[Interdisciplinarity for obese patient global management]. / L'interdisciplinarité pour un traitement global du patient obèse.

Obesity is a chronic illness involving serious somatic comorbidities and psychological disorders. Furthermore, obese patients often suffer from personal and / or socio-cultural problems. Taken together these elements amount to a complex illness requiring comprehensive patient care and hence an interdisciplinary approach aimed at integrating and coordinating the interventions of the different health professionals. Through various initiatives, the Interdisciplinary group for the treatment of obesity (GITO) endeavours to apply and promote an interdisciplinary approach both in clinical practice and in the debate on the problems relating to obesity.

L'obésité est une maladie chronique compliquée par des comorbidités somatiques graves et par l'association à des troubles de la sphère psychologique. De plus, le patient obèse souffre souvent de problématiques d'ordre personnel et / ou socioculturel. L'interaction entre tous ces facteurs correspond au concept de maladie complexe, qui, très clairement, nécessite une prise en charge globale. Ceci implique un travail interdisciplinaire dont le but est d'intégrer et coordonner les actions des différents thérapeutes qui assurent le suivi du patient. Par le biais de différentes initiatives, le Groupe interdisciplinaire pour le traitement de l'obésité (GITO) s'efforce d'appliquer et de promouvoir les principes de l'interdisciplinarité aussi bien dans l'activité clinique que dans la réflexion sur les problématiques liées à l'obésité.

[Reciprocal interactions between bariatric surgery and psychopathology]. / Queues interférences réciproques entre chirurgie bariatrique et psychopathologie?

In this article, the results of a bibliographic research concerning the interactions between bariatric surgery and psychopathologies are presented. In the preoperative phase, although not scientifically demonstrated, uncontrolled psychopathologies as well as the abuse of illicit substances are often considered as exclusion criteria for the intervention. From the psychological point of view, neither the existence of a "typical" profile, nor the presence of predictive factors have been demonstrated. However some "attitudes" or "personality traits" could influence the issue of the intervention. In the postoperative phase, the pre-existing psychopathologies transiently improve. On the other hand, alcohol and illicit substances abuse as well as suicide are increased.

Effect of orlistat in obese patients with binge eating disorder.

OBJECTIVE: Binge eating disorder represents a significant public health problem, with up to 50% of weight loss program participants displaying this disorder. In previous studies with orlistat, patients with binge eating disorder were excluded. The goal of this study was to assess the efficacy of orlistat in obese patients with binge eating disorder. RESEARCH METHODS AND PROCEDURES: Eighty-nine patients with clinically diagnosed binge eating disorder and a BMI > or = 30 kg/m2 were randomized in double-blind fashion to 24 weeks of treatment with 120 mg of orlistat or placebo three times daily, in combination with a mildly reduced-calorie diet. RESULTS: After 24 weeks, the mean weight loss from baseline for orlistat-treated patients was significantly greater than for patients receiving placebo (-7.4% vs. -2.3%; p = 0.0001) (intent-to-treat analysis). The overall Eating Disorder Inventory 2 score at week 24 was significantly lower in patients treated with orlistat than in those in the placebo group (p = 0.011). DISCUSSION: Orlistat may be considered as part of the management for patients with obesity and binge eating disorder.

Progressive defect of insulin action on glycogen synthase in obesity and diabetes.

The purpose of the present work was to have a closer view on the changes in the regulation of glycogen synthase (GS) activity by insulin in relationship with the impairment of nonoxidative glucose disposal in human obesity. Obese patients with normal glucose tolerance (12), impaired glucose tolerance (11), diabetes (10), and lean control subjects (15) participated to the study. A euglycemic, hyperinsulinemic clamp was performed and associated with indirect calorimetry. Muscle needle biopsies were taken before and at the end of the 2-hour clamp for measurements of glycogen synthase fractional velocity and total activity. Total GS activity was significantly decreased (P <.05), while its percent activation by insulin was still normal in the obese glucose-tolerant group, and nonoxidative glucose disposal was decreased by 56% (P <.001) and glucose oxidation still normal. Total GS activity was decreased by about 50% (P <.01) and GS was unresponsive to insulin in the glucose-intolerant and diabetic groups. In conclusion, our data show that insulin-stimulated nonoxidative glucose disposal and total glycogen synthase are very early defects observed in obese patients.