[Weight loss: when the body image does not keep up]. / Perte de poids : quand l'image du corps ne suit pas.

The body image, defined as an individual's 'inner vision' of himself, stems from the combination of multiple factors. The body dissatisfaction, which represents its negative version, is associated with eating disorders, a sedentary lifestyle and weight gain. Several patients suffering from obesity consider weight loss as a strategy to work on their body image. Multiples studies confirm a positive association between weight loss and improved body images. Nevertheless, few elements seem to predispose to body dissatisfaction persistence, such as a history of strict diets, eating disorders or other psychopathologies. To treat body dissatisfaction, we need to focus our attention on self-esteem, a balanced lifestyle, and media education.

L'image corporelle, définie comme la « vision interne ¼ qu'une personne a d'elle-même, est multifactorielle. L'insatisfaction corporelle, qui représente sa version négative, est associée avec des troubles du comportement alimentaire, la sédentarité et la prise de poids. Certains patients visent une amélioration de leur image corporelle avec la perte pondérale. Si nombre d'études confirment une association bénéfique entre perte de poids et amélioration de l'image du corps, certains éléments, notamment les antécédents de régimes stricts et la présence de troubles alimentaires ou d'autres psychopathologies semblent prédisposer à la persistance de l'insatisfaction corporelle. La prise en charge de l'insatisfaction corporelle repose sur le renforcement de l'estime de soi, une hygiène de vie correcte et l'éducation aux médias.

[Awakening the senses to change our relationship with the body. A group experiment with people suffering from obesity]. / Éveiller les sens pour modifier le rapport au corps. Une expérience de groupe chez des personnes en situation d'obésité.

People living with obesity frequently have low self-esteem and a negative body image. Their relationship with their body is painful, which can lead them to dissociate themselves from it. This detachment is not conducive to lasting behavioural change. The "Awakening the Senses" programme offered to a group of patients at the Therapeutic Patient Education Unit combines aspects of cognitive behavioural therapy, mindfulness and art therapy. Its aim is to help patients reconnect with their bodies through sensory and creative experiences. This article presents the programme, the clinical observations made and the results of the various evaluations carried out.

Les personnes en situation d'obésité ont fréquemment une basse estime d'elles-mêmes et une image corporelle négative. Le rapport au corps est douloureux ce qui peut les amener à s'en dissocier. Ce détachement est défavorable à la mise en place de changements comportementaux durables. Le programme « Éveil des sens ¼, proposé à un groupe de patients de l'Unité d'éducation thérapeutique du patient, combine des aspects de la thérapie cognitivo-comportementale, de la pleine conscience et de l'art-thérapie. Son objectif est d'amener les patients à renouer avec leur corps à travers des expériences sensorielles et créatrices. Cet article présente ce programme, les observations cliniques réalisées ainsi que les résultats des différentes évaluations effectuées.

[Weight gain during menopause: physiology and practical implications]. / Prise de poids pendant la ménopause : physiologie et implications pratiques.

Fluctuations in sex hormones at different stages of reproductive life, such as the menopausal transition, have been suggested as players in weight regulation. Indeed, the transition from a predominantly estrogenic state to an androgenic state characteristic of the menopausal transition contributes to changes in body composition with accumulation of fat and simultaneous loss of lean mass. However, whether these changes contribute to the weight gain remains debatable. Other physiological and psychosocial factors come into play. It is therefore important to offer individualized support with the objective to minimize the risk of weight gain and associated complications.

La fluctuation des hormones sexuelles à différentes étapes de la vie reproductive, telles que la transition ménopausique, a été proposée comme une des composantes de la régulation de poids. Effectivement, le passage d'un état principalement œstrogénique à un état androgénique, caractéristique de la transition ménopausique, contribue à des modifications de la composition corporelle avec une accumulation de graisse et une perte simultanée de masse maigre. Cependant, la question de savoir si ces changements contribuent à une prise de poids reste discutable. L'obésité est une maladie multifactorielle et d'autres facteurs d'ordre physiologique et psychosociaux rentrent en jeu. Il est donc important d'offrir un accompagnement individualisé aux femmes concernées pour les aider à minimiser le risque de prise pondérale et des complications associées.

[Nutrition-obesity. New program about behavioural issues involved in weight loss through surgery]. / Nutrition-obésité. Nouveau programme ciblant les enjeux comportementaux de la perte de poids à l'aide de la chirurgie.

Bariatric surgery is an effective treatment to improve metabolic health as long as behavioural changes are made. Opting for this therapeutic choice represents a real commitment on the part of patients which is complementary to the informative bariatric surgery consultation. After all, what practitioner has not been confronted with an urgent request from patients suffering from obesity who are over-investing in this operation? Therapeutic Patient Education offers the opportunity to work with patients to develop their status as committed actors through a new outpatient educational program. Increased feelings of self-efficacy and socio-cognitive conflict are ingredients that allow patients to invest in long-term changes.

Pour perdre du poids en situation d'obésité, la chirurgie bariatrique est un traitement efficace améliorant la santé métabolique sous réserve de changements comportementaux. Opter pour ce choix thérapeutique représente un véritable travail sur l'engagement des patients qui s'inscrit en complément de la consultation informative de chirurgie bariatrique. En effet, quel praticien n'a-t-il pas été confronté à l'impasse d'une demande urgente par des patients en souffrance surinvestissant cette intervention ? L'éducation thérapeutique du patient offre l'opportunité de travailler avec les patients à leur statut d'acteur engagé au travers d'un nouveau programme éducatif ambulatoire. L'augmentation du sentiment d'auto-efficacité et le conflit sociocognitif sont des ingrédients qui permettent aux patients en réflexion d'investir les changements à long terme.

A randomized controlled trial investigating the effect of liraglutide on self-reported liking and neural responses to food stimuli in participants with obesity.

BACKGROUND/OBJECTIVES: Obesity is a complex condition and the mechanisms involved in weight gain and loss are not fully understood. Liraglutide, a GLP-1 receptor agonist, has been demonstrated to successfully promote weight loss in patients with obesity (OB). Yet, it is unclear whether the observed weight loss is driven by an alteration of food liking. Here we investigated the effects of liraglutide on food liking and the cerebral correlates of liking in OB. SUBJECTS/METHODS: This study was a randomized, single-center, double-blind, placebo-controlled, parallel group, prospective clinical trial. 73 participants with OB and without diabetes following a multidisciplinary weight loss program, were randomly assigned (1:1) to receive liraglutide 3.0 mg (37.40 ± 11.18 years old, BMI = 35.89 ± 3.01 kg) or a placebo (40.04 ± 14.10 years old, BMI = 34.88 ± 2.87 kg) subcutaneously once daily for 16 weeks. INTERVENTIONS/METHODS: We investigated liking during food consumption. Participants reported their hedonic experience while consuming a high-calorie food (milkshake) and a tasteless solution. The solutions were administered inside the scanner with a Magnetic Resonance Imaging (MRI)-compatible gustometer to assess neural responses during consumption. The same procedure was repeated during the pre- and post-intervention sessions. RESULTS: None of the effects involving the intervention factor reached significance when comparing liking between the pre- and post-intervention sessions or groups. Liking during food reward consumption was associated with the activation of the ventromedial prefrontal cortex (vmPFC) and the amygdala. The liraglutide group lost more weight (BMI post-pre = -3.19 ± 1.28 kg/m2) than the placebo group (BMI post-pre = -0.60 ± 1.26 kg/m2). CONCLUSIONS: These results suggest that liraglutide leads to weight loss without self-report or neural evidence supporting a concomitant reduction of food liking in participants with OB.

Intelligent plantar pressure offloading for the prevention of diabetic foot ulcers and amputations.

The high prevalence of lower extremity ulceration and amputation in people with diabetes is strongly linked to difficulties in achieving and maintaining a reduction of high plantar pressures (PPs) which remains an important risk factor. The effectiveness of current offloading footwear is opposed in part by poor patient adherence to these interventions which have an impact on everyday living activities of patients. Moreover, the offloading devices currently available utilize primarily passive techniques, whereas PP distribution is a dynamically changing process with frequent shifts of high PP areas under different areas of the foot. Thus, there is a need for pressure offloading footwear capable of regularly and autonomously adapting to PPs of people with diabetes. The aim of this article is to summarize the concepts of intelligent pressure offloading footwear under development which will regulate PPs in people with diabetes to prevent and treat diabetic foot ulcers. Our team is creating this intelligent footwear with an auto-contouring insole which will continuously read PPs and adapt its shape in the forefoot and heel regions to redistribute high PP areas. The PP-redistribution process is to be performed consistently while the footwear is being worn. To improve adherence, the footwear is designed to resemble a conventional shoe worn by patients in everyday life. Preliminary pressure offloading and user perceptions assessments in people without and with diabetes, respectively, exhibit encouraging results for the future directions of the footwear. Overall, this intelligent footwear is designed to prevent and treat diabetic foot ulcers while enhancing patient usability for the ultimate prevention of lower limb amputations.

[What is the relationship between alcohol and obesity?] / Quelle relation entre alcool et obésité ?

The prevalence of alcohol consumption and obesity continues to increase. The aim of this literature review was to give an overview of the association between these two health and socioeconomic problems. Ethanol must be considered as an orexigenic molecule, acting on the cerebral regulation of hunger and satiety and on the mesolimbic reward system. Moreover, studies showed that alcohol blocks the fatty acid beta oxidation, promoting the storage of lipids. Observational and experimental studies struggle to find a solid correlation between the two entities, but they have several biases and limitations. Experts agree to consider ethanol ingestion as a potential contributing factor of the higher obesity rates observed in the last decades.

Les prévalences de la consommation d'alcool et de l'obésité ne cessent d'augmenter. L'objectif de cette revue de la littérature est de donner un aperçu de l'association entre ces deux problématiques sanitaires et socio-économiques. L'éthanol, agissant sur la régulation cérébrale de la faim et de la satiété ainsi que sur le système mésolimbique de la récompense, est à considérer comme une substance orexigène. En outre, il bloque la bêta-oxydation des lipides, prédisposant à leur stockage. Malgré des évidences scientifiques discordantes, qui sont cependant conditionnées par des biais et limitations, les experts sont d'accord de considérer la consommation de boissons alcoolisées comme un probable facteur contribuant à l'incrémentation du taux d'obésité observé lors des dernières décennies.

[Preparation program for bariatric surgery designed with patients: challenges and benefits]. / Programme de préparation à la chirurgie bariatrique conçu avec les patients : enjeux et bénéfices.

Despite the weight and metabolic efficiency of bariatric surgery, nearly 35 % of operated patients regain weight due to insufficient behavioral changes. Collaborating with patient partners to co-construct an educational preparation program represents an opportunity to promote patient involvement adjusted to societal developments. This partnership starts with an exploration of the partners' needs and follows a progressive and tailored process that responds to the issues of place and power raised. It leads to the creation of a day of teaching, at the beginning of the course, aimed at informed consent and to a program, at the end of the course, focused on behavioral changes in their concrete dimension in support of a new and recognized health actor: the patient partner.

Malgré l'efficacité pondérale et métabolique de la chirurgie bariatrique, près de 35 % des patients opérés présentent une reprise pondérale liée à des changements comportementaux insuffisants. Collaborer avec des patients partenaires pour co-construire un programme éducatif de préparation représente une opportunité ajustée à l'évolution sociétale de favoriser l'implication des patients. Ce partenariat débute par l'exploration des besoins des partenaires et suit un processus progressif et sur mesure qui répond aux enjeux de place et de pouvoir soulevés. Il aboutit à la création d'une journée d'enseignement, en début de parcours, visant le consentement éclairé et à un programme, en fin de parcours, centré sur les changements comportementaux dans leur dimension concrète, à l'appui d'un nouvel acteur de santé reconnu : le patient partenaire.

[The evolution of the perception of obesity: the "weight" of social norms]. / Évolution de la perception de l'obésité : le « poids ¼ des normes sociales.

The perception of obesity and the ideal body image has evolved over time, largely due to social norms that are not always guided by scientific knowledge. The use of social media for health promotion is an emerging area of investigation. Preliminary research suggests that they have the potential to both serve as a platform for combating the stigma of obesity and promoting positive body image. But there is also evidence that supports the contrary. In particular, the dissemination of digitally altered images that convey ideals of the slim female form can be detrimental to physical and psychological health. Further research is needed to determine how best to use social networks and media as a health promotion tool.

La perception de l'obésité et du corps idéal a bien évolué au cours du temps, liée en grande partie à des normes sociales qui ne sont pas toujours guidées par les connaissances scientifiques. L'utilisation des médias sociaux pour la promotion de la santé est un domaine d'investigation émergent. Les recherches préliminaires suggèrent qu'ils ont le potentiel d'être une plateforme permettant à la fois de lutter contre la stigmatisation de l'obésité et de promouvoir une image corporelle positive. Mais il y a également des preuves qui suggèrent le contraire. Notamment, la diffusion d'images retouchées qui véhiculent des idéaux de minceur irréalistes peut nuire à la santé physique et psychologique. Des recherches supplémentaires sont nécessaires pour déterminer comment utiliser au mieux les réseaux et médias sociaux comme outil de promotion de la santé.

Effectiveness of Therapeutic Patient Education Interventions in Obesity and Diabetes: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Diabetes mellitus (DM) and obesity account for the highest burden of non-communicable diseases. There is increasing evidence showing therapeutic patient education (TPE) as a clinically and cost-effective solution to improve biomedical and psychosocial outcomes among people with DM and obesity. The present systematic review and meta-analysis present a critical synthesis of the development of TPE interventions for DM and obesity and the efficacy of these interventions across a range of biomedical, psychosocial and psychological outcomes. A total of 54 of these RCTs were identified among patients with obesity and diabetes and were thus qualitatively synthesized. Out of these, 47 were included in the quantitative synthesis. There was substantial heterogeneity in the reporting of these outcomes (I2 = 88.35%, Q = 317.64), with a significant improvement noted in serum HbA1c levels (standardized mean difference (SMD) = 0.272, 95% CI: 0.118 to 0.525, n = 7360) and body weight (SMD = 0.526, 95% CI: 0.205 to 0.846, n = 1082) in the intervention group. The effect sizes were comparable across interventions delivered by different modes and delivery agents. These interventions can be delivered by allied health staff, doctors or electronically as self-help programs, with similar effectiveness (p < 0.001). These interventions should be implemented in healthcare and community settings to improve the health outcomes in patients suffering from obesity and DM.

Cardiovascular outcomes trials: a paradigm shift in the current management of type 2 diabetes.

Cardiovascular disease (CVD) is the leading cause of mortality and morbidity in patients with type 2 diabetes (T2D). Historical concerns about cardiovascular (CV) risks associated with certain glucose-lowering medications gave rise to the introduction of cardiovascular outcomes trials (CVOTs). Initially implemented to help monitor the CV safety of glucose-lowering drugs in patients with T2D, who either had established CVD or were at high risk of CVD, data that emerged from some of these trials started to show benefits. Alongside the anticipated CV safety of many of these agents, evidence for certain sodium-glucose transporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have revealed potential cardioprotective effects in patients with T2D who are at high risk of CVD events. Reductions in 3-point major adverse CV events (3P-MACE) and CV death have been noted in some of these CVOTs, with additional benefits including reduced risks of hospitalisation for heart failure, progression of renal disease, and all-cause mortality. These new data are leading to a paradigm shift in the current management of T2D, with international guidelines now prioritising SGLT2 inhibitors and/or GLP-1 RAs in certain patient populations. However, clinicians are faced with a large volume of CVOT data when seeking to use this evidence base to bring opportunities to improve CV, heart failure and renal outcomes, and even reduce mortality, in their patients with T2D. The aim of this review is to provide an in-depth summary of CVOT data-crystallising the key findings, from safety to efficacy-and to offer a practical perspective for physicians. Finally, we discuss the next steps for the post-CVOT era, with ongoing studies that may further transform clinical practice and improve outcomes for people with T2D, heart failure or renal disease.

Abdominal pain patterns during COVID-19: an observational study.

Abdominal pain and liver injury have been frequently reported during coronavirus disease-2019 (COVID-19). Our aim was to investigate characteristics of abdominal pain in COVID-19 patients and their association with disease severity and liver injury.Data of all COVID-19 patients hospitalized during the first wave in one hospital were retrieved. Patients admitted exclusively for other pathologies and/or recovered from COVID-19, as well as pregnant women were excluded. Patients whose abdominal pain was related to alternative diagnosis were also excluded.Among the 1026 included patients, 200 (19.5%) exhibited spontaneous abdominal pain and 165 (16.2%) after abdomen palpation. Spontaneous pain was most frequently localized in the epigastric (42.7%) and right upper quadrant (25.5%) regions. Tenderness in the right upper region was associated with severe COVID-19 (hospital mortality and/or admission to intensive/intermediate care unit) with an adjusted odds ratio of 2.81 (95% CI 1.27-6.21, p = 0.010). Patients with history of lower abdomen pain experimented less frequently dyspnea compared to patients with history of upper abdominal pain (25.8 versus 63.0%, p < 0.001). Baseline transaminases elevation was associated with history of pain in epigastric and right upper region and AST elevation was strongly associated with severe COVID-19 with an odds ratio of 16.03 (95% CI 1.95-131.63 p = 0.010).More than one fifth of patients admitted for COVID-19 presented abdominal pain. Those with pain located in the upper abdomen were more at risk of dyspnea, demonstrated more altered transaminases, and presented a higher risk of adverse outcomes.

Sex-specific modulation of circulating growth differentiation factor-15 in patients with type 2 diabetes and/or obesity.

Objective: Growth differentiation factor-15 (GDF15), a key metabolic regulator, is associated with obesity and diabetes in which sex-specific differences have been reported. Thus, we assessed whether GDF15 could be dependent on sex in diabetes and/or obesity groups. Methods: We measured serum GDF15 levels by ELISA in eight lean women and men (n = 16), eight women and eight men having obesity (n = 16), eight women and eight men with type 2 diabetes (T2D, n = 16), and seven women and nine men with both diabetes and obesity (n = 16). Estimation of the difference in the means of each group was performed by two-way ANOVA. The interdependence of the different variates was addressed by multivariate analysis. Correlations between GDF15 levels and HOMA-IR, HbA1c, triglycerides, HDL, and LDL were explored by linear regression. Results: Being a woman and having obesity alone or in combination with diabetes decreased GDF15 serum levels (ß = -0.47, CI = -0.95, 0.00, P = 0.052; ß = -0.45, CI = -0.94, 0.05, P= 0.075). Diabetes independently of metformin treatment and obesity were not predictive of low GDF15 levels (ß = 0.10, CI = -0.36, 0.57, P = 0.7). Correlation analysis showed that HOMA-IR (r = 0.45, P = 0.008) and triglycerides (r = 0.41, P = 0.017) were positively correlated and HDL (r = -0.48, P = 0.005) was negatively correlated with GDF15 levels in men. Conclusions/interpretation: GDF15 level was significantly different between men and women, as well as between the groups. Sex and group interaction revealed that being a woman and having obesity alone or in combination with diabetes decreased GDF15 levels.

Evolution of Therapeutic Patient Education: A Systematic Scoping Review and Scientometric Analysis.

Therapeutic patient education (TPE) aims to empower the patients and their caregivers to effectively care for and manage their conditions. Such educational programs have been shown to improve health behaviors, disease outcomes, and quality of life among different patient populations. The field of TPE has evolved extensively over decades, owing to interdisciplinary research. No study so far has been done to map this field, to identify the stakeholders and gaps requiring future research. By leveraging the theory of co-citation, CiteSpace was used to visualize the bibliographic data pertaining to TPE research. A total of 54,533 articles published in English language were analyzed to identify influential funders, regions, and institutes contributing to this field. Besides these, significant theoretical and empirical contributions that shaped this field were mapped. Our analysis revealed several important insights. Most of the important theories that helped shape TPE were inspired from the social sciences. Five important research themes were identified: disorders, study designs utilized in TPE research, the scope of the TPE literature and outcomes, and populations. The research focused on improving perceptions, behaviors, and attitudes toward health promotion, reducing stigma, self-management and medication adherence. Most of the research was developed in the context of high-income countries. Future research should involve patients and use digital technology. Meta-analytical studies need to be done to identify the effectiveness and moderators of TPE interventions across different disorders. Further research should involve low and middle-income countries (LMIC) to ensure knowledge and technology transfer.

[How to manage obesity in the general practitioner's office ?] / Comment prendre en charge l'obésité au cabinet d'un médecin généraliste ?

The prevalence of obesity continues to increase and only a change in behavior can lead to a reduction in weight and an improvement of the cardio-metabolic profile. The general practitioner plays an important role in preventing excess weight and in identifying patients at risk. He is often on the front line to provide hygiene- dietetic advice and long-term support. The purpose of this article is to give the primary care physician some guidelines from reception at the office to referral to a specialist center if necessary.

La prévalence de l'obésité ne cesse d'augmenter et seul un changement de comportement peut permettre une diminution de poids et une amélioration du profil cardiométabolique. Le médecin généraliste joue un rôle important dans la prévention de l'excès pondéral et dans l'identification des patients à risque. Il est souvent en première ligne pour leur donner des conseils hygiénodiététiques et pour les accompagner sur le long terme. Le but de cet article est de fournir au médecin de premier recours quelques directives dans la prise en charge de l'obésité, de l'accueil au cabinet médical jusqu'à l'orientation vers un centre spécialisé en cas de nécessité.

[Evolution and effectiveness of therapeutic patient education for obesity and diabetes]. / Évolution et efficacité de l'éducation thérapeutique du patient pour l'obésité et le diabète.

Therapeutic patient education (TPE) aims to help patients acquire or maintain the skills they need to best manage their lives with a chronic disease. Through a scientometric analysis of the literature, we identified the most influential bibliographic data related to TPE research that have strengthened the field and increased its effectiveness. These were studies from the fields of education, philosophy, psychology, anthropology and medical sociology. We have conducted a meta-analysis that has demonstrated the effectiveness of TPE for the management of obesity and diabetes on biological and psychological parameters. It allowed patients to improve their knowledge, their therapeutic adherence and their sense of self-efficacy.

L'éducation thérapeutique du patient (ETP) vise à aider les patients à acquérir ou maintenir les compétences dont ils ont besoin pour gérer au mieux leur vie avec une maladie chronique. À travers une analyse scientométrique de la littérature, nous avons identifié les données bibliographiques les plus influentes, relatives à la recherche en ETP, qui ont permis de renforcer le domaine et augmenter son efficacité. Ce sont des études issues des sciences de l'éducation, de la philosophie, de la psychologie, de l'anthropologie et de la sociologie médicale. Nous avons mené une méta-analyse qui a permis de démontrer l'efficacité de l'ETP pour la prise en charge de l'obésité et du diabète sur les paramètres biologiques et psychologiques. Elle a permis aux patients d'améliorer leurs connaissances, leur adhérence thérapeutique et le sentiment d'efficacité personnelle.

[Weight-loss promoting dietary supplements : overview of their efficacy and safety]. / Compléments alimentaires pour la perte de poids : revue de leur efficacité et sécurité.

Due to the increase in the prevalence of obesity, the consumption of dietary supplements promoting weight loss has increased in the last few years. Many dietary supplements are available on the market, such as L-carnitine, glucomanan, chitosan, and Hoodia gordonii. The safety and clinical effectiveness of most of these supplements have not been assessed by high-quality trials. The scientific evidence of their benefit remains weak. The risk of adverse effects and drug interactions, most often unknown to patients, exists and must be carefully considered before initiating supplementation, in consultation with a physician, in the same way as other aspects of the treatment of obese patients.

Face à l'augmentation de la prévalence de l'obésité, la consommation de compléments alimentaires promouvant la perte pondérale s'est accrue au cours des dernières années. De nombreux compléments alimentaires sont disponibles sur le marché, tels que la L-carnitine, le glucomannane, le chitosan et la Hoodia gordonii. La sécurité et l'efficacité clinique de la plupart de ces compléments n'ont pas été évaluées par des essais de bonne qualité. L'évidence scientifique de leur bénéfice reste ainsi faible. Le risque d'effets indésirables et d'interactions médicamenteuses, le plus souvent méconnu des patients, existe et doit être pris en considération avant de débuter une supplémentation, en consultation avec un médecin, au même titre que les autres aspects de la prise en charge des patients obèses.