[Obesity psychological treatment: beyond cognitive and behavioral therapy]. / Prise en charge psychotogique de l'obésité: au-delà de la thérapie cognitivo-comportementale.

The psychological assessment of the patient with obesity aims to identify the factors of maintenance of excess weight, such as eating disorders or anxio-depressive disorders. Psychotherapy helps a better weight management. Cognitive-behavioral therapy has shown its effectiveness in the treatment of obesity. New psychotherapeutic approaches are explored. The hypnosis and mindfulness are proposed for the management of emotions and stress. A targeted approach on the body image disorder decreases body dissatisfaction. When post-traumatic stress syndrome is involved, EMDR (Eye Movement Desensitization & Reprocessing) is better than other types of therapies. Family therapy is indicated when the entourage is impacted. Psychological difficulties should be the subject of specific care.

[Development and validation of a nutritional knowledge questionnaire among 9- to 15-year-olds]. / Développement et validation d'un questionnaire permettant d'évaluer les connaissances alimentaires (QuesCA) auprès de jeunes de 9 à 15ans.

Improving nutritional knowledge is a frequent goal in nutritional education programs. However, there is a lack of valid instruments to assess nutritional knowledge in children. Questionnaires on nutritional knowledge are usually related to a specific curriculum or program, and their development or validation process is rarely available. Our goal was to develop a valid, self-administered questionnaire to assess nutritional knowledge among French-speaking children and adolescents aged 9-15 years. The conceptual framework and concepts were based on a literature review. For each concept, an expert panel selected a number of items, and successive versions of the questionnaire were pretested. The edited version of a 30-item questionnaire (QuesCA) was administered to 475 children aged 9-15, in two French-speaking cantons in Switzerland. We calculated internal consistency (Cronbach alpha), the rate of correct answers for each question, and the mean scores for each concept. The mean scores were 16.32 (95% CI: [15.69; 16.94]) in the 9- to11-year-olds and 18.62 [18.19; 19.06] in the 12- to 15-year-olds (maximum possible, 30). Beverages, breakfast, fruit, and vegetables were the concepts that gathered the most correct answers. The overall Cronbach alpha score was good (0.66), but as the internal consistency for each concept was low (0.06-0.45), we developed an optimal scale for each age group. The result is a two-part questionnaire: QuesCA 9-11 and QuesCA 12-15, with 9 items each, that enables a rapid and reliable assessment of nutritional knowledge in children and adolescents.

Cognitive distortions in obese patients with or without eating disorders.

In the normal weight population, cognitive distortions are more often found in people with eating disorders such as anorexia and bulimia than in a control population. With these cognitive distortions, weight and body image become central elements in self-esteem. This exploratory study investigated cognitive distortions in obese patients suffering from binge eating disorder or not. The hypothesis was that the patients suffering from binge eating disorder would have more cognitive distortions. Twenty-nine obese women (11 without and 18 with binge eating disorder) and 13 non-obese female controls were selected. To evaluate the cognitive distortions, subjects completed the Mizes Anorectic Cognitions-Revised (MAC-R) questionnaire. Contrary to our hypothesis, we found no difference in evidence between the two obese groups with or without eating disorders. Possible perspectives for treatment are discussed.

Factors influencing energy intake and body weight loss after gastric bypass.

OBJECTIVE: The gastric bypass-induced quantitative and qualitative modifications of energy intake (En In, kcal/day) and their impact on body weight (bw) loss were evaluated. The factors influencing energy intake and body weight loss were also investigated. DESIGN: Longitudinal study. SETTING: University Hospital of Geneva. SUBJECTS: Fifty obese women undergoing a Roux-en-Y gastric bypass. RESULTS: The reduction of EnIn was significantly related to bw loss expressed either in kg or as percentage correction of excess bw (P<0.01 for both), whereas the post-operative modifications of diet composition did not play a role. Age and initial bw significantly influenced bw loss (P<0.0001 and P<0.001, respectively), as shown by multiple regression analysis. Patients were divided into four sub-groups according to their age (under or over 35 y) and initial bw (under or over 120 kg). ANOVA showed that under 35-y-old subjects reduced their EnIn significantly more than their older counterparts having similar bw (P<0.02 and P<0.05); consequently, bw loss, expressed in kg, was significantly (P<0.0001 and P<0.0005) larger in younger patients. Subjects with an initial bw over 120 kg lost significantly (P<0.001 and P<0.02) more weight as compared to patients with a smaller degree of obesity (under 120 kg) and similar age. CONCLUSIONS: Gastric bypass-induced body weight loss is mainly due to the reduction of EnIn, whereas the qualitative modifications of the diet do not play a role. Younger subjects have a greater capacity to reduce EnIn and, therefore, lose more weight. Pre-operative high degree of obesity leads to a larger weight reduction, probably because of a greater energy deficit.

[Behavioural and cognitive approach to obese persons]. / Approche comportementale et cognitive de la personne obèse.

We present a description of basic concepts of the cognitive-behavioural approach in obese patients with binge eating disorders. In the first place, we propose the process leading to a behavioural reorganization. Then, we evoke some components of the cognitive restructuring that allow to understand the link between an event and binge eating disorders. We also give practical advice to the health care providers.

Energy economy hampers body weight loss after gastric bypass.

The impact of energy economy on body weight loss was investigated in 20 obese women, submitted to Roux-en-Y gastric bypass. Resting energy expenditure (REE), substrate oxidation rates, plasma glucose, free fatty acid, and insulin and leptin levels were measured before and 3, 6, and 12 months after surgery. Predicted REE was obtained from linear regression analysis of REE and fat free mass, in a group of 85 women, whose body mass index ranged between 20 and 60 kg/m(2). The deviation from predicted REE, calculated as area under the curve (AUC) over the 12-month period for each patient, was considered as the expression of energy economy. Energy economy AUC was significantly (P: < 0.005) negatively related to the weight lost during 12 months after surgery. Energy intake, calculated from self-reported food consumption, was also expressed as AUC. Energy intake AUC showed a significant (P: < 0.002) positive correlation with weight loss. Lipid oxidation rate, also calculated as AUC, significantly correlated, negatively, with energy economy (P: < 0. 001) and, positively, with energy intake (P: < 0.002). Preoperative leptin values were significantly (P: < 0.01) linked to individual energy economy capacity. In conclusion, after Roux-en-Y gastric bypass, energy economy hampers the weight loss process, probably through a low fat oxidation rate.