options thérapeutiques pour traiter l’obésité

L’obésité est a chronic disease that can cause daily difficulties but also has a negative impact on health. In fact, it can lead to other pathologies such as diabetes, high blood pressure, hypercholesterolemia, and sleep apnea syndrome.

17% of adults in France are obese, while 49% are overweight. Although the prevalence of overweight remains stable at around 30%, the prevalence of obesity has rapidly increased in recent years. This figure has risen from 8.5% in 1997 to 15% in 2012 and 17% in 2020.

There are several therapeutic options to treat obesity, including bariatric surgery.

What is bariatric surgery?

The High Authority for Health recently published a guide to care paths for overweight and obese adults on the occasion of World Obesity Day on March 4th. One chapter is dedicated to bariatric surgery. Also known as obesity surgery, this intervention “modifies the anatomy of the digestive system. It is a mechanical and metabolic aid that allows for a decrease in the amount of food consumed (restriction principle) and/or assimilation of food by the body (malabsorption principle).”

Who benefits from bariatric surgery?

Bariatric surgery is not always possible. Three criteria must be met for this to be possible:

– Suffer from massive obesity (BMI ≥ 40 kg/m²) or severe obesity (BMI ≥ 35 kg/m²) when associated with at least one complication correctable by surgery (diabetes, high blood pressure, sleep apnea syndrome, joint disorders, etc.);

– Have tried, unsuccessfully, to lose weight through a particular medical treatment for several months with dietary follow-up, physical activity, and psychological treatment;

– Has no contraindications to surgery (e.g. alcohol dependence) and general anesthesia.

Thus, in its report, the HAS emphasizes that “bariatric surgery is a therapeutic option that is considered when a personalized treatment and support plan has been implemented for 6 to 12 months by professionals with the support and participation of the patient without sufficient benefit to their overall health.” Therefore, this treatment cannot be offered directly to patients.

Whom should I contact for bariatric surgery?

You should first discuss this with your doctor or an obesity specialist. The patient will then be directed to a multidisciplinary team that can indicate if surgical intervention is possible. If this occurs, the preparation phase begins, and it is at the end of this phase that the multidisciplinary team will present its final opinion.

How long does it take to prepare before surgery?

“The minimum duration is 6 months from the planning of personalized preparations for bariatric surgery and provided that the objectives of the preparation are achieved,” adds the HAS. However, a longer preparation time is often necessary to fully understand the stakes of the surgery, acquire the necessary skills after bariatric surgery (self-care), treat other pathologies, remove contraindications, etc.

What are the techniques of bariatric surgery?

Restriction techniques involve reducing the size of the patient’s stomach, mainly through gastric banding or gastrectomy (the practice of removing part of the stomach). Another mixed technique (restrictive and malabsorptive) is gastric bypass. According to the specialized center for obesity in Marseille, this “reduces the amount of food ingested (the size of the stomach is reduced to a small pouch) and the assimilation of this food by the body, thanks to a short circuit of the stomach and intestines. Food arrives directly in the central part of the small intestine and is therefore assimilated in smaller quantities.”

And after the surgery?

Throughout the journey, the patient must be well informed that surgery alone is not enough. “Bariatric surgery is only one step in the management of a patient,” explains Dr. Séverine Ledoux, a specialist in overweight and obesity, in a video posted online by the APHP. She emphasized that obesity is multifactorial, and these factors vary from patient to patient. “Surgery will only address one of the determining factors of obesity, namely food volume. The patient must tackle the determining factors, such as eating disorders, physical activity, stress, sleep, etc.,” continued the specialist. In addition to newly adopted habits, psychological difficulties may arise related to changes in body image and relationships with others. Psychological assistance is offered to patients to overcome this problem.

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