[Food addiction]. / L'addiction à la nourriture.

Food addiction is a common term used in everyday language by obese patients. Although the neurobiological evidence points to some similarities between addictive mechanisms and the consumption of certain foods, this diagnosis is not yet officially recognized. After a brief history of food addiction compared to other eating disorders, we review the neurobiological processes underlying this concept. A food addiction assessment tool is presented and discussed with the current literature and new classifications of the DSM-5. The concept of food addiction needs to be rethought and requires further research.

[How to lose weight effectively and in a sustainable manner: a review of current topics]. / Comment perdre du poids de manière efficace et durable: une revue de l'actualité.

There is a lot of conflicting information regarding the best way to lose weight, especially regarding food diets. A recent study compared the different diets and ultimately revealed that there is no significant difference in their efficacy for weight loss. Furthermore, it is recommended to lose weight gradually because rapid weight loss was a risk factor for more rapid and important weight regain. This notion has been challenged by a study that compared the two approaches and demonstrated that the rate of weight loss has no influence on weight regain. Ultimately, the key is to develop strategies that are best suited to the patient, so that he can adhere more easily and maintain his efforts on the long run.

[The cure of type 2 diabetes and patient education]. / Guérison du diabète de type 2 et éducation thérapeutique.

Type 2 diabetes is a potentially reversible disease. Patient education encompasses a deep investment of the health care providers, who with the aid of pedagogic tools, help the pa tient commit to this path. This facilitates the learning of uncommon knowledge and skills required. Whether or not it leads to a complete remission of the disease may not be the main purpose. The main goal lies in the patient's motivation to learn and change on a long term basis.

[Rehabilitation: a case for obese patients?]. / Readaptation: les patients obèses aussi?

In the word obesity, a clinical concept of chronic systemic disease pairs up with pejorative individual or social representations. Being obese is also facing situations of disability, organ failure, uncertainty of the fate and stigmatization. A care concept inspired by rehabilitation and therapeutic patient education could offer a new way and other purposes to the treatment of obesity. Restoring functions, learning how to adapt and change their environment, obese people may live better today, out of their isolation and develop partners in their projects of life and health. Rehabilitation of an obese patient is much more than weight loss!

[The role of patient education in bariatric surgery]. / Place de l'éducation thérapeutique du patient dans lato chirurgie bariatrique.

Therapeutic patient education (TPE) has demonstrated its efficacy in treating numerous chronic conditions, including obesity. Currently, TPE has broadened its field of activity to the preparation of obese patients undergoing bariatric surgery. A preparative program allows informing patients about the surgery, the necessity of the follow-up and the risk of weight regain. It also aims to allow the patient to understand the behaviors which initially brought about its obesity and to help modify these behaviors in order to avoid weight regain after the surgery. A follow-up post surgery by trained health care providers is also recommended. Current literature suggests that patients are satisfied with such educational programs, and that they help them to lose weight before surgery. The efficacy on post surgery weight loss and compliance is yet to be proved.

[Understanding obesity in Africa: the effect of [economic] development and [mental] concepts]. / Comprendre l'obésite en Afrique: poids du développement et des representations.

Obesity is becoming more and more common in Africa. It is the direct consequence of the socio-economic development that the continent is going through and the changes in lifestyle that it entails: greater consumption of calorically dense foods accompanied by a more sedentary lifestyle. Furthermore, there are various representations and beliefs that promote voluntary weight gain. Studies have shown that obesity is not only a criterion of beauty but also often perceived as a sign of wealth and even good health. To remedy this problem, the authorities in collaboration with health care professionals must develop populational strategies that take into account the different representations and beliefs in order for them to be effective.

Fasting insulin at baseline influences the number of cardiometabolic risk factors and R-R interval at 3years in a healthy population: the RISC Study.

AIM: This was a cross-sectional and longitudinal study of factors contributing to the number of cardiometabolic risk factors, common carotid artery intima-media thickness (CCA-IMT) and R-R interval in clinically healthy subjects without diabetes. METHODS: Anthropometric and cardiometabolic parameters were measured in the Relationship between Insulin Sensitivity and Cardiovascular Disease (RISC) Study cohort at baseline (n=1211) and 3years later (n=974). At baseline, insulin sensitivity was assessed by the euglycaemic clamp technique. The CCA-IMT was echographically measured and the R-R interval was electrocardiographically evaluated at baseline and at the 3-year follow-up. RESULTS: Higher baseline BMI, fasting insulin and tobacco use as well as greater changes in BMI and fasting insulin but lower adiponectin levels, were associated with a greater number of cardiometabolic risk factors at the 3-year follow-up independently of insulin sensitivity (all P<0.02). The CCA-IMT increased with the number of cardiometabolic risk factors (P=0.008), but was not related to fasting insulin, whereas higher fasting insulinaemia and its 3-year changes were significantly associated with a smaller R-R interval (P=0.005 and P=0.002, respectively). These relationships were independent of baseline age, gender, BMI, adiponectin, insulin sensitivity, tobacco use and physical activity. CONCLUSION: In clinically healthy subjects, fasting insulinaemia, adiponectin and lifestyle parameters are related to the presence of one or two cardiometabolic risk factors before criteria for the metabolic syndrome are met. These results underline the importance of fasting insulinaemia as an independent cardiometabolic risk factor at an early stage of disease development in a healthy general population.

Taking small steps towards targets - perspectives for clinical practice in diabetes, cardiometabolic disorders and beyond.

Big changes are hard. When trying to achieve guideline targets in diabetes and cardiometabolic disorders, patients can lack commitment or suffer despondency. It is much easier to make small changes in lifestyle or treatment, which are less noticeable and easier to manage long-term. Obesity is central to the cardiometabolic disorders, and even small weight losses of 2-5% can improve the cardiometabolic risk profile and substantially reduce the risk of developing type 2 diabetes. Likewise, small increases in physical activity, such as 15-30 min of brisk walking per day, can cut the risk of heart disease by 10%. Lifestyle or treatment changes that lead to small improvements in metabolic parameters also impact patient outcome - for example, a 5 mmHg decrease in blood pressure can translate into significant reductions in the rates of myocardial infarction and cardiovascular mortality. Benefits of small changes can also be seen in health economic outcome models. Implementing change at an individual versus a population level has different implications for overall benefit and patient motivation. Even very small steps taken in trying to reach guideline targets should represent a positive achievement for patients. Patient engagement is essential - only when patients commit themselves to change can benefits be maintained, and physicians should recognise their influence. Small changes in individual parameters can result in significant beneficial effects; however, a major impact can occur when small changes are made together in multiple parameters. More research is required to elucidate the full impact of small changes on patient outcome.

[How can we evaluate medication adherence? What are the methods?]. / Comment évaluer l'adhésion médicamenteuse? Le point sur les méthodes.

INTRODUCTION: Identifying the difficulties of the patient towards following his medication regimen remains complex for the healthcare provider. This can be explained by the multidimensional character of medication adherence and, actually, the evaluation of this phenomenon. The objective of this work was to review the various methods to measure medication adherence. METHODS: We performed a search on PubMed completed by a manual one. RESULTS: Two types of measure are described. The "direct" methods are based on the measurement of the level of medicine or metabolite in blood or urine, measurement of biologic markers in blood or measurement of physiologic or clinical markers. The "indirect" methods are represented by the analysis of the administrative databases (prescription, rate of prescription refills); pill counts; electronic medication monitors; the self-reported measures by the patient or his close relations (questionnaires, diaries, interviews); the opinion of the healthcare provider. DISCUSSION: None of these tools supplants the others, each having limits either of feasibility, or reliability. In the end, it is the crossing of the information stemming from these various equipments that allows an idea on the adherence behavior of the patient and especially, dimensions on which he is most in trouble. CONCLUSION: The identification of these difficulties can allow the healthcare provider to develop behavioral and organizational skills tailored to the patient follow-up.

Impact of lifestyle intervention on body weight and the metabolic syndrome in home-care providers.

AIM: The study evaluated the impact of lifestyle intervention on body weight, metabolic syndrome parameters, nutrition and physical activity in home-care providers (HCPs). METHODS: Of 551 screened employees of a nursing agency, 173 were eligible to participate and were assigned to either the intervention (n=129) or the control (n=44) group. Participants in the intervention group followed an educational programme that encouraged physical activity and healthy nutrition, and were equipped with bicycles free of charge. Anthropometric, biological and lifestyle parameters were assessed at baseline, and after 6 and 12 months. RESULTS: Body weight, waist circumference and systolic blood pressure significantly decreased at 12 months in both study groups. Incidence of the metabolic syndrome in the intervention group at 12 months was reduced by 50% (from 17 to 9.2%; P=0.04). There were also decreases in LDL cholesterol (-0.36 mmol/L; P<0.01), total cholesterol/HDL cholesterol ratio (-0.57; P<0.01) and fasting glucose (-0.4 mmol/L; P<0.05), and an increase in HDL cholesterol (+0.22 mmol/L; P<0.01) in the intervention group. At 12 months, a decrease in daily caloric intake (-391 kcal/day; P<0.001) and an increase in the percentage of participants engaging in physical activity (+3.4%; P<0.05) were also observed in the intervention group. CONCLUSION: Lifestyle changes among HCPs are possible with relatively modest behavioural education and within a short period of time. Educational strategies and workshops are effective, efficient and easy to perform, and should be encouraged in HCPs to promote the implementation of lifestyle modifications in their patients.

Biofeedback can reduce foot pressure to a safe level and without causing new at-risk zones in patients with diabetes and peripheral neuropathy.

BACKGROUND: Plantar pressure reduction is mandatory for diabetic foot ulcer healing. Our aim was to evaluate the impact of a new walking strategy learned by biofeedback on plantar pressure distribution under both feet in patients with diabetic peripheral neuropathy. METHODS: Terminally augmented biofeedback has been used for foot off-loading training in 21 patients with diabetic peripheral sensory neuropathy. The biofeedback technique was based on a subjective estimation of performance and objective visual feedback following walking sequences. The patient was considered to have learned a new walking strategy as soon as the peak plantar pressure (PPP) under the previously defined at-risk zone was within a range of 40-80% of baseline PPP in 70% of the totality of steps and during three consecutive walking sequences. The PPP was measured by a portable in-shoe foot pressure measurement system (PEDAR(®)) at baseline (T0), directly after learning (T1) and at 10-day retention test (T2). RESULTS: The PPP under at-risk zones decreased significantly at T1 (165 ± 9 kPa, p < 0.0001) and T2 (167 ± 11, p = 0.001), as compared with T0 (242 ± 12 kPa) without any increase of the PPP elsewhere. At the contralateral foot (not concerned by off-loading), the PPP was slightly higher under the lateral midfoot at T1 (68 ± 8 kPa, p = 0.01) and T2 (65 ± 8 kPa, p = 0.01), as compared with T0 (58 ± 6 kPa). CONCLUSIONS: The foot off-loading by biofeedback leads to a safe and regular plantar pressure distribution without inducing any new 'at-risk' area under both feet.

Efficacy of rimonabant in obese patients with binge eating disorder.

In obesity, a dysregulation of the endocannabinoid system has been shown. The endocannabinoid receptor blockage by rimonabant demonstrated interesting metabolic effects. However, the role of rimonabant in weight loss of patients with binge eating disorder has not been investigated. Thus, our aim was to evaluate the effects of rimonabant on body weight in obese patients with binge eating disorders. This multicenter, randomized, double-blind, placebo-controlled study included 289 obese subjects (age 18-70 years, body mass index 30-45 kg/m(2)) with binge eating disorders. Subjects were randomized (1:1) to receive rimonabant 20 mg/day or placebo for 6 months. In total, 289 participants (age: 43.2±10.5 yrs, 91% of women) were randomized. The completer rate was similar (71%) in both treatment and placebo groups. Participants treated with rimonabant lost 4.7±5.2% of their initial body weight, vs. 0.4±4.5% in the placebo group (difference between both groups: 4.4±0.6 kg, p<0.0001). The rimonabant group showed a greater reduction on the binge eating scale total score (mean±SD - 40.9±35.2%) vs. placebo ( - 29.9±34.6%, p=0.02). The incidence of treatment emergent adverse events was comparable in both the rimonabant (82.5%) and placebo (76.0%) group. Discontinuations due to treatment emergent adverse events occurred in 13.3% rimonabant-treated vs. 6.2% placebo-treated participants. In conclusion, this is the only randomised, placebo-controlled, double-blind trial having assessed the effect of rimonabant in patients with binge eating disorders. The rimonabant treatment reduced body weight significantly more than placebo in obese subjects with binge eating. Trial registration number (clinicaltrials.gov): NCT00481975.

Depressive symptoms, insulin sensitivity and insulin secretion in the RISC cohort study.

AIM: This study explored the association of depressive symptoms with indices of insulin sensitivity and insulin secretion in a cohort of non-diabetic men and women aged 30 to 64 years. METHODS: The study population was derived from the 3-year follow-up of the Relationship between Insulin Sensitivity and Cardiovascular Disease Risk (RISC) study. Presence of significant depressive symptoms was defined as a Center for Epidemiologic Studies Depression Scale (CES-D) score ≥ 16. Standard oral glucose tolerance tests were performed. Insulin sensitivity was assessed with the oral glucose insulin sensitivity (OGIS) index. Insulin secretion was estimated using three model-based parameters of insulin secretion (beta-cell glucose sensitivity, the potentiation factor ratio, and beta-cell rate sensitivity). RESULTS: A total of 162 out of 1027 participants (16%) had significant depressive symptoms. Having significant depressive symptoms was not related to either OGIS [standardized beta (ß) -0.033; P=0.24] or beta-cell glucose sensitivity (ß -0.007; P=0.82). Significant depressive symptoms were related to decreased beta-cell rate sensitivity (odds ratio for significant depressive symptoms of the lowest vs. highest quartile of beta-cell rate sensitivity was 2.04; P=0.01). Also, significant depressive symptoms were associated with a statistically significant decrease in the potentiation factor ratio in unadjusted models, but not in the fully adjusted model. CONCLUSION: Depressive symptoms were not related to insulin sensitivity and tended to be weakly associated to some parameters of insulin secretion in non-diabetic individuals. Prospective studies are needed to study the temporal association between depression and insulin secretion.

Randomised controlled trial of a guided self-help treatment on the Internet for binge eating disorder.

Binge eating disorder (BED) is a common and under-treated condition with major health implications. Cognitive behavioural therapy (CBT) self-help manuals have proved to be efficient in BED treatment. Increasing evidence also support the use of new technology to improve treatment access and dissemination. This is the first randomised controlled study to evaluate the efficacy of an Internet guided self-help treatment programme, based on CBT, for adults with threshold and subthreshold BED. Seventy-four women were randomised into two groups. The first group received the six-month online programme with a six-month follow-up. The second group was placed in a six-month waiting list before participating in the six-month intervention. Guidance consisted of a regular e-mail contact with a coach during the whole intervention. Binge eating behaviour, drive for thinness, body dissatisfaction and interoceptive awareness significantly improved after the Internet self-help treatment intervention. The number of objective binge episodes, overall eating disorder symptoms score and perceived hunger also decreased. Improvements were maintained at six-month follow-up. Dropouts exhibited more shape concern and a higher drive for thinness. Overall, a transfer of CBT-based self-help techniques to the Internet was well accepted by patients, and showed positive results for eating disorders psychopathology.

[What is the evolution of metabolically normal obesity?]. / Que deviennent tes sujets obèses "métaboliquement" normaux?

A subgroup of obese subjects which could be protected from the cardiometabolic complications of obesity is described in the literature as "metabolically normal obese subjects". However, the lack of a joint definition of metabolic normality makes the available data difficult to interpret and to compare. A recent analysis of more than 1200 subjects in a prospective study showed that 21% of obese metabolically normal subjects at baseline developed the metabolic syndrome after three years. The obese subjects who remained metabolically normal showed, at three years, significantly higher values of cardiometabolic parameters as compared to subjects with normal body weight. In conclusion, the obese subjects even without any metabolic abnormality should benefit of a closer medical monitoring as well as a regular follow-up to avoid further weight gain.

[Understanding the life of the obese patient. A contribution to therapeutic patient education]. / Comprendre l'expérience de vie des personnes obèses: un apport pour l'éducation thérapeutique du patient.

This article presents an approach of obesity centered on patients' experience. How is obesity defined by these latter? Is it considered as a disease? Is it apprehended by them as an element to fight or as a potentially meaningful event? Has the sick person the feeling to suffer from obesity or to have resources to face it? At the crossroads of three human sciences (sociology, anthropology and education), this approach aims to enrich and increase the efficiency of therapeutic patient education for obese patients. Extended experience narration extracts are presented in this article, obtained from research interviews. They show the importance of taking into account the "subjective experience" of the disease when accompanying persons affected by obesity.

[A new program of therapeutic education for obese patients]. / Un nouveau programme d'éducation thérapeutique pour les patients obèses.

Obesity is a chronic disease which is increasing over the past thirty years. This disease is complex and its treatment is difficult and generally frustrating for the patients and the medical team because of a high risk of relapse. Indeed, a dietetic approach alone is most of the time not good enough to obtain a long-lasting weight loss; the few drugs on the market should also be prescribed as a part of a more global approach. A multidisciplinary approach with a long-standing follow-up including a cognitive-behavioral therapy coupled to a diet and physical activity is mandatory to avoid any weight regain. We propose a new multidisciplinary program of two years with in hospital-stay and ambulatory follow-up which is showing some promising results (90% of success at one year).

Natural history and physiological determinants of changes in glucose tolerance in a non-diabetic population: the RISC Study.

AIMS/HYPOTHESIS: The natural history and physiological determinants of glucose intolerance in subjects living in Europe have not been investigated. The aim of this study was to increase our understanding of this area. METHODS: We analysed the data from a population-based cohort of 1,048 non-diabetic, normotensive men and women (aged 30-60 years) in whom insulin sensitivity was measured by the glucose clamp technique (M/I index; average glucose infusion rate/steady-state insulin concentration) and beta cell function was estimated by mathematical modelling of the oral glucose tolerance test at baseline and 3 years later. RESULTS: Seventy-seven per cent of the participants had normal glucose tolerance (NGT) and 5% were glucose intolerant both at baseline and follow up; glucose tolerance worsened in 13% (progressors) and improved in 6% (regressors). The metabolic phenotype of the latter three groups was similar (higher prevalence of familial diabetes, older age, higher waist-to-hip ratio, higher fasting and 2 h plasma glucose, higher fasting and 2 h plasma insulin, lower insulin sensitivity and reduced beta cell glucose sensitivity with increased absolute insulin secretion). Adjusting for these factors in a logistic model, progression was predicted by insulin resistance (bottom M/I quartile, OR 2.52 [95% CI 1.51-4.21]) and beta cell glucose insensitivity (bottom quartile, OR 2.39 [95% CI 1.6-3.93]) independently of waist-to-hip ratio (OR 1.44 [95% CI 1.13-1.84] for one SD). At follow up, insulin sensitivity and beta cell glucose sensitivity were unchanged in the stable NGT and stable non-NGT groups, worsened in progressors and improved in regressors. CONCLUSIONS/INTERPRETATION: Glucose tolerance deteriorates over time in young, healthy Europids. Progressors, regressors and glucose-intolerant participants share a common baseline phenotype. Insulin sensitivity and beta cell glucose sensitivity predict and track changes in glucose tolerance independently of sex, age and obesity.