[Eating disorders in the light of addiction]. / Troubles du comportement alimentaire à l'aune de l'addiction.

Eating disorders (ED) are complex and damaging to health. They cause suffering similar to that of addictions. Although they share some similarities, eating disorders remain distinct from addictions. Fundamental differences emerge in binge eating and restrictive behaviors. Eating disorder treatment in adolescents relies mainly on family therapy and can incorporate a reflection on these similarities and differences. For instance, understanding the addictive nature of the illness helps parents and patients to avoid sterile negotiations around food. An individualized approach is crucial to the effective management of ED by a specialized multidisciplinary team. Clarity in explaining physiological mechanisms strengthens the therapeutic alliance.

Les troubles du comportement alimentaire (TCA) sont complexes et portent atteinte à la santé. Ils peuvent engendrer des souffrances similaires à celles des addictions. Bien qu'ils partagent des similitudes, les TCA demeurent distincts des addictions. Des différences fondamentales émergent dans les comportements d'hyperphagie et de restriction. La prise en charge des TCA, axée sur la thérapie familiale, peut intégrer une réflexion sur ces similitudes et ces différences. Par exemple, la compréhension de la nature addictive de la maladie aide parents et patients à éviter des négociations stériles autour de l'alimentation. Une approche individualisée est cruciale pour une prise en charge efficace des TCA par une équipe multidisciplinaire spécialisée. La clarté dans l'explication des mécanismes physiologiques renforce l'alliance thérapeutique.

Factors associated with weight gain in anorexia nervosa inpatients.

OBJECTIVE: Nutrition restoration in inpatients with anorexia nervosa (AN) is a core element in treatment, enabling recovery of cognitive functions essential for psychological care. This study aims to identify factors associated with inpatient weight gain. METHODS: Medical records from 107 inpatients aged 13-55 years with AN, hospitalized for more than 7 days at a specialized unit, were examined in a retrospective study. Weight evolution graphs were created for each patient and graded independently as optimal, moderate, and inadequate weight gain after 2 weeks and increasing, flat or decreasing weight in the first 2 weeks by expert clinicians. Driven by explicit hypotheses, bivariable analyses were carried out to detect relevant factors associated with weight gain during and after the first 2 weeks of admission. RESULTS: Initial weight gain in the first 2 weeks of hospitalization and the introduction of a protocol harmonizing treatment procedures around rapid refeeding were strong factors associated with optimal weight gain after 2 weeks of hospitalization, whereas prior hospitalization in a psychiatric unit, diagnosis with binge-eating/purging subtype and age over 18 years were significantly associated with inadequate weight gain (p < 0.001-0.05). CONCLUSION: To promote weight gain during hospitalization, clinicians should consider the following therapeutic measures: rapid refeeding strategies, renutrition protocols, and controlling purging behaviors. LEVEL OF EVIDENCE: Level III, retrospective cohort study.

Nutrition Approach for Inpatients With Anorexia Nervosa: Impact of a Clinical Refeeding Guideline.

OBJECTIVE: This study assesses the impact of a clinical refeeding guideline on weight restoration, length of stay, rate of refeeding complications, and rehospitalizations. METHOD: This retrospective study included patient records of 107 participants aged 13-55 years with a diagnosis of AN, admitted for at least 7 days for renutrition before and after introduction of the refeeding guideline. Weight evolution graphs were rated by 2 clinical experts independently. Binary logistic regression models were erected to identify clinical outcomes associated independently with the guideline as well as to control for potential confounding by sociodemographic and clinical characteristics at admission. RESULTS: The proportion of patients achieving optimal weight gain after the first 2 weeks increased significantly from 6.3% pre-guideline to 41.8% post guideline (adjusted odds ratio [AOR] = 37.6; 95% confidence interval [CI], 2.77-510.3; P = 0.006). Average length of hospitalization was reduced from 96.7 (SD 48.3) days pre-guideline to 62.2 (SD 45.5) days post guideline (AOR = 0.99; 95% CI, 0.97-1.01; P = 0.18). None of the patients developed a full refeeding syndrome. There was no significant change in the rate of rehospitalization: 48.5% pre-guideline to 43.2% post guideline (OR = 0.81; 95% CI, 0.36-1.84; P = 0.62). DISCUSSION: The clinical guideline proved highly effective in bolstering weight gain via intensive refeeding procedures while also being safe. Harmonizing clinical practices improves quality of care for patients with anorexia and, interestingly, may decrease costs by cutting average length of stay by a third without increasing the rehospitalization rate.

[Fatigue in the adolescent athlète]. / La fatigue chez l'athlète adolescent.

Adolescent athletes frequently complain of fatigue. Acute fatigue after intense training is physiological and necessary in order to develop capacity and increase performance. However, healthcare practitioners must question persistant fatigue, which causes are multiple, sometimes clear, though mostly multifactorial. A comprehensive and holistic approach is especially required in adolescents, with a complete somatic, psychosocial and athletic history. The role of healthcare professionals is to quickly identify specific signs and complex diagnoses, which can lead to physical and psychological consequences in the long term (overtraining, burnout, abuse, eating disorders). Finally, in a time where overweight and inactivity is rampant in the youth, we must imperatively avoid adolescents dropping out of sports and activity.

La fatigue est un motif de consultation fréquent chez l'athlète adolescent. Une fatigue aiguë après un effort intensif est physiologique, voire même recherchée dans le but d'améliorer les performances. Une fatigue qui s'installe doit interpeller. Les causes sont multiples, parfois bien précises, mais souvent multifactorielles. Une approche holistique est indispensable, surtout chez l'adolescent, avec une anamnèse somatique, psychosociale et sportive détaillée. Le rôle du professionnel de la santé est de détecter au plus vite les premiers signes, certains diagnostics difficiles à poser pouvant avoir de lourdes conséquences physiques et psychiques à long terme (surentraînement, burnout, abus, trouble du comportement alimentaire). En cette ère d'épidémie de surpoids chez les jeunes, l'abandon du sport est à éviter absolument.

[Adolescents suffering from anorexia nervosa: an evidence-based approach of the parent's role in 2018]. / Adolescents souffrant d'anorexie mentale Le rôle des parents, une approche baséesur l'évidence : bilan en 2018.

A new paradigm in the management of adolescents with eating disorders promotes different treatment orientations aiming at increasing therapeutic effectiveness as well as offering a more integrated and coherent care for families. Particular attention is given to the process of refeeding to avoid the severe somatic sequelae of eating disorder and the risk of a chronic course for a disorder which is well known for its « addictive ¼ power and influence. The parents and the need for a strong alliance with the healthcare team stand at the centre of this new paradigm. This type of management requires professionals who are trained in these specific approaches and in multidisciplinary work.

Les paradigmes de prise en charge des troubles alimentaires chez l'adolescent ont changé et entraînent de ce fait des traitements différents, visant une meilleure efficacité thérapeutique, ainsi qu'une prise en charge plus intégrée et cohérente des familles. Une attention particulière est accordée à la renutrition, pour éviter tant les séquelles somatiques du trouble alimentaire que l'installation dans un trouble dont on connaît maintenant le pouvoir « addictif ¼ et l'emprise. Une alliance solide avec les parents ­ placés au centre de ce processus, soutenus par les équipes de soins ­ est nécessaire. La prise en charge par des équipes formées et travaillant en collaboration multidisciplinaire s'avère essentielle.

[Novelties 2016 in pediatrics]. / Pédiatrie.

Nutrition is central in pediatric care : essential for growth and development, it plays also a role in the prevention of many diseases.Even if breastfeeding is highly recommended, its implementation may be difficult in particular for premature and ill newborns. The creation of a specific unit for breastfeeding support in neonatology allows to help mothers willing to nurse and to improve the rate of breastfeeding for these vulnerable infants.Eating disorders represent an important challenge for patient care. Early detection and rapid management of anorexia is essential for the prognosis. This article describes the challenges and the practical process underlying the development of a practical guideline to manage children and adolescents hospitalized for anorexia.

La nutrition est un thème central en pédiatrie : essentielle pour la croissance et le développement de l'enfant, elle joue également un rôle dans la prévention de nombreuses maladies.Bien que fortement recommandée, la mise en place de l'allaitement peut être difficile en particulier chez les nouveau-nés prématurés ou malades. La création d'une unité de soutien à l'allaitement en néonatologie a permis d'offrir un soutien aux mères souhaitant allaiter et d'améliorer le taux de lactation. Les troubles du comportement alimentaire représentent un important challenge de prise en charge. Une détection et une prise en charge rapide de l'anorexie sont essentielles pour le pronostic. Cet article décrit les enjeux et le processus parcouru pour élaborer un guide de prise en charge des enfants et adolescent(e)s hospitalisé(e)s pour une anorexie.

[Adolescents with an eating disorder: an evidence-based approach on the role of parents]. / Prise en charge d'adolescents souffrant d'anorexie mentale: le rôle des parents, une approche basée sur l'évidence.

Adolescence is a time of great change and therefore, potentially of great vulnerability. Thus, physical and psychological changes induced by pubertal processes are fertile ground for the emergence of an eating disorder (ED). Family therapy according to Maudsley or "family based treatment" (FBT) has emerged in parallel with neurobiological advances confirming a multifactorial origin of eating disorders. This therapy places parents at the centre of care for adolescents with EDs. Its great asset is the evidence-based approach underpinning the therapy.