[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.

[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.

Effectiveness of individual and group programmes to treat obesity and reduce cardiovascular disease risk factors in pre-pubertal children.

Childhood obesity results in premature atherosclerosis and requires early intervention. Compare the effectiveness of 6-month lifestyle interventions (with choice of either individual or group therapy) with standard care on body mass index (BMI) z-score and cardiovascular disease (CVD) risks factors in children with obesity. This 6-month randomized controlled trial with a 6-month follow-up included 74 pre-pubertal children with obesity (7.5-11.9 years) assigned randomly (2:1) to intervention or control. Families in the intervention arm choose between an individually delivered treatment (3 hours paediatrician + 4 hours dietician) or group treatment (35 hours with a multidisciplinary team). Children participated also to a weekly physical activity programme. We measured BMI, BMI z-score; waist circumference (WC); total and abdominal fat; blood pressure; common carotid artery intima-media thickness and incremental elastic modulus (Einc); endothelium-dependent and independent dilation (nitroglycerin-mediated dilation [NTGMD]) of the brachial artery; fasting plasma glucose, insulin, lipids; and high-sensitivity C-reactive protein (hs-CRP). Compared to controls, at 6 months, abdominal fat and hs-CRP were reduced in both interventions. The group intervention was also effective in reducing BMI (-0.55 kg/m2 ; 95% confidence interval -1.16 to 0.06) and BMI z-score (-0.08; -0.15 to 0.00) at 6 months and BMI, BMI z-score, WC, NTGMD, total and abdominal fat at 12 months. Abdominal fat and low-grade inflammation were significantly decreased in both interventions. High-intensity group treatment improved early signs of atherosclerosis in children with obesity. These findings are important for the promotion of cardiometabolic health in this population.