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En lien avec la feuille de route interministérielle sur l'obésité (2019-2022), la Haute Autorité de Santé (HAS) a publié en 2022 un guide pour optimiser le parcours de soins de l'enfant et de l'adolescent en situation de surpoids ou d'obésité et ainsi accompagner les professionnels de santé dans sa mise en œuvre. Ce guide insiste tout particulièrement sur l'importance de la surveillance de l'indice de masse corporelle (IMC) tout au long de l'enfance à chaque occasion afin d'optimiser le dépistage du surpoids et de l'obésité. En cas d'excès pondéral avéré, il détaille l'importance de l'évaluation multidisciplinaire de chaque situation avec la prise en compte des différents aspects (contexte socioculturel, psychoaffectif entre autres) et les leviers que les professionnels peuvent utiliser tout au long du parcours de soins qui doit être coordonné, gradué et inscrit dans la durée pour espérer être efficace. In link with the interministerial plan for obesity (2019-2022), the French National Authority for Health (HAS) has published in 2022 a guide to optimize the care pathway for overweight and obese children and adolescents to support healthcare professionals in its implementation. The guide particularly emphases on the importance of calculating Body Mass Index (BMI) throughout childhood, at every opportunity, to optimize screening for overweight and obesity. In case where excess weight has been established, it details the importance of multidisciplinary assessment of each situation, with considering several important aspects (socio-cultural, psycho-affective, etc.) and detailing the levers that professionals can use throughout this care pathway that must be coordinated and graduated on the long-term manner if it is to be effective. [ABSTRACT FROM AUTHOR]

To explore if individuals living with obesity participate, have interest, and benefit from circuit resistance training (RT+) and evaluate if the RT+ reaches moderate aerobic intensity and the association between oxygen consumption and heart rate while performing the RT+. Ten inactive adults living with obesity participated in the RT+ program for 12 weeks. Participants performed 150 min of the RT+ program using four exercises (squats, chest press, lunges and lat-pull down) for three sessions of 50 min each week. Measured outcomes included attendance, fitness, lipids, anthropometrics body composition. Oxygen consumption and heart rate were captured during a single session of the RT+ program using portable indirect calorimetry. Participants attended 90% of offered sessions (32.5/36.0 sessions). A significant improvement was observed in the body mass index (P = 0.03). The RT+ program was permitted to reach moderate intensity regardless of the indicator used to establish moderate intensity (3METs, 46%VO 2peak , 40%VO 2reserve , 64%HR max and 40%HR reserve). The association between HR and VO 2 while performing the RT+ program was 0.27; P < 0.01. This study suggests that people with obesity achieve moderate intensity when performing RT+. As a result, performing RT in a circuit manner could contribute to the aerobic portion of the guidelines for adults living with obesity. [ABSTRACT FROM AUTHOR]

La prise en charge de l'obésité infantile est un enjeu majeur de santé publique, compte tenu de son impact sur la santé physique et mentale des jeunes. Elle ne peut pas faire l'économie d'un examen psychiatrique exhaustif, à la recherche notamment d'un trouble du comportement alimentaire. Dans cet article de mise au point, nous présenterons dans le premier paragraphe les troubles alimentaires les plus spécifiquement liés à l'obésité (l'hyperphagie boulimique, la perte de contrôle alimentaire et l'hyperphagie nocturne) ainsi que les comorbidités psychiatriques associées. Dans une deuxième partie, nous étudierons certains facteurs (l'alimentation émotionnelle, la restriction cognitive alimentaire et la stigmatisation sociale) pouvant favoriser l'émergence de troubles alimentaires chez des jeunes en situation d'obésité. Cette approche psychopathologique ouvre la voie à une compréhension plus holistique de la problématique complexe de l'obésité infantile, pouvant aboutir à des stratégies thérapeutiques et préventives plus efficaces. Childhood obesity is a significant public health concern due to its adverse effects on both physical and mental health. It cannot dispense with a comprehensive psychiatric examination, particularly in the search for an eating behavior disorder. In this review article, we present, in the first part, eating disorders most specifically related to obesity (binge eating disorder, loss of control overeating, and night eating syndrome) as well as associated psychiatric comorbidities. In the second part, we examine specific factors (emotional eating, cognitive restriction, and social stigmatization) that may contribute to the emergence of eating disorders in young individuals with obesity. This psychopathological approach will facilitate a more comprehensive understanding of the complex issue of childhood obesity, potentially leading to more effective therapeutic and preventive strategies. [ABSTRACT FROM AUTHOR]

Physical inactivity in older diabetes patients. ▪ We aimed to examine self-reported physical activity (PA) and sitting time (ST) in older patients with type 1 diabetes (T1D) and type 2 diabetes (T2D) in daily clinical practice, and their associations with metabolic health, namely body mass index (BMI) and glycemic control (HbA1c). This cross-sectional cohort non-exposure study included 117 patients (n = 29 T1D and n = 88 T2D), aged 71.6 ± 1.1 years, on insulin regimens. Statistical analyses were conducted on data gathered with the validated International Physical Activity Questionnaire. T1D patients reported a longer duration of weekly physical activity and shorter duration of sitting time compared to T2D patients (active 162 ± 32 vs 72 ± 12 minutes weekly; sedentary 4.4 ± 0.7 vs 6.7 ± 0.9 hours daily, respectively) (P < 0.01 for both). PA was negatively associated with BMI in T1D (r = –0.5; P < 0.01). ST was positively associated with BMI in T2D (r = 0.2; P < 0.05). Only the (T2D + T1D) patients who achieved > 1500 metabolic equivalent-minutes weekly had significantly lower HbA1c (7.9 ± 1.6% vs.7.3 ± 1.2% (P < 0.05). Physical inactivity was associated with a higher BMI in a real-world cohort of older patients with diabetes, on insulin treatment. Beneficial effects of PA on glycemic control were observed only in the highly active subgroup. Assessing and addressing health-enhancing physical activity should be integrated into everyday clinical practice, since encouraging different modes of physical activity and interrupting sitting behavior has potential health implications. [ABSTRACT FROM AUTHOR]

This review and meta-analysis examine the effects of aerobic exercise training on central arterial stiffness in obese individuals. Original articles were searched in PubMed, Scopus, and Coachrane from January 2005 to December 2021. Fixed-effects modeling was used to compare changes between pre- and post-interventions and control group. Comparisons between pre- and post-interventions (n = 13 studies) reveals a significant decrease in central PWV [standardized mean difference (SMD): 0.263; confidence interval (CI) 95%: 0.101 to 0.426, p = 0.001]. However, comparisons between control and exercised individuals (n = 4 studies) show no significant differences in central PWV [SMD: 0.241 (CI 95%, −0.116 to 0.599), p = 0.186]. In conclusion, aerobic exercise training reduces central arterial stiffness in obese adults. These results are of clinical relevance since it might be associated with reduced cardiovascular diseases and all-cause mortality. [ABSTRACT FROM AUTHOR]

Une patiente en établissement d'hébergement pour personnes âgées dépendantes était atteinte de sclérose latérale primitive (SLP), qui est une maladie neuromusculaire d'évolution lente, dans son cas, très handicapante. Elle développait progressivement une obésité. La possibilité d'une sarcopénie sous-jacente était éliminée et la prise de poids était expliquée par une très faible activité physique et surtout des grignotages non contrôlés. En l'absence de traitement de la SLP, la patiente était considérée comme en situation palliative. Invoquant le respect de sa qualité de vie, elle refusait de modérer ses grignotages. Le seul recours était de prodiguer des conseils diététiques auprès de la patiente, des équipes et de sa famille. Ce cas clinique souligne la difficulté d'évaluation et de prise en charge nutritionnelles des personnes atteintes de maladies neurologiques et neuromusculaires. A patient in a nursing home suffered from primary lateral sclerosis (PLS), which is a slowly progressive neuromuscular disease, in her case, very disabling. She gradually developed obesity. The possibility of an underlying sarcopenia was eliminated, and the weight gain was explained by very low physical activity and especially uncontrolled snacking. In the absence of treatment for PLS, the patient was considered to be in a palliative situation. Invoking respect for her quality of life, she refused to moderate her snacking. The only recourse was to provide dietary advice to the patient, the teams and her family. This clinical case highlights the difficulty of nutritional assessment and management of people with neurological and neuromuscular diseases. [ABSTRACT FROM AUTHOR]

L'obésité et le surpoids s'avèrent être des problèmes de santé publique de manière pandémique réduisant significativement l'espérance de vie des personnes touchées et présentant un impact médicoéconomique important, en lien avec les traitements qu'ils requièrent et leurs comorbidités. En France, la prise en charge thérapeutique de cette pathologie se résume à une modification du mode de vie ou à une approche chirurgicale. L'endoscopie a permis le développement d'alternatives thérapeutiques ces dernières années, bien que ces méthodes ne soient à l'heure actuelle pas toutes recommandées en France alors même que des résultats probants aient été démontrés. À l'heure de l'avènement de l'endoscopie interventionnelle préservant les organes, des procédures thérapeutiques novatrices mini-invasives ont vu le jour et vont tendre à se développer afin d'occuper une place à part entière dans le traitement de cette maladie chronique. Avec la mise à disposition de nouveaux traitements médicamenteux efficaces comme les agonistes du GLP-1, des approches combinées « endoscopie-médicament » pourraient être nouvellement définies permettant d'atteindre une efficacité clinique sans précédent. L'objectif de cette mise au point est de rappeler les techniques endoscopiques actuelles existantes dans la prise en charge de l'obésité, d'exposer les innovations dans le domaine en cours de développement et d'esquisser quel pourrait être l'avenir de l'endoscopie bariatrique. Obesity and overweight are proving to be pandemic public health problems that significantly reduce the life expectancy of those affected. Obesity has a significant medico-economic impact, in relation to the treatments it requires and its comorbidities. In France, the therapeutic management of this pathology is limited to a lifestyle modification or a surgical approach. Endoscopy has allowed the development of therapeutic alternatives in the management of obesity in recent years, although not all of these methods are currently recommended in France, even though convincing results have been shown. With the advent of organ-sparing interventional endoscopy, innovative minimally invasive therapeutic procedures have emerged and will tend to develop in order to take a full place in the treatment of this chronic disease. More ambitious endoscopic procedures could also be combined, thus combining the different modes of action of each of them. Finally, with the availability of new effective drug treatments, combined "endoscopy-drug" approaches could be newly defined to achieve unprecedented clinical effectiveness. The objective of this review will be to present the current endoscopic techniques available for the management of obesity, to discuss the innovative procedures under development and to outline the future of bariatric endoscopy, either by combining procedures or by combining them with medical therapies. [ABSTRACT FROM AUTHOR]

In recent years, psychological factors, including anxiety and post-traumatic stress disorder, have emerged as possible background factors for obesity and its comorbidities. Post-traumatic stress disorder (PTSD) has been associated with higher body mass index (BMI) and metabolic syndrome (MetS) compared to other psychiatric disorders, but this association remains partly mysterious and intriguing, especially considering the effect of childhood trauma. We decided to conduct a review in order to obtain the most recent information on this association with a focus on developmental elements. The studies considered were very heterogeneous, in terms of sample size and results, and do not lend themselves to meta-analysis but rather to discursive synthesis. There are many different and complex planes of interrelationship between PTSD and obesity which offer different therapeutic clues for the clinician. Integrated psychotherapies and interventions focusing on exercise and mindfulness can be used in different settings to promote recovery from both disorders. [ABSTRACT FROM AUTHOR]

À l'heure actuelle, l'évaluation psychologique préopératoire fait partie des éléments incontournables pour toute personne souhaitant bénéficier d'une chirurgie bariatrique. Toutefois, il aura fallu attendre la fin du XIXe siècle pour que la prise en charge de l'obésité s'inscrive dans une approche pluridisciplinaire, posant ainsi les bases de l'évaluation psychologique dans ce domaine. En étant intégrée comme un traitement possible, la chirurgie va renforcer l'intérêt d'une telle perspective, notamment en s'appuyant sur ce type d'évaluation qui a pour fonction d'établir l'existence éventuelle de contre-indications. Celles-ci sont définies selon les pays par différentes instances comme l' American Society for Bariatric and Metabolic Surgery ou la Haute Autorité de santé. Bien qu'il n'existe pas d'outil spécifique pour ce type de bilan, certains font figure de référence depuis l'émergence de cette discipline dont l'Inventaire Multiphasique de la Personnalité du Minnesota. Depuis sa création, il est utilisé dans l'univers de la chirurgie bariatrique, démontrant sa validité et ses qualités psychométriques au fil du temps. Par ailleurs, la littérature continue à s'enrichir de travaux de recherche concernant sa capacité prédictive des suites d'une chirurgie renforçant la pertinence et l'intérêt de son utilisation dans cette pratique. At present, the preoperative psychological assessment is one of the essential elements for anyone wishing to undergo bariatric surgery. However, it was not until the end of the 19th century that the management of obesity became part of a multidisciplinary approach, thus laying the foundations for psychological assessment in this area. By being integrated as a possible treatment, surgery will reinforce the interest of such a perspective, in particular by relying on this type of assessment, which has the function of establishing the possible existence of contraindications. These are defined in different countries by different bodies such as the American Society for Bariatric and Metabolic Surgery or the Haute Autorité de santé. Although there is no specific tool for this type of assessment, some have been used as a benchmark since the emergence of this discipline, including the Minnesota Multiphase Personality Inventory. Since its inception, it has been used in the world of bariatric surgery demonstrating its validity and psychometric qualities over time. In addition, the literature continues to be enriched by research work concerning its predictive capacity for the aftermath of surgery, reinforcing the relevance and interest of its use in this practice. [ABSTRACT FROM AUTHOR]

To determine the status of 25(OH)D and parathyroid hormone (PTH) levels in patients with severe obesity who undergo and not undergo gastric bypass (GB); and analyzed their correlation with the degree of obesity and fat mass. Cross-sectional study in 34 patients, analyzed in two groups: a) patients who not undergo GB and b) patients who did undergo GB. Height, weight, BMI, body composition, % excess weight loss (EWL) and % total weight loss (TWL) were determinate. 25(OH)D level was categorized according to the Endocrine Society criteria. Mean age was of 37.24 ± 5.83 vs 40.82 ± 9.03 years (P = 0.021) and BMI of 44.92 ± 8.63 vs 31.28 ± 5.60 kg/m2 (P = 0.001) in patients who did not undergo GB and underwent GB respectively. Patients who underwent GB showed decreased levels of 25(OH)D: 14.04 ± 10.42 ng/mL vs patients without surgery 31.95 ± 31.00 ng/mL (P < 0.001). Vitamin D deficiency was identified in 70% patients having GB vs 59% patients without surgery (P < 0.05). Of all patients with GB, 35% were diagnosed with hyperparathyroidism vs 29% of those without GB (P = 0.492). Serum 25(OH)D concentrations were disclosed a significant inverse relationship with the % TWL after surgery, but not with weight, BMI and fat mass. Vitamin D deficiency is prevalent in patients with severe obesity and patients who did undergo GB. The major determinant of low levels of 25(OH)D was % TWL after surgery. Hyperparathyroidism did not indicate vitamin D deficiency. [ABSTRACT FROM AUTHOR]

This study aimed to examine the impact of 12 weeks of aerobic interval, resistance and combined exercise on inflammatory markers of TNF-a, IFN-y, Metrnl and IL-4 in obese men. Forty-four individuals (35–55 years; body mass index (BMI): 30–40 kg/m2) voluntarily participated, and were randomly divided into four groups: aerobic interval exercise (n = 10) (5 × 3-min intervals at ∼40–80% peak heart rate), resistance exercise (n = 11) (2–3 sets, 8–20 repetitions at 40–80% one-repetition maximum), combined exercise (n = 12) (a combination of both aerobic and resistance exercises) and control (n = 11). The exercise protocol in all three groups was 12 weeks with a frequency of three sessions per week. IL-4 increased significantly in aerobic interval (P = 0.005), resistance (P = 0.005), and combined (P = 0.022) exercise groups. TNF-α decreased significantly only in the aerobic (P = 0.005) and combined (P = 0.012) groups, but it increased in the resistance group (P = 0.025). None of the exercise interventions resulted in a significant change in Meteorin-like protein (Metrnl) and IFN-γ levels (P > 0.05). The results suggest that aerobic and combined exercises may have more beneficial effects in improving the inflammatory status than resistance exercise alone in obese individuals. [ABSTRACT FROM AUTHOR]

Après une perte de poids massive, le thorax chez les hommes peut présenter des déformations importantes. Le traitement chirurgical de la gynécomastie après un amaigrissement massif reste une chirurgie difficile et partiellement incomprise en raison de 4 facteurs principaux : un excès cutané complexe en hauteur et largeur et qui peut parfois se poursuivre en axillaire ou en dorsal, une composante graisseuse prédominante plutôt que glandulaire, la malposition de la plaque aréolo-mamelonnaire (PAM) qui est souvent élargie et un sillon sous mammaire (SSM) souvent marqué. Les techniques actuellement décrites sont soit insuffisantes, soit elles entraînent des complications fréquentes et/ou importantes. Les auteurs décrivent une nouvelle approche qui dissocie le traitement du volume et de la peau avec une résection « sur mesure » qui est simple, reproductible et sécure. Notre objectif est d'améliorer la satisfaction des patients tout en réduisant les taux de complications. Dix-sept patients présentant une adipomastie avec excès cutané après amaigrissement massif ont été opérés selon la technique de lipoaspiration et redrapage cutané sur mesure après pose d'agrafes. Les auteurs décrivent la technique, les indications et contre-indications de la procédure et analysent les résultats. L'âge moyen des patients est de 39 ans. L'indice de masse corporelle (IMC) moyen avant la perte de poids est de 42,7 kg/m2, la perte moyenne de poids avant la correction corporelle est de 49 kg, avec un delta moyen de perte de BMI de 15,34 kg/m2. Le séjour moyen à l'hôpital est de 1,3 nuits. Aucun patient n'a présenté de complications majeures (hématome, hémorragie, nécrose, thrombophlébite, reprise chirurgicale immédiate pour traiter des complications). Les complications mineures incluant les déhiscences cicatricielles, les infections, les stéatonécroses, les corrections cicatricielles à distance, ont été rapportées pour 2 patients, soit 11 %. La torsoplastie assistée par liposuccion et désépidermisation sur mesure est moins invasive que les techniques décrites antérieurement. Les résultats sont reproductibles et les taux de complications sont faibles. Ses avantages sont multiples : absence d'espace de décollement et donc aucun drain n'est nécessaire, le respect des vaisseaux, nerfs et lymphatiques, peu de douleur et une courte durée d'hospitalisation. Cette technique est simple, rapide, facile à apprendre et reproductible. Cependant, elle n'est applicable que dans l'adipomastie pure. Une technique différente doit être utilisée en présence de tissu glandulaire ferme. After massive weight loss (MWL), the chest in men may show significant deformities. The surgical treatment of gynecomastia after MWL remains a difficult and partially misunderstood surgery due to 4 main factors: a complex excess of skin in height and width that sometimes continues in the axilla or dorsal region, a predominantly fatty rather than glandular component, the malposition of the nipple-areola complex (NAC) that is often enlarged and an inframammary fold (IMF) that is often marked. The techniques currently described are either insufficient or lead to frequent and/or significant complications. The authors describe a new approach that dissociates the treatment of the volume and the skin with a customized resection that is simple, reproducible and safe. Our goal is to improve patient satisfaction while reducing complication rates. Seventeen patients with adipomastia with excess skin after massive weight loss were operated on using liposuction and skin redraping technique. The authors describe the technique, indications and contraindications of the procedure and analyze the results. The average age of the patients was 39 years. The average body mass index (BMI) before weight loss is 42,7 kg/m2, the average weight loss before body correction is 49 kg, with an average delta of BMI loss of 15,34 kg/m2. The average stay in hospital is 1,3 nights. No patient had major complications (hematoma, hemorrhage, necrosis, thrombophlebitis, immediate surgical revision to treat complications). Minor complications including scar dehiscence, infection, steatonecrosis, and distant scar correction were reported in 2 patients, i.e. 11%. Liposuction assisted and desepidermization torsoplasty is a new technique for correction of pseudogynecomastia in MWL patients. The results are reproductible and the complication rates are low. There is no dead space and therefore no drains are needed. There is little pain and a short hospital stay. This technique is simple, quick and easy to learn. However, it is only applicable in adipomastia. A different technique should be used in the presence of firm glandular tissue. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of eight weeks of vitamin D supplementation and water exercise on cardiometabolic profile in women with type 2 diabetes. Forty women with type 2 diabetes participated in this study voluntarily and randomly divided to four groups: 1) vitamin D+ water exercise, 2) vitamin D, 3) water exercise, and 4) control groups. Water exercise groups (groups 1 and 3) performed 3 sessions of water training per week during 8 weeks (15 minutes of warm-up, 45 to 60 minutes of main activity with a Borg scale of 14 and 10 minutes of cooling). Vitamin D groups (groups 1 and 2) received 50,000 (IU) vitamin D supplements once a week. Levels of fasting blood sugar (FBS), insulin, hemoglobin A1c (HbA 1c), C- reactive protein (CRP) levels, as well as lipid profile were measured before and after intervention. Insulin resistance was also obtained by calculating HOMA-IR. Weight, waist circumference, and body fat mass were significantly decreased after intervention in Vitamin D+ water exercise group (P = 0.001, 0.032, and 0.013 respectively), as well as CRP, glycemic and lipid profile were significantly improved after intervention in water exercise group. The results of the present study showed that water exercise plus vitamin D supplementation had synergism beneficial effects on anthropometric indices and lipid and glycemic status of type 2 diabetic patients and can be used as a non-pharmacological and non-invasive method to improving these mentioned parameters of type 2 diabetes. IRCT20201223049811N1, data of registration: 12.01.2021; https://en.irct.ir/trial/53230. [ABSTRACT FROM AUTHOR]

Nonshivering thermogenesis, a component of whole-body energy expenditure, is regulated by many factors. The effect of a high-fat diet and endurance training was not yet explored on many NST factors at thermoneutrality. This study aimed to probe a high-fat diet and endurance training effect on newly identified NST factors, specifically Uncoupling Protein 1 -independent agents, at thermoneutrality. C57BL/6 mice were assigned into four groups including, Control, HFD, ET, and HFD-ET. The mice were housed at 28 °C (as a thermoneutrality). HFD group was fed an HFD for 12 weeks, and ET group had continuous running for six weeks. Likewise, HFD-ET group was submitted to ET for six weeks besides feeding HFD for 12 weeks. Real-time–PCR was used to assay the mRNA expression of NST-factors. The high-fat diet caused a significant increase in Uncoupling Protein 1 and Sarcolipin gene expression in brown fat and soleus muscle at thermoneutrality, respectively. Endurance training also caused a rise in Mitocondria Creatin Kinase 2 expression in beige fat. Neither the high-fat diet nor endurance training significantly changed the expression of Ca2+cyle-related factors and Uncoupling Protein 1 in beige fat. Endurance training restrained the increasing effect of the high-fat diet on the expression of brown fat's Uncoupling Protein 1 and Sarcolipin at thermoneutrality. The high-fat diet and endurance training may not homogeneously affect the NST factors under thermoneutrality. However, endurance training appears to be able to modulate the High-fat diet-induced nonshivering thermogenesis. [ABSTRACT FROM AUTHOR]

Étudier le lien entre la prise du petit déjeuner et l'obésité. Une enquête transversale a été réalisée auprès de 284 adultes Algériens. La consommation et la composition du petit déjeuner ont été estimées par le rappel de 24 h répété trois fois. Les consommateurs du petit déjeuner ont été définis comme ceux ayant un apport de 300 Kcal et plus dans ce repas. Les mesures anthropométriques ont concerné le poids et la taille. Notre population compte 46,5 % d'hommes et 53,5 % de femmes. Au total, 62,3 % des adultes étaient en surpoids dont 25,4 % avaient une obésité. Plus de la moitié de la population (54,2 %) prenait un petit déjeuner. Il était habituellement composé d'un produit céréalier, d'un laitage et d'un produit sucré, accompagnés d'un café ou un thé. Aucune différence significative n'a été observée entre la prévalence de l'obésité chez les consommateurs et les non-consommateurs du petit déjeuner. Aucune corrélation n'a été trouvée entre l'IMC et l'apport énergétique du petit déjeuner. En excluant l'apport énergétique du petit déjeuner, les non-consommateurs du petit déjeuner avaient un apport énergétique total plus élevé que ceux qui consommaient un petit déjeuner. Dans notre étude, le saut du petit déjeuner ne semble pas avoir de relation avec l'obésité. Celle-ci semble plutôt être liée à un excès en énergie totale. To study the association between breakfast consumption and obesity. A cross-sectional study was conducted among 284 Algerian adults. The breakfast consumption and composition were assessed by the 24-hour recall repeated on three times. Breakfast consumers were defined as having consumed 300 Kcal and more in this meal. Anthropometric measurements included weight and height. Our population counts 46.5% men and 53.5% women. A total of 62.3% of adults were overweight, including 25.4% having obesity. Over half of the population (54.2%) ate breakfast. It usually consisted of a cereal product, a dairy product and a sweet product accompanied by coffee or tea. No significant difference was observed between the prevalence of obesity in breakfast consumers and non-consumers. No correlation was found between BMI and energy intake at breakfast. Non-consumers of breakfast had a higher total energy intake excluding breakfast than breakfast consumers. In our study, skipping breakfast does not appear to be related to obesity. Rather, it appears to be related to an excess in total energy. [ABSTRACT FROM AUTHOR]

Le tissu adipeux est modifié en quantité et qualité au cours de l'obésité : hypertrophie des adipocytes, diminution de leur expansibilité et fibrose, productions de cytokines et adipokines proinflammatoires, infiltration inflammatoire par des macrophages pro-inflammatoires M1, des lymphocytes T. Ainsi, l'excès de tissu adipeux et l'obésité sont associés à une inflammation de bas grade qui peut aggraver les pathologies inflammatoires chroniques, impacter l'effet des traitements, l'apparition des comorbidités et le développement de la maladie à sa phase préclinique. L'obésité augmente le risque de développer une polyarthrite rhumatoïde (PR), un psoriasis, un rhumatisme psoriasique avec un effet dose dépendant du poids. C'est aussi un facteur de moins bonne réponse aux traitements en particulier aux anti-TNF. La perte de poids induite par la chirurgie bariatrique diminue le risque de psoriasis et de rhumatisme psoriasique, et améliore l'activité de la maladie et la rémission sous traitement dans la PR. Une perte de poids d'au moins 5 % avec un régime hypocalorique améliore la réponse thérapeutique aux traitements anti-TNF dans le rhumatisme psoriasique avec un effet dose dépendant de la perte de poids. Dans la PR, l'effet bénéfique de la perte de poids au cours d'un régime hypocalorique sur l'activité de la maladie est rapporté dans quelques études observationnelles mais n'a pas été démontré dans un essai randomisé contrôlé. Le dépistage et la prise en charge de l'obésité font partie des recommandations de la SFR sur l'alimentation des patients ayant un rhumatisme inflammatoire chronique et doivent bien sûr être associés aux autres facteurs modifiables, arrêt du tabac, qualité de l'alimentation, activité physique et lutte contre la sédentarité. Adipose tissue is altered in quantity and quality during obesity: hypertrophy of adipocytes, decrease in expandability and fibrosis, production of proinflammatory cytokines and adipokines, inflammatory infiltration by pro inflammatory macrophages M1, T lymphocytes. Thus, excess adipose tissue and obesity are associated with low-grade inflammation that can aggravate chronic inflammatory diseases, decrease the treatment efficacy, the development of comorbidities, and of the disease in its preclinical phase. Obesity increases the incidence of rheumatoid arthritis (RA), psoriasis, psoriatic arthritis with a weight dose effect. It is also predictor of poorer response to treatments, in particular TNF inhibitors. Weight loss induced by bariatric surgery decreases the risk of psoriasis and psoriatic arthritis, and improves disease activity and remission in RA. A weight loss of at least 5% with a hypocaloric diet improves the response to TNF inhibitor in psoriatic arthritis with a dose-dependent effect of weight loss. In RA, the beneficial effect of weight loss during a hypocaloric diet on disease activity has been reported in a few observational studies but has not been demonstrated in a randomized controlled trial. Screening and management of obesity are part of the dietary recommendations of the French Society for Rheumatology in patients with chronic inflammatory rheumatic diseases and should of course be associated with others modifiable lifestyle factors such as smoking, quality of food, physical activity and sedentary lifestyle. [ABSTRACT FROM AUTHOR]

Meta-inflammation is a pathological aspect of immunometabolism disturbances in obesity. This inflammatory state is promoted by inflammatory cytokine overexpression partially related to the toll-like receptor 4 pathway. Here, we assessed the direct effects of exercise (in the absence of body fat changes) on serum cytokine concentration by constructing a short-term exercise training intervention among overweight/obese subjects. Thirty young inactive females were allocated to two groups: the inactive group (IG, continued their inactive lifestyle, n = 15) and the active group (AG, participated in two weeks combined high-intensity interval training, n = 15). Before and after the intervention, serum cytokines' concentration was measured by ELISA technique. The body composition parameters did not significantly change in both groups. Interleukin (IL)-10 levels were increased significantly in comparison with both pre-testing (P = 0.008) and IG (P = 0.007) values. Also, there was a significant decrease in tumor necrosis factor-α levels compared to IG (P = 0.05). No statistically significant changes (P > 0.05) were found in interferon (IFN)-γ (Δ% = −20.41), pentraxin 3 (Δ% = −13.57), and fibroblast growth factor 21 (FGF21) (Δ% = 24.02). However, FGF21 changes revealed a significant positive correlation with IL-10 (r = 0.65) and a significant negative correlation with IFN-γ (r = 0.58). Although our exercise training protocol reduced the TLR4 activities and induced an anti-inflammatory environment, this impact seems to be not related to body fat changes, indicating the direct immunomodulatory impact of exercise. More interventions are needed to evaluate the clinical implications of crosstalk between skeletal muscle, liver, adipose tissue, and inflammatory response. [ABSTRACT FROM AUTHOR]

Évaluer, sur la population des enfants et des adolescents, la validité d'un modèle de cercle vicieux de la stigmatisation de l'obésité qui, dans une compréhension psychopathologique, inclut les concepts de dépression et d'alimentation émotionnelle. Revue de question répertoriant les études publiées dans PubMed et PsychINFO avant 2005, portant sur des participants âgés de moins de 18 et incluant les différents facteurs du modèle (stigmatisation, dépression, alimentation émotionnelle et obésité). Dans l'état actuel des publications, le modèle n'a pas été validé dans sa globalité, notamment concernant le lien entre alimentation émotionnelle et d'une part la dépression, d'autre part la prise de poids. Cependant, l'existence d'une association bidirectionnelle « stigmatisation × obésité » a été confirmée. Cette association semble en partie médiée par des manifestations dépressives. Des études longitudinales doivent être entreprises afin de vérifier le rôle de l'alimentation émotionnelle dans le modèle. La santé mentale des enfants et des adolescents apparaît comme un facteur de risque de perpétuation du surpoids ou de l'obésité. Le phénomène de stigmatisation des enfants et adolescents de forte corpulence doit être une préoccupation centrale en termes de prévention et de prise en charge. To assess the validity of a vicious circle model of obesity stigma in the child and adolescent population that includes the concepts of depression and emotional eating in a psychopathological understanding. A review of studies published in PubMed and PsychINFO prior to 2005, involving participants under 18 years of age and including the different factors of the model (stigma, depression, emotional eating and obesity). In the current state of the literature, the model has not been validated in its entirety, particularly concerning the link between emotional eating and depression on the one hand and weight gain on the other. However, the existence of a bidirectional association "stigma × obesity" has been confirmed. This association seems to be partly mediated by depressive manifestations. Longitudinal studies should be undertaken to verify the role of emotional eating in the model. The mental health of children and adolescents appears to be a risk factor for the perpetuation of overweight or obesity. The phenomenon of stigmatization of overweight children and adolescents must be a central concern in terms of prevention and management. [ABSTRACT FROM AUTHOR]

This narrative review is aimed at presenting recent evidence on the association between two widespread, chronic, and growing diseases in childhood: attention-deficit/hyperactivity disorder (ADHD) and obesity. Several hypotheses have been put forward about the correlations between the two conditions, concerning prenatal, perinatal and postnatal factors. We approached this topic through a search of recent literature on this subject, from the perspective of a child psychiatrist, a specialist in child development with an integrative view of the various factors involved in the onset, development and maintenance of a pathological condition, as well as a clinical approach, directed at addressing these factors in a combined manner. The most important point that emerged from our research and to be considered, as a child mental health specialist, seems to maintain an integrated view of the etiology and the management of mental disorders, through an integrative approach. [ABSTRACT FROM AUTHOR]

The effectiveness of endurance training at low to moderate intensities targeted at the level of maximal lipid oxidation (LIPOXmax) is confirmed by recent international work. It may seem paradoxical, given the low level of caloric expenditure involved. One of the explanations for this paradox is that LIPOXmax training has epigenetic effects and regulatory effects on eating behavior. Indeed, exercise at this level favors satiety and reduces the urge to snack, whereas at higher intensity, in the lipid oxidation zone, 30 to 60 minutes of endurance exercise favors food intake and may determine a paradoxical weight gain. In our previously published database of 3739 calorimetries we have recalculated the kinetics of the lipid/carbohydrate oxidation ratio and we observe that it peaks on average 12% below LIPOXmax (39.45% ± 0.20% vs. 44.87% ± 0.23% VO2max; P < 0.0001) at a level we propose to call "optimal level of fat/carbohydrate oxidation ratio" (OLORFOX) and that this level may present in many cases wide inter-individual variations, so that there are profiles of subjects in whom it is frankly disjointed from that of LIPOXmax. A preliminary series of 11 patients with this profile who were trained at OLORFOX confirms that this approach over 3 years is effective for weight loss (−11.5 ± 1.5% of initial weight P < 0.001), even though this level is set below the LIPOXmax which is itself located at a low to moderate intensity. These preliminary data lead us to study more widely this type of targeting of training in overweight individuals. [ABSTRACT FROM AUTHOR]

The major problem in the management of obesity is the weight gain that occurs after all treatments currently employed. Regular physical activity remains the most effective measure to stop this weight gain. Among the types of training offered, endurance at low to moderate intensities targeting the level of maximum lipid oxidation (LIPOX max) is one of the easiest to implement and seems to stand out for its unexpected long-term effectiveness on fuel metabolism, eating behavior, and body composition. Our objectives in this study were to investigate the effect of this type of exercise on body composition after prolonged follow-up over 8 years. We continued to follow the cohort presented in our previous works showing the effectiveness at 1 year, 2 years, 3 years and 6 years of this training. In this non-randomized longitudinal study, the subjects were trained with LIPOXmax (3 × 45 min/week at home with regular follow-up, after induction in a hospital environment) with exercise calorimetry and segmental bioelectrical impedance which were carried out at the beginning and at the 104th month. 8-year extended follow-up results are available for 10 subjects. Over the 8 years of follow-up, subjects lost on the average a maximum of -13.73 ± 2.63 kg (P < 0.0002) of body weight (i.e. −14.50 ± 2.06 of the initial weight or −69.81 ± 9.53% of the excess weight) and at 96 months their weight is maintained −9.08 ± 2.31 kg below the initial weight (i.e. −9.53 ± 1.86% of the initial weight or 45.07 ± 8.94% of the excess weight). Body composition analysis performed at the end of the 8th year shows that this corresponds to −9.51 ± 2.74 kg (P < 0.001) of fat and −2.23 ± 0.67 kg (P < 0.02) of non-muscular lean mass while the muscle mass remains statistically unchanged. The waist circumference decreases (−5.54 ± 1,96 cm P = 0.015) but not the hip circumference. The maximum ability to oxidize lipids has increased (P < 0.001) and especially if expressed by units of muscle mass (+96% P = 0.0005). There is also a decrease in diastolic blood pressure (−14.44 + 4.58 mmHg P < 0.02) and mean blood pressure (P < 0.02). The follow-up of this cohort is still in progress but it confirms the prolonged effectiveness of endurance training targeted at the LIPOXmax over a period of at least 8 years. At this time, we observe that this weight loss affects the different components of fat mass (truncal and appendicular) but also lean mass only in its non-muscular component. The beneficial effects noted at 2 years on blood pressure and on muscle's ability to oxidize lipids during exercise is still observed at 8 years. [ABSTRACT FROM AUTHOR]

L'hypertension intracrânienne idiopathique est caractérisée par une augmentation de la pression intracrânienne, dont la nature est indéterminée. Cette maladie se manifeste par des troubles visuels, des céphalées, des acouphènes pulsatiles, qui peuvent avoir de profondes répercussions sur la qualité de vie, en plus d'entrainer un handicap visuel irréversible dans certains cas. Les femmes obèses en âge de procréer représentent la population de prédilection, et l'incidence augmente avec la prévalence croissante de l'obésité dans le monde. Un déséquilibre des taux d'hormones sexuelles est également décrit comme un facteur de risque. La physiopathologie, désormais mieux connue, implique une perturbation des voies d'évacuations des liquides intracrâniens causée par l'augmentation de la pression veineuse intracrânienne. L'imagerie cérébrale est utile pour le diagnostic en recherchant différents signes dont la sténose bilatérale des sinus transverses qui joue un rôle majeur dans la pathogénèse de la maladie en créant une boucle de rétroaction positive qui majore l'hypertension veineuse intracrânienne et contribue aux manifestations cliniques. Le traitement a pour but de soulager les symptômes et de prévenir une atteinte visuelle permanente. Les thérapies médicamenteuses, dont l'acétazolamide et le topiramate ont une efficacité modérée. Parmi les traitements invasifs, le stenting des sinus transverses apparait comme la proposition la plus intéressante à considérer, chez les patients résistants au traitement médicamenteux. La perte de poids reste primordiale pour espérer une amélioration durable en agissant synergiquement par réduction de la pression veineuse centrale. De futurs essais randomisés sont attendus pour aboutir à un consensus sur cette prise en charge. Clinical features include visual disturbances, headaches, and pulsatile tinnitus that can be associated with reduced quality of life, and a risk of irreversible visual impairment in some cases. Obese women of childbearing age represent the main at-risk population, and the incidence of the disease is increasing because of rising prevalence of obesity worldwide. In addition, an imbalance in sex hormones is reported as a contributing risk factor. The pathophysiology of idiopathic intracranial hypertension involves a disturbance of the evacuation pathway of intracranial fluids caused by the increase in intracranial venous pressure. Brain imaging is useful for diagnosis with several signs including bilateral stenosis of the transverse sinuses that plays a major role in the pathogenesis of the disease by creating a positive feedback loop that increases intracranial venous hypertension and contributes to clinical manifestations. Treatment aims to relieve symptoms and prevent permanent visual impairment. Drug therapies including acetazolamide and topiramate have moderate effectiveness. Among invasive treatments, transverse sinus stenting seems to be the most interesting option to consider in drug-resistant patients. Weight loss remains essential to achieve a sustainable improvement by reducing central venous pressure. Future randomized trials are expected to reach a consensus on this treatment. [ABSTRACT FROM AUTHOR]

L'évolution des technologies de santé connectée dans la prise en charge du surpoids et de l'obésité nécessite de mieux connaître les raisons pour lesquelles certains patients adhèrent et d'autre pas. Les objectifs de cette revue des revues systématiques sont d'examiner comment l'adhésion aux interventions de santé connectée dans la gestion du poids est conceptualisée et d'identifier les facteurs qui influencent l'adhésion et comment ils l'influencent. Sept revues systématiques publiées entre 2010 et 2022 ont été incluses. Les définitions et les mesures de l'adhésion ainsi que les conceptions de l'intervention sont très hétérogènes dans la littérature existante, ce qui rend difficiles les conclusions sur les réels niveaux d'adhésion. Quatre composantes ont été identifiées comme favorisant l'adhésion aux interventions de gestion de poids auprès de patients en situation de surpoids ou d'obésité : (1) l'auto-surveillance dont la facilité et la rapidité d'emploi lui confèrent un bon niveau d'adhésion ; (2) l'entretien motivationnel avec une relation soignant-patient via la vidéo ou le téléphone qui favorise l'adhésion ; (3) la thérapie comportementale demandant surtout des échanges fréquents, au mieux hebdomadaires ; (4) et la personnalisation qui doit être effective tout au long de l'intervention pour rester pertinente au regard des objectifs du patient. Cependant, la complexité des phénomènes impliqués dans l'obésité impose une analyse plus fine de l'adhésion qui ne se focalise pas simplement sur l'outil, mais qui importe également de prendre en considération leurs appropriations dans des contextes variés et donc de l'étudier du point de vue des utilisateurs. The evolution of eHealth technologies in the management of overweight and obesity requires a better understanding of the reasons why some patients are engaged, and others are not. The objectives of this review of systematic reviews are to examine how adherence to eHealth interventions in weight management is conceptualized, to identify which factors influence adherence, and how they influence it. Seven systematic reviews published between 2010 and 2022 were included. Definitions, measures of adherence and intervention designs are highly heterogeneous in the existing literature, making it difficult to draw conclusions about actual adherence levels. Four designs have been identified as promoting adherence to weight management interventions with adult patients who are overweight or obese: (1) self-monitoring which ease and speed of use give a good level of adherence; (2) motivational interviewing with a caregiver-patient relationship via video or phone that promotes adherence; (3) behavioral therapy requiring especially frequent exchanges at best weekly; (4) and personalization that must be effective throughout the intervention to remain relevant to the patient's goals. However, the complexity of the phenomena involved in obesity requires a more detailed analysis of adherence that does not only focus on the tool, but also considers the point of view of the users and their appropriation in various contexts. [ABSTRACT FROM AUTHOR]

Beyond somatic consequences, excess weight affects quality of life. In the literature this has markedly improved in the first 6 months, but has decreased later. The originality of our work in that is based on the comparison of two groups of patients, surgical and non-surgical ones, monitored by a multi-professional team for 3 years. The sample is comprised of 32 subjects divided into two groups: 17 subjects from the non-surgical pathway and 15 from the surgical one. The Quality of Life, Obesity, and Dietetics questionnaire (QOLOD), the Hospital Anxiety and Depression Scale (HADS) and the Dutch Eating Behaviour Questionnaire (DEBQ), age, BMI, and sex were recorded. At baseline, age was significantly different between two groups (surgery vs. non-surgery). BMI and QOLOD improvement were significantly more important in surgical group (−13.6 kg [−19.2; −10.8] vs. 0.0 kg [−2.8; 3.0] P < 0.001 and 16.9 [8.5; 32.2 vs. 2.1 [−9.4; 16.2], P = 0.004). The progression of the QOLOD score correlated negatively with the progression of BMI (r = −0.5, P = 0.005) There is a link between post-surgery weight loss and improved quality of life at 36 months. We suggest a qualitative follow-up survey for surgical and non-surgical obese patients. [ABSTRACT FROM AUTHOR]

To determine the resting energy expenditure (REE) in Chinese adults using indirect calorimetry (IC), and evaluate the validity of published predictive equations for estimating REE in overweight and obese subjects comparing to IC. 181 subjects with different body mass index (BMI) were recruited. Body composition was determined by bio-electrical impedance analysis (BIA). REE was measured by IC and estimated by 29 REE prediction equations to analyze the accuracy of REE prediction equations. For all participants combined, the Bernstein et al. and Bernestin et al. (BC) equations similarly predicted REE values between -4% and 8% (P > 0.05) of measured REE. When participant data were stratified by sex, BMI, the accuracy of each regression equation is different. In male overweight and obese group, the highest accuracy of the Bernestin et al. (BC) was 65.5% and 70.4%. In female overweight and obese group, the highest accuracy of the Bernestin et al. (BC) and Bernestin et al. was 79.6% and 69.4%. The Bernestin et al. (BC) was closest to IC in male overweight/obese and female overweight, and the Bernestin et al was closest to IC in female obese. However, because those equations have shown considerable variability, they should be used cautiously when estimating the individual REE. When the IC method cannot be used, the Bernestin et al. (BC) and Bernestin et al are more accurate. [ABSTRACT FROM AUTHOR]

L'obésité est une pathologie complexe multifactorielle considérée comme une maladie des centres régulateurs du poids. La contribution de la génétique est constante mais son impact est variable selon les situations allant des obésités génétiques de cause rare (environ 5 % des obésités) aux situations d'obésité dite polygénique (ou obésité commune) plus souvent rencontrées (95 % des cas). D'autres facteurs (déterminants précoces pré- et post-nataux, sociétaux ou psychologiques) interagissent toujours étroitement avec ces facteurs génétiques expliquant la grande variabilité du phénotype et la physiopathologie complexe. Un véritable continuum existe entre toutes ces situations via l'implication de variants génétiques plus ou moins rares situés dans des gènes codant pour des protéines clé de la régulation centrale de la prise alimentaire. Cette meilleure compréhension des mécanismes a permis de mieux préciser les phénotypes associés et d'aboutir depuis quelques années à des innovations thérapeutiques ciblant ces gènes-clé. Cette évolution permet d'envisager à moyen terme le développement d'une véritable médecine personnalisée dans l'obésité précoce associant des traitements médicamenteux ciblés selon l'anomalie génétique identifiée et/ou une prise en charge globale multidisciplinaire ciblée selon le phénotype du patient voire le recours à la chirurgie bariatrique selon les situations cliniques. Obesity is a complex, multifactorial disease due to a dysfunction of the hypothalamic control of weight and food intake. The contribution of genetics is constant, but its impact is variable depending on the situations ranging from rare genetic obesities (around 5% of cases) to more frequently polygenic obesity (or common obesity) (95% of cases). Other factors as pre- and post-natal, societal or psychological determinants always interact closely with these genetic factors explaining the high variability of the phenotype and the complex pathophysiology. A true continuum exists between all these situations through the involvement of more or less rare genetic variants located in genes encoding key proteins in the central regulation of food intake. Rare forms of obesity are characterized by their common phenotype including a very early-onset severe obesity (BMI Z score greater than + 3 SD early before the age of 3 years) with resistance to medical treatment, and major eating disorders characterized by difficulties in voluntary control of food intake. Central endocrine abnormalities such as hypogonadotropic hypogonadism or GH deficiency for example, and metabolic abnormalities due to abnormal adipose tissue distribution are also associated with variable degrees (Alström syndrome for example). Neuropsychological abnormalities are also present such as neurodevelopmental disorders (intellectual disability with variable intensity and/or adaptive development disorders which are part of many syndromes such as in Prader-Wili Syndrome; autism spectrum disorders (in SH2B1 or MYT1L deficiency for example), cognitive disorders with difficulties in emotional regulation (eg: Bardet-Biedl Syndrome or specific rare variants located on genes of the melanocortin pathway), behavioral or psychiatric disorders, sleep disorders and major hypothalamic dysfunctions (eg: Prader-Willi Syndrome, Smith Magenis syndrome). This better understanding of the mechanisms has made it possible to better precise the associated phenotypes and, recently, to lead to therapeutic innovations targeting these key genes. This evolution helps to quickly envisage the development of a real personalized medicine in early onset obesity using the combination of drug treatments targeted according to the identified genetic anomaly and/or a multidisciplinary global approach targeting the patient's phenotype or even the bariatric surgery in specific situations. [ABSTRACT FROM AUTHOR]

Les auteurs s'intéressent à la problématique de l'obésité sévère, notamment au fonctionnement psychique sous-jacent des patients en demande de chirurgie bariatrique. Ils proposent une comparaison interculturelle entre la France et la Turquie en questionnant l'implication de la culture dans la psychogénèse de cette maladie chronique. Ils présentent les résultats d'un premier volet exploratoire qualitatif, par l'analyse comparée de deux cas cliniques, représentatifs de chacun des deux pays. Cette analyse s'appuie sur des entretiens cliniques, des autoquestionnaires et sur le test de Rorschach. Cette comparaison culturelle montre que les deux cas cliniques représentatifs ont des antécédents de vie difficiles et traumatiques, souvent d'origine infantile. Ces événements conduisent à des difficultés de mentalisation des affects, constatés lors des entretiens cliniques, des autoquestionnaires et de la passation du test de Rorschach. Ainsi, l'impossibilité de ce travail de transformation psychique conduit à des Troubles des Conduites Alimentaires (TCA). Ces premiers résultats invitent à poursuivre la construction et la validation d'un modèle transculturel de l'obésité sévère, permettant dans l'avenir de proposer des recommandations internationales pour la prise en charge psychologique de cette maladie chronique, particulièrement lors d'une chirurgie bariatrique. The authors are interested in the problematic of severe obesity, particularly in the underlying psychic function of patients who seek bariatric surgery. They propose an intercultural comparison between France and Turkey by questioning the implication of culture in the psychogenesis of this chronic disease. They represent the results of a first qualitative exploratory section, by the comparative analysis of two clinical cases which are representatives of each of the two countries. This analysis is based on clinical interviews, self-questionnaires and Rorschach Test. This cultural comparison shows that two representative clinical cases have antecedents with difficult and traumatic life experiences, mostly based on infancy background. These incidents lead to difficulties of mentalization of affects as it is occurred during the clinical interviews, the self-questionnaires and the process of Rorschach Test. Therefore, the impossibility of this work of psychic transformation leads to Eating Disorders. These initial results call for further construction and validation of a cross-cultural model of severe obesity, allowing in the future to propose international recommendations for the psychological treatment of this chronic disease, especially during bariatric surgery. [ABSTRACT FROM AUTHOR]

En 40 ans l'obésité infanto-juvénile a été multipliée par dix. Les personnes souffrant d'obésité présentent une altération de la représentation corporelle et un décalage entre leur corps réel et leur corps perçu. Une des explications avancées par les neurosciences serait la difficulté d'intégration et de traitement de l'information sensorielle, notamment d'une réduction de la sensibilité intéroceptive. Peu d'études ont été menées chez les adolescents, bien qu'il soit suggéré qu'un mécanisme intéroceptif atypique soit positivement associé à l'apparition de psychopathologies et d'une diminution de compétences socio-émotionnelles à l'âge adulte. Nous présentons ici les premiers résultats d'une recherche qualitative qui explore la dimension expérientielle de l'intéroception vécue par les adolescents présentant une obésité dans un contexte d'hospitalisation et évalue les facteurs d'influence principaux de la conscience de soi intéroceptive : l'anxiété et la douleur. Recherche qualitative exploratoire. T0 (30 min) : Evaluations initiales : échelle d'autoévaluation de l'anxiété (échelle STAIC), échelle visuelle analogique de la douleur (échelle EVA) et échelle d'autoévaluation multidimensionnelle de la conscience de soi intéroceptive (auto-questionnaire MAIA). T1 et T2 (60 min) : réalisation de trois poses simples de 1 min chacune (T1) alternées par un entretien de type explicitation explorant le vécu intéroceptif (T2). Les premiers résultats de cette étude mettent en évidence les points suivant : i) la sévérité de l'obésité n'est pas positivement associée au niveau de conscience intéroceptive, ii) la corrélation des facteurs d'influence (douleur et anxiété) et de la conscience de soi intéroceptive perçue est faible, iii) la catégorisation thématique selon les huit critères intéroceptifs définis par Mehling souligne chez les participantes : 1/la capacité d'identifier ses perceptions corporelles par la majorité d'entre elles, 2/la capacité inégale à maintenir un niveau d'attention sur le corps dans son entier, 3/la capacité à ne pas s'inquiéter des sensations d'inconfort est influencée par l'hyper-rationalisation ou la négation des perceptions, 4/la respiration apparait comme le levier le plus facilement mobilisable pour réguler l'attention, 5/les liens entre les perceptions corporelles et les émotions ressenties sont influencés par la rationalisation, l'expérience corporelle ou un fléchissement thymique, 6/l'autorégulation est influencée par l'expérience corporelle qui permet une prise de conscience et un réajustement postural, 7/l'écoute du corps est influencé par le transfert de pratiques corporelles passées, 8/La notion de confiance dans ses perceptions corporelles n'est pas toujours bien comprise et n'est pas en lien avec la capacité des sujets à identifier leurs manifestations internes ; la confiance perçue est liée au niveau de rationalisation et peut être renforcée par la pratique posturale. Comme rapporté dans la littérature, le niveau intéroceptif des patientes interrogées est globalement bas sur les échelles d'évaluations, mais il apparaît que les données chiffrées du MAIA ne révèlent pas toujours la réalité perçue du soi corporel des adolescentes interviewées et que l'accompagnement des participantes dans l'explicitation de leur expérience corporelle révèle une dimension intéroceptive beaucoup plus large. Nous qualifions ce champ exploratoire guidé de zone proximale intéroceptive ou zone de pré-conception intéroceptive. Nous suggérons qu'une meilleure compréhension des mécanismes intéroceptifs vécus par les personnes présentant une obésité permet d'accompagner les patients dans une dimension expérientielle plus sécure de leur corps. Les recherches futures devraient enrichir cette perspective qualitative de l'intéroception et ouvrir des dimensions plus incarnées du soin. Childhood obesity has increased tenfold over the past 40 years. People with obesity present alterations of their bodily perceptions and a discrepancy between their actual body and their perceived body. One of the explanations advanced by neuroscience is the difficulty of integrating and processing sensory information, particularly the interoceptive interformation. There has been little research on this question in adolescent populations, although it is suggested that an atypical interoceptive mechanism is positively associated with the onset of psychopathologies and decreased socio-emotional skills in adulthood. We present here the first results of a qualitative research study that explores the experiential dimension of interception by obese adolescent girls in a hospitalization context and that assesses the main factors that influence interoceptive self-awareness: anxiety and pain. Exploratory qualitative research. T0 (30 min): Initial assessments: State trait anxiety Inventory for Children (STAIC Scale), visual analog scale for pain and Multidimensional Assessment of Interoceptive Awareness (MAIA Self-Questionnaire). T1 and T2 (60 min): perform three simple poses, each 1 min (T1) alternated with an explanatory interview exploring the interoceptive experience (T2). The first results of this study highlights that: i) the severity of obesity is not positively associated with the level of interoceptive awareness; ii) the correlation of influencing factors (pain and anxiety) and the level of awareness interoceptive is weak; iii) the thematic categorization according to Mehling's eight interoceptive criteria demonstrates, for the participants: 1/the ability to identify their bodily perceptions by the majority of them; 2/the uneven capacity to maintain a level of attention on the body in its ensemble; 3/the ability not to worry about feelings of discomfort is influenced by hyper-rationalization or the negation of perceptions; 4/breathing appears to be the most mobilized lever to regulate attention; 5/the links between bodily perceptions and felt emotions are influenced by rationalization, bodily experience, or mood decline; 6/self-regulation is influenced by bodily experience, which enables awareness and postural readjustment; 7/listening to the body is influenced by the transfer of past bodily practices; 8/the notion of confidence in one's bodily perceptions is not always well understood and is not related to subjects' ability to identify their internal manifestations, while perceived confidence is related to the level of rationalization and can be improved through postural practice. As reported in the literature, the interoceptive level of patients interviewed is generally low on the rating scales, but it appears that the MAIA results do not always reveal the perceived reality of body-self of the adolescent girls interviewed; guiding the participants in explaining their bodily experience reveals a much greater interoceptive dimension. We qualify this guided field of exploration as an interoceptive proximal zone or an interoceptive preconception zone. We suggest that a better understanding of the interoceptive mechanisms experienced by obese people helps guide patients towards a safer experiential dimension of their body. Future research should enrich this qualitative perspective of interoception and open up more embodied dimensions of care. [ABSTRACT FROM AUTHOR]

La généralisation des interventions de chirurgie bariatrique a entrainé ces dernières années une explosion de la demande pour les chirurgies de séquelles d'amaigrissement. Ces opérations peuvent être source de complications post-opératoires, et l'obésité résiduelle, définie par un IMC ≥ 30 est classiquement considérée comme une contre-indication relative. L'objectif est d'étudier l'influence d'un IMC ≥ 30 sur la survenue de complications post-opératoires. Une étude rétrospective a été menée sur l'ensemble des patients ayant bénéficié d'une chirurgie pour leurs séquelles d'amaigrissement entre 2014 et 2020 au Centre hospitalier d'Arras. Les taux de complications majeures ont été comparés chez les patients obèses et les non-obèses. Deux cent vingt-trois patients ont été inclus, représentant un total de 247 interventions chirurgicales : 124 dans le groupe IMC < 30 et 123 dans le groupe IMC ≥ 30. Seize interventions ont été suivies d'au moins une complication majeure, soit 6 dans le groupe I contre 10 dans le groupe II (RR = 1,7 (0,6–4,5), NS, p = 0,29). Il n'y avait donc pas significativement plus de complications majeures chez les patients obèses. L'incidence des complications majeures dans les suites des chirurgies de séquelles d'amaigrissement n'est pas modifiée par la présence d'un IMC supérieur à 30, moyennant un geste précautionneux et adapté à chaque patient. L'IMC n'est donc pas un critère suffisant pour contre-indiquer ce type de chirurgie. The generalization of bariatric surgery interventions has led in recent years to an explosion in demand for body contouring surgeries. These operations can be followed by postoperative complications; and residual obesity, defined by a BMI ≥ 30, is traditionally considered as a relative contraindication. The objective is to study the influence of a BMI ≥ 30 on the risk of postoperative complications. A retrospective study was conducted on all patients who underwent body contouring surgery between 2014 and 2020 at the Arras Hospital Center. Major complication rates were compared in obese and non-obese patients. Two hundred twenty-three patients were included, representing a total of 247 surgeries: 124 in the BMI < 30 group and 123 in the BMI ≥ 30 group. Sixteen surgeries were followed by at least one major complication, 6 in group I versus 10 in group II (RR = 1.7 (0.6–4.5), NS, P = 0.29). Therefore there were not significantly more major complications in obese patients. The incidence of major complications following body contouring surgeries is not modified by the presence of a BMI greater than 30, subject to a precautionary procedure adapted to each patient. BMI is therefore not a sufficient criterion to contraindicate this type of surgery. [ABSTRACT FROM AUTHOR]

L'obésité est un fléau social. L'hypertension artérielle masquée (HTAM) est une entité de description relativement récente qui pose un problème de diagnostic. Le but de cette étude était de déterminer les caractéristiques cliniques et paracliniques de ces patients, et identifier les facteurs prédictifs de l'HTAM. Il s'agit d'une étude prospective incluant des patients obèses normo-tendus en mesure clinique. Tous ces patients ont bénéficié d'une mesure ambulatoire de la pression artérielle (MAPA) pour dépister une HTAM, une exploration biologique et une étude échocardiographique avec étude des déformations myocardiques. Nous avons recruté 50 patients dont l'âge moyen était de 46,52 ± 10,4 ans. Le recueil des chiffres tensionnels en consultation avait montré une pression artérielle systolique (PAS) moyenne de 120, 8 ± 8,8 mmHg et une PA diastolique (PAD) moyenne de 75 ± 7,3 mmHg. La prévalence d'HTAM chez les adultes obèses était de 36 % avec un profil majoritairement non dippers (38 %). L'étude des paramètres échocardiographiques a retrouvé que l'oreillette gauche (OG) était dilatée chez 16 patients (32 %). Le ventricule gauche (VG) était hypertrophié chez 32 patients (64 %). Le strain longitudinal global (SLG) du VG était en moyenne de −18,85 ± 0,9 % et le SLG de l'OG était en moyenne de 37,35 ± 4,5 %. Dans notre étude, le syndrome métabolique, des taux de HDL cholestérol bas, une glycémie à jeun élevée, une hyperuricémie, une dilatation de l'OG, une hypertrophie ventriculaire gauche, une dysfonction diastolique du VG et une altération des déformations myocardiques étaient des facteurs associés à une HTAM chez les adultes obèses. Il paraît primordial de réaliser un dépistage de l'HTA par une mesure ambulatoire chez les patients obèses à risque qui présenteraient des facteurs associés à l'HTAM. La morbi-mortalité induite et le risque cardiovasculaire seraient non négligeables et le justifie pleinement. Obesity is a worldwide health problem. Masked hypertension is a relatively recent reported entity with a diagnostic problem. The aim of this study was to determine the clinical and paraclinical characteristics and to identify the predictive factors of masked hypertension in obese patients. It is a prospective study including obese patients with normal arterial pressure at office. All of these patients were given ambulatory blood pressure measurement (ABPM) to screen for masked hypertension, laboratory tests and a complete echocardiography study. A total of 50 patients were included. The mean age was 46.52 ± 10.4 years. The mean systolic blood pressure (BP) at office was 120.8 ± 8.8 mmHg and the mean diastolic BP was 75 ± 7.3 mmHg. The prevalence of masked hypertension in obese adults was 36% with a predominantly non-dipper profile (38%). The study of echocardiographic parameters found dilated left atrium (LA) in 16 patients (32%). The left ventricle (LV) was hypertrophied in 32 patients (64%). The overall LV global longitudinal strain (GLS) was on average −18.85 ± 0.9% and the LA GLS was on average 37.35 ± 4.5%. In our study, metabolic syndrome, low HDL cholesterol, elevated fasting blood glucose, hyperuricemia, LA dilatation, LV hypertrophy, diastolic LV dysfunction and altered myocardial deformities were factors associated with masked hypertension in obese adults. It is important to screen for hypertension by ambulatory measurement in at-risk obese patients who present associated cardiovascular risk factors to reduce morbidity and mortality. Echocardiography and speckle tracking analysis could be helpful in detection sub-clinical myocardial deterioration in obese patients with masked hypertension. [ABSTRACT FROM AUTHOR]

The aim of our study was to evaluate the prevalence of obesity and overweight and their determinants among a sample of youth and adults with Down syndrome (DS) in Morocco. A retrospective survey conducted between 2014 and 2017 based on a standardized questionnaire, addressed to the parents of 264 children, adolescents and adults with DS aged from 2 to 40 years old. The classification of corpulence in children and adolescents was determined according to the WHO (2007). Chi2 (χ2) and Mann–Whitney tests were used for testing statistical significance. The overweight rate was 2 times higher in males than in females (31.7% and 16.0%, respectively). While the obesity was more than 2.5 times higher in females than in males (29.0% and 11.5%, respectively). Binary logistic regression analysis showed that none of the factors studied (sex, age, family socioeconomic level, parent's level of education, number of meals per day, physical activity) was risk factor for obesity in our population, except the behavior of eating in the absence of hunger (OR = 4.99; 95% CL: 2.51–9.90; P < 0.0001). Overweight and obesity can be considered as factors of over-handicap for this population; hence, the need of a nutritional and physical activity approach must be added to the medical and paramedical care of individuals with DS. [ABSTRACT FROM AUTHOR]

To evaluate the impact of obesity on the control and the severity of asthma in a Tunisian population. It was a retrospective, descriptive and analytic study, including asthmatic patients regularly followed up in the pulmonology department of Charles Nicolle's hospital of Tunis, during 18 months (January 2016 to June 2017). Data were collected from medical records, including characteristics of asthma and nutritional status based on body mass index. Out of the 170 included patients, 126 (74%) were women. They had an average BMI of 28.6 kg/m2 ± 5.8 (17 to 54.5 kg/m2). Obesity was present in 32.9% of patients. Asthma was well controlled in 56% of cases and no controlled in 37%. It was classified as moderate in 48.8% and severe in 15.9%. Compared to normal weight asthmatics, obese asthmatics were more advanced (P = 0.002), mostly women (P = 0.002) and had more co-morbidities (P = 0.049). They were more symptomatic (P = 0.037) and had lower Forced Vital Capacity (P < 0.001) and lower Forced Expiatory Volume 1st second (P = 0.017). Multivariate analysis, after adjustment for age, smoking and GERD, revealed that obesity tripled the risk of uncontrolled asthma (OR = 3; 95% CI [1.2-7.6]; P = 0.019). However, asthma severity was not impacted by obesity. Despite the discrepancy of our results with those reported in the literature regarding the relationship between obesity and asthma severity, our study was able to confirm the deleterious effect of obesity on asthma control. We, therefore, emphasize the importance of taking account of obesity and its management, especially in patients with poorly controlled asthma. [ABSTRACT FROM AUTHOR]

Décrire l'évolution du syndrome métabolique et de ses différents composants, six mois et un an après sleeve gastrectomie. Il s'agit d'une étude prospective menée auprès de 40 patients obèses (7 hommes et 33 femmes) ayant bénéficié d'une sleeve gastrectomie entre 2016 et 2018. Les données cliniques et biologiques ont été recueillies avant l'intervention, à six mois et un an après chirurgie. Le syndrome métabolique a été défini en se référant aux critères diagnostiques de la fédération internationale du diabète émises en 2009. L'insulinorésistance a été évaluée suivant la méthode HOMA (homeostasis model assessment) et définie par un indice de HOMA-IR ≥ 2,4. L'âge moyen était de 34,6 ± 8,2 ans. L'indice de masse corporelle (IMC) moyen était de 50,2 ± 8,3 kg/m2. La fréquence du syndrome métabolique est passée de 67 % (27 patients) avant l'intervention à 12 % (5 patients) après six mois (p < 0,05) et à 7 % (3 patients) une année après la SG (p < 0,05), soit un taux de rémission de 89 %. La fréquence de l'insulinorésistance est passée de 89 % avant l'intervention à 4 % après un an (p < 0,05). Le pourcentage moyen de perte d'excès pondéral (PEP) était de 40,2 ± 14 % à six mois et de 55,8 ± 20,5 % à un an. La sleeve gastrectomie améliore significativement l'insulinorésistance et tous les composants du syndrome métabolique à court terme. Ces bénéfices métaboliques pourraient contribuer à la réduction du risque cardiovasculaire chez le sujet obèse à long terme. Describe the evolution of metabolic syndrome and its components, six months and one year after sleeve gastrectomy. It is a prospective study including 40 obese patients (7 men and 33 women) who underwent sleeve gastrectomy between 2016 and 2018. Clinical and biological parameters were collected before the intervention, at six months and one year after surgery. Metabolic syndrome has been defined according to the international diabetes federation's diagnostic criteria of 2009. Insulin resistance was assessed using the HOMA (homeostasis model assessment) method and defined by a HOMA-IR index ≥ 2.4. The mean patients' age was 34.6 ± 8.2 years. The mean body mass index (BMI) was 50.2 ± 8.3 kg/m2. The frequency of metabolic syndrome decreased from 67% (27 patients) before the intervention to 12% (5 patients) after six months (P <0.05) and to 7% (3 patients) one year after sleeve gastrectomy (P < 0.05), the remission's rate was 89%. The frequency of insulin resistance decreased from 89% before intervention to 4% after one year (P < 0.05). Mean excess weight loss (EWL) was 40.2 14% at six months and 55.8 20.5% at one year. Sleeve gastrectomy improves significantly insulin resistance and all components of the metabolic syndrome in the short-term. These metabolic benefits could contribute to the reduction of cardiovascular risk in obese subjects in the long-term. [ABSTRACT FROM AUTHOR]

Le but de notre travail est d'évaluer les effets d'un réentraînement en zone de LIPOXmax sur les paramètres anthropométriques, impédancémétriques et cardiorespiratoires chez des femmes obèses d'âge périménopausique. Soixante et une femmes obèses (IMC ≥ 30 kg/m2) ont participé au protocole de réentraînement individualisé dans la zone du LIPOXmax (40–50 % de V ⋅ O 2 max mesurée) réalisé sur ergocycle. Le protocole s'est étalé sur trois semaines à raison de trois séances par semaine. Chaque séance dure 60 mn. Le poids, l'IMC et la composition corporelle ont été évalués avant et après réentraînement. Les capacités cardiorespiratoires (V ⋅ O 2 max, FCmax, dépense énergétique liée à l'effort [DEE] et Mets) obtenues suite à un test d'effort maximal (FCmax mesurée ≥ 90 % valeur prédite) ont été évaluées avant et après réentraînement. Le protocole de réentraînement individualisé en zone de LIPOXmax a permis des changements tant sur le poids, sur la composition corporelle que sur les fonctions cardiorespiratoires. Le poids total et l'IMC ont diminué de manière significative (poids 92,97 ± 15,46 vs 95,02 ± 15 kg, p = 0,001) (IMC 37,58 ± 5,86 vs 38,66 ± 5,9 kg/m2, p = 0,002). Il y a une diminution non significative de la masse grasse (42,78 ± 10,38 vs 43,98 ± 10,25 kg, p = 0,08), mais une perte très significative de la graisse viscérale (passant de 11,77 ± 3,37 à 11,36 ± 3,35 ; p = 0,005) et une légère diminution de la masse maigre (passant de 51,56 ± 5,64 à 50,61 ± 6,2 kg p = 0,003). On a pu constater une amélioration significative du V ⋅ O 2 max (16,11 ± 3,04 vs 14,40 ± 4,46 mL/kg/mn, p = 0,001). Ce protocole peut donc être proposé afin d'initier une diminution du poids chez des sujets obèses. This study wants to assess the effects of training in the LIPOXmax zone on the anthropometric, impedancemetric and cardiorespiratory parameters in middle-age obese women. Sixty-one obese women (BMI ≥ 30 kg/m2) participated in the individualized training protocol in the LIPOXmax zone (40–50% of measured peak V ⋅ O 2) performed on Ergocycle. The protocol spanned three weeks three times a week. Each session lasts 60 mn. Weight, BMI and body composition were assessed before and after training. Cardiorespiratory capacities ([peak V ⋅ O 2 ], HRmax, Energy Expenditure [EE] and Mets), obtained following a maximum effort test (HRmax measured ≥ 90% predicted value), were evaluated before and after training. The individualized training protocol in the LIPOXmax zone allowed changes in both weight, BMI, body composition and cardiorespiratory functions. Total weight and BMI decreased significantly (weight 92.97 ± 15.46 vs. 95.02 ± 15 kg, P = 0.001) (BMI 37.58 ± 5.86 vs. 38.66 ± 5.9 kg/m2, P = 0.002). There is an insignificant decrease in body fat (42.78 ± 10.38 vs. 43.98 ± 10.25 kg, P = 0.08) with a significant loss of visceral fat (from 11.77 ± 3.37 to 11.36 ± 3.35 ; P = 0.005) and a slight decrease in fat-free mass (from 51.56 ± 5.64 to 50.61 ± 6.2 kg; P = 0.003). There was a significant improvement in peak V ⋅ O 2 (16.11 ± 3.04 vs. 14.40 ± 4.46 mL/kg/mn, P = 0.001). This protocol can thus be proposed in order to initiate a weight loss in obese subjects. [ABSTRACT FROM AUTHOR]

L'obésité, définie par un excès de masse grasse, représente un problème majeur de santé publique. Sa prévalence a fortement augmenté à l'échelle mondiale depuis la seconde moitié du XXe siècle, à tel point que l'on parle « d'épidémie » d'obésité ou encore de « globésité ». Au vu des résultats souvent insuffisamment probants des mesures physiques et nutritionnelles, l'indication de chirurgie bariatrique peut être posée dès l'adolescence pour des cas d'obésité sévère, après échec d'autres stratégies thérapeutiques. L'indication de cette chirurgie pour les patients mineurs est encadrée en France par les recommandations de la Haute Autorité de Santé publiées en 2016. Elle a pu montrer pour cette population son efficacité à court terme sur la réduction de l'Indice de Masse Corporelle, le traitement des comorbidités et une amélioration de la qualité de vie. Cependant la réussite à la chirurgie n'est pas systématique et des données de l'évolution à plus long terme de ces adolescents sont requises pour appréhender au mieux cette chirurgie. Il est primordial de repérer et renforcer des éléments de motivation interne et de capacités d'adaptation du jeune, afin d'affiner la demande et d'améliorer l'efficacité de la chirurgie. Elle s'intègre dans une prise en charge pluridisciplinaire indispensable. The prevalence of severe and morbid obesity in children and adolescents is sharply increasing. Severe obesity is defined by a body mass index > 120% of BMI IOTF-30 cut off and morbid obesity by a BMI > 140% of BMI IOTF-30 cut off. It concerns 5 to 10% of French obese adolescents. This condition is simple to diagnose but complex to manage. Somatic complications can be found in about half of these patients, and psychiatric symptoms such as depression and anxiety are common. These comorbidities have a real impact on the quality of life of these patients. In case of severe obesity, bariatric surgery can be indicated for adolescents once other therapeutic strategies have failed. It is an effective option when lifestyle interventions – such as nutritional, physical and behavioural care – turn out to be inefficient. The three techniques used are gastric banding, gastric bypass and sleeve gastrectomy. It has shown short-term effeciency in adolescents with severe and morbid obesity regarding weight loss, treatment of comorbidities and improvement of quality of life. However, success in surgery is not systematic and side effects can occur. Sometimes, patients require another surgery. Also, obesity in adolescence is associated with a context of psychological vulnerability. It seems wise to identify and reinforce elements of internal motivation and adaptive capacities of the young person in order to refine the demand and improve the efficiency of surgery. When a psychiatric disorder is identified, it is essential to take it into account and propose a fitting psychiatric care. Medical care has to be performed in specialized multidisciplinary centers. Multidisciplinary follow-up must be standardized and continued even into adulthood. Data regarding middle-term and long-term evolution are sparse, thus it is primordial to pursue this follow-up in order to improve knowledge of the clinical evolution of these patients and to maintain a sustainable efficacy. It is also essential to identify the factors that could be responsible of failure of bariatric surgery so that effectiveness can be improved. French recommendations regarding bariatric surgery indications and specialized multidisciplinary care have been published by the French National Health Authority (Haute Autorité de Santé) in 2016. [ABSTRACT FROM AUTHOR]

Cinq millions de décès par an dans le monde pourraient être évités si les recommandations d'activité physique (AP) étaient respectées. Le risque attribuable de mortalité liée à l'inactivité physique est de 6 % et la fraction préventive de 15 %. Les études ont démontré avec un haut niveau de preuves scientifiques que l'activité physique et sportive régulière permettait de prévenir et de traiter la plupart des maladies chroniques non transmissibles : maladies cardiovasculaires, diabète de type 2, cancer du côlon, du sein, de l'endomètre. L'AP contribue aussi à la prévention des principaux facteurs de risques de ces maladies. En France, quelles que soient les tranches d'âge, l'AP est considérée comme insuffisante au regard des recommandations de l'OMS et les temps de sédentarité atteignent 12 h/jour. Les enfants sont les plus impactés par cette association « inactivité et sédentarité ». Pour modifier ce comportement associant insuffisance d'activité physique et sédentarité dès le plus jeune âge, les changements doivent concerner tous les composants de l'AP et de la sédentarité (école, études, vie professionnelle, loisirs), dès le plus jeune âge, tout au long de la vie jusqu'aux séniors. Five million deaths per year worldwide could be prevented if physical activity (PA) recommendations were followed. The attributable risk of mortality due to physical inactivity is 6 % and the preventive fraction is 15 %. Studies have demonstrated with a high level of scientific evidence that regular physical activity and sport can prevent and treat most chronic non-communicable diseases: cardiovascular disease, type 2 diabetes, colon, breast and endometrial cancer. Physical activity also contributes to the prevention of the main risk factors of these diseases. In France, regardless of age group, PA is considered insufficient in relation to WHO recommendations and sedentary times reach 12 h/day. Children are the most impacted by this association of "inactivity and sedentary lifestyle". In order to change this behaviour associating insufficient physical activity and sedentariness from an early age, changes must concern all components of PA and sedentariness (school, studies, professional life, leisure activities), from a very young age, throughout life and up to the elderly. [ABSTRACT FROM AUTHOR]

Sucrose drink induced obesity and metabolic syndrome in human and animal models. However, age-specific metabolic effects of sucrose beverages are not clear yet. The purpose of this study was then to investigate changes in plasma biochemical parameters, oxidative stress markers, as well as lipid and redox contents and lipolytic activities in insulin target organs (liver, adipose tissue) in sucrose drinking rats at 10% and 30% during one month (day 30) and three months (day 90). Our results emphasized that sucrose drink induced obesity, adipose tissue accumulation with hyperinsulinemia, hyperglycemia, hyperlipidemia, liver steatosis, alterations in lipases activities and oxidative stress. These metabolic alterations were worsened by the amount of sucrose in the drink (30% versus 10%). The changes were apparent in young rats at day 30 and persisted until adulthood at day 90. Adult rats presented more sucrose-induced-metabolic abnormalities. In conclusion, sucrose drink induced an early increase in metabolic syndrome components. These data indicate the need of corrective nutritional intervention for young people and also for adults. [ABSTRACT FROM AUTHOR]

• Cette revue met en évidence l'insuffisance des preuves concernant le bénéfice d'une perte de poids avant une arthroplastie totale de genou (ATG) chez les patients atteints d'obésité sévère. • Des recherches supplémentaires sont nécessaires pour clarifier les bénéfices de la perte de poids comme stratégie efficace de prise en charge de la gonarthrose avancée avant une ATG. • Une perte de poids rapide avant une ATG n'a probablement que peu d'avantages et pourrait même contribuer à l'apparition d'une obésité sarcopénique. L'augmentation du risque d'infection après une arthroplastie totale de genou (ATG) chez les patients ayant un indice de masse corporelle (IMC) élevé, en particulier ≥ 40 kg/m2, suggère qu'il pourrait être important de faire diminuer l'IMC (en perdant du poids) avant une ATG. Cependant, les effets de la perte de poids sur la réduction du risque de l'ATG ne sont pas clairement établis. Par ailleurs, une perte de poids peut avoir des conséquences négatives, notamment fonte musculaire et développement d'obésité sarcopénique, d'où un possible paradoxe pour les adultes atteints d'obésité et de gonarthrose avancée. Nous avons mené une revue critique des preuves existantes en faveur de la perte de poids chez les adultes obèses présentant une gonarthrose avancée. Nous nous sommes concentrés sur trois domaines principaux : (1) comparaison du risque de complications de l'ATG entre patients atteints d'obésité sévère (IMC ≥ 40 kg/m2) et d'obésité (IMC entre 30,0 et 39,9 kg/m2) ; (2) recommandations de perte de poids chez les individus présentant une gonarthrose avancée ; et (3) résultats de l'ATG après une perte de poids préopératoire. Les bases de données Medline et CINAHL ont été examinées entre janvier 2010 et mai 2020 pour identifier des preuves solides et/ou ayant une influence clinique (revues systématiques, méta-analyses et recommandations pour la pratique clinique). La littérature ne montre pas de relation claire entre perte de poids et réduction des complications de l'ATG ni de signes que le risque individuel d'un patient diminue lorsque son IMC descend d'un seuil ≥ 40 kg/m2 à une valeur ≤ 39,9 kg/m2. Les études ayant conclu à un bénéfice de la perte de poids dans la gonarthrose ne portaient pas sur des patients ayant un IMC très élevé (≥ 40 kg/m2) ou une gonarthrose plus avancée. Il n'existe pas non plus de preuves claires qu'une perte de poids avant une ATG entraîne un bénéfice sur les résultats de l'intervention. Ces lacunes en matière de preuve sont importantes et suggèrent qu'il faudrait modérer les recommandations de réduction de l'IMC avant une ATG à la lumière des incertitudes de la littérature actuellement disponible. Les preuves en faveur d'un bénéfice de la perte de poids avant une ATG sont insuffisantes. Tant que ces lacunes ne seront pas comblées, il est recommandé aux praticiens de prendre en compte les besoins et les risques spécifiques à leurs patients avant de préconiser une perte de poids (et donc une diminution de l'IMC). [ABSTRACT FROM AUTHOR]

The objective of this study was to review the beta-adrenergic (β-AR) signaling pathways in adipose tissue, highlight key proteins involved in lypolisis and examine the effects of aerobic exercise on adipose tissue metabolism. Obesity is related to increased body fat and chronic subclinical inflammation. In this framework, lipolytic signaling pathways play a key role in the adipose tissue metabolism. The sympathetic activity through beta-adrenergic receptors is responsible for the lipolysis in white adipose tissue (WAT) and thermogenesis in brown adipose tissue (BAT), as well as for the browning of WAT. Aerobic exercise training protects against obesity by reducing body fat and chronic inflammation. Along with lipid oxidation, eating behavior and epigenetic reprogramming, the benefits of exercise are related to increases in lipolysis and browning in WAT, and thermogenesis in BAT by activation of the beta-adrenergic signaling pathways. The β-adrenergic signaling pathways in adipose tissue in a condition of obesity reflect more complex scenarios requiring further investigations. Concerning aerobic exercise effects, researches should address other possible lipid metabolism pathways, new cytokines involved in lypolisis and inflammation, eating behavior and epigenetic. Thus, new therapeutic strategies to face obesity and associated comorbidities should come up. Aerobic exercise training protects against obesity. It induces adipose tissue metabolism by increasing lipolysis and browning of WAT, thermogenesis in BAT, and expression of cytokines related to lipid oxidation and inflammation, not to mention eating behavior and epigenetic reprogramming. Such benefits are helpful in the prevention and treatment of obesity. [ABSTRACT FROM AUTHOR]

To provide basis for effective exercise intervention for young obese women through comparative study of three types of exercise intervention effects, namely, maximum fat oxidation intensity continuous aerobic training (FATmax AT), high intensity intermittent training (HIIT) and resistance training (RT), on body composition in different intervention durations. Fifty-four eligible young obese women (BF% > 30%) aged 22.14 ± 1.32 years old were randomized to FATmax AT, HIIT or RT group. They respectively completed continuous aerobic, high intensity intermittent or anti-resistance exercise 3 sessions per week (45 min per session) for 12 weeks. Body fat rate (BF%), body fat mass (FM), fat-free mass (FFM) and muscle mass (MM) were measured at pre-mid- and post-intervention. (1) Significant interactions of group × time on BF% (F = 18.35, P = 0.00), FM (F = 13.96, P = 0.00), FFM (F = 21.55, P = 0.00) and MM (F = 8.17, P = 0.00) were found, but there is no main effect in either group or time factors. (2) BF% and FM of the participants in FATmax AT, HIIT and RT group decreased significantly when compared to pre-exercise session (P < 0.05), with a greater decrease in HIIT group than those in FATmax AT group and RT group (HIIT: − 40.18% and − 44.97% vs. FATmax: − 24.59% and − 28.09% vs. RT: − 22.84% and − 29.32%, all P < 0.05). (3) FFM and MM of participants in FATmax AT group and HIIT group and MM of RT group increased continuously and significantly after 12-week exercise. FFM with a greater increase in HIIT group and FATmax AT group than that in RT group (HIIT: 8.49% and FATmax AT: 5.67% vs. RT: − 0.04 both P < 0.05), and MM with a greater increase in RT group than those in HIIT group and FATmax AT group (RT: 27.14% vs. HIIT:23.15% and FATmax AT: 24.26%, both P < 0.05). At the end of the 6th weeks, FFM of HIIT group increased significantly more than that of RT group (4.97% vs. 3.37%, P < 0.05), and MM of FATmax group and RT group increased significantly more than that of HIIT group (FATmax AT: 19.93% and RT: 19.57% vs. HIIT: 12.95%, both P < 0.05). Generally speaking, the change rate in duration of 7–12 week was less than that in 0-6 week. This study shows that 12 weeks of exercise training (3 × 45 min/wk) are an efficient weight-reducing procedure, either with FATmax AT, HIIT or RT. Not surprisingly, the heavier protocol (45 min HIIT) induces a slightly greater reduction in BF% and increases FFM, while RT is most helpful in the increase of MM. Therefore, HIIT can be selected for people who can endure high-intensity exercise and are in urgent need of fat loss. However, since the three protocols are not matched for energy expenditure, no general conclusion about the superiority of one protocol over another can be given. A further study investigating this comparison with matched levels of energy expenditure will help to elucidate this question. [ABSTRACT FROM AUTHOR]

The main problem in obesity management is weight regain that occurs after all currently used slimming procedures. Regular physical activity remains the most effective measure to stop this weight regain. Among the varieties of training that can be offered, endurance exercise at low to moderate intensities targeted at the level of maximum lipid oxidation (LIPOX max) is one of the easiest to implement and has well-documented effects on glucose metabolism, blood lipids, eating behavior, and body composition. Our purpose in this study was to study the effect of this type of exercise on body composition over 2 years. Nonrandomized controlled longitudinal study. Forty-five obese subjects (14 men, 31 women, age = 20–85 years old) were re-trained with LIPOXmax (3 × 45 min/week at home with regular follow-up after induction in hospital) over 2 years. They were compared to a matched control group of 26 subjects. Exercise calorimetry and segmental bioelectric impedance were performed at the beginning and at the 24th month. Trained group lost weight (− 6 ± 1.44 kg) over 2 years. This is explained by a loss of fat mass (− 5 ± 1.26 kg), affecting truncal fat mass (− 2.66 ± 0.62 kg P < 0.0001), and appendicular fat mass (1.38 ± 0.72 kg P < 0.01). There is also a reduction in lean body mass (− 2.41 ± 0.86 kg, P < 0.01). Controls gain 3 ± 0.85 kg (P < 0.001). In the trained group, the ability to oxidize lipids increased (P < 0.001) and there was a positive correlation between weight changes and mean arterial blood pressure at 24 months (R = 0.37 P = 0.02). The weight loss effectiveness of endurance training targeted at the LIPOXmax is maintained for 24 months. This weight loss affects both trunk and appendicular fat mass but also lean mass. It associated with a decrease in blood pressure and an improvement in the ability to oxidize lipids during exercise. [ABSTRACT FROM AUTHOR]

Si les personnes avec une insuffisance rénale chronique terminale et vivant en situation d'obésité ont un pronostic considérablement amélioré par la transplantation rénale, elles sont encore confrontées à de nombreux freins à l'accès à la greffe. L'effet de l'obésité sur la survie du greffon et la survie toutes causes est de moins en moins démontré. Les questions sur la gestion des immunosuppresseurs, des diabètes post transplantation et des syndromes d'hyperfiltration glomérulaire restent, cependant, toujours un enjeu. Néanmoins, la barrière principale est celle du geste chirurgical. Les complications opératoires restent un frein à l'inscription sur liste. Parallèlement, les programmes d'amaigrissement en dialyse avant inscription se confrontent à la surmortalité des cohortes. La question de la chirurgie bariatrique pour les personnes avec les IMC les plus importants peut être une solution qui doit encore être consolidée. Les programmes de réentraînement physique en dialyse sont aussi des pistes de recherche clinique dont l'exploration doit se poursuivre. Enfin, L'arrivée du robot pour la chirurgie pourrait permettre de lever certaines barrières. Ces notions chirurgicales nous amènent, par ailleurs, à nous demander si l'IMC est le bon indicateur. Le tour de taille, reflet du tablier abdominal, n'est-il finalement pas l'élément bloquant du chirurgien ? Quoi qu'il en soit, la Haute Autorité de Santé ne fixe, aujourd'hui, une limite à la transplantation rénale que pour des IMC au-dessus de 50 kg/m2. Cette règle est encore loin d'être une réalité pour les personnes vivant en situation d'obésité en France et dans le monde. While patients with an end-stage renal disease and living with obesity have a significantly improved prognosis with kidney transplantation, they still face many barriers to access to it. Obesity effect on graft survival and all-cause survival is less and less established. However, questions about immunosuppressive drugs management, post-transplant diabetes and glomerular hyperfiltration syndromes remain an issue. Nevertheless, surgical gesture remains the main barrier. Complications from surgery still restrain registration. At the same time, pre-registration weight-loss programs under dialysis face an excess of mortality. Bariatric surgery issue for people with the highest BMIs might be a solution that still needs more research. Exercise rehabilitation during dialysis programs are also major avenues that need further explorations. Finally, robot-assisted surgery arrival could remove many restrictions. These surgical notions also lead us to wonder whether BMI is the right indicator. Isn't the waist circumference, a direct reflection of the abdominal apron, the blocking element for surgery? In any case, the French National Authority for Health currently only sets a limitation on kidney transplantation for BMIs above 50 kg/m2. This rule is still far from being a reality for people living with obesity in France and around the world. [ABSTRACT FROM AUTHOR]

Our goal was to test the anti-obesity effects of supplementing inulin and compound probiotic (CP) alone or in combination on HFD-mice model. Fifty C57BL/6 mice were randomly divided into five groups of varying diets as follows: normal chow diet (NCD), high-fat diet(HFD), HFD + inulin, HFD + CP, HFD + inulin + CP. Each group consisted of five males and five females. All mice were sacrificed to test obesity parameters adipocytokines、blood lipid parameters and inflammatory factor after seven weeks. Compared to male mice HFD group, the supplement of inulin and CP alone significantly improved HFD-induced obesity by regulating weight gain blood lipid metabolism inflammatory cytokines and adipokines. However, inulin combined CP had a better anti-obesity effect. For the female mice, body weight blood lipids and glucose liver weight and Free fatty acid (FFA) were influenced to different degrees. Besides, the beneficial effects of inulin and CP treatment on HFD-induced obesity showed gender-difference. This study demonstrated that prebiotic inulin and CP could have paly antiobesity effects on HFD male mice, respectively. The synergism of inulin combined with CP on improving HFD-induced obesity was observed in our study. Meanwhile, there were differences between male and female mice of above beneficial effects, providing a rational therapeutic method of HFD-induced obesity in the future. [ABSTRACT FROM AUTHOR]

L'éducation thérapeutique (ET) est un outil permettant au patient de trouver ses propres stratégies de changement en se confrontant au point de vue des autres, en abordant de nouvelles connaissances et en remobilisant certaines compétences. Le changement implique une multitude de processus psychologiques que l'on interroge peu. Quelle place accorde-t-on à ces processus psychologiques ? Quel est le rôle du psychologue de la santé dans l'ET ? Nous aborderons ces notions en parcourant un cas clinique d'un patient obèse ayant participé à une éducation thérapeutique « pour une perte de poids durable » (unité médicale de la nutrition, hôpital universitaire de Toulouse). The Therapeutic Education is a tool allowing the patient to find its own strategies of change by confronting with the point of view of others, by approaching new knowledge and recapturing some skills. The change involves a multitude of psychological processes, which we rarely question. What place do we grant to these psychological processes? What is the role of the psychologist of the health in the ET. We shall approach these notions by discussing a clinical case of a patient obese having participated in a therapeutic patient education "for a long-lasting loss of weight" (Medical Unit of the Nutrition, CHU de Toulouse). [ABSTRACT FROM AUTHOR]