < 0.01) and trait anxiety (STAI) decreased (p < 0.001) after weight reduction only in premenopausal women. Improvements in selected lipid-lipoprotein indices, eating behaviors, and perceived health-state components were better in pre- than in postmenopausal women, suggesting that menopausal status has an influence on some metabolic and behavioral responses to weight loss.