Impact of Preoperative Psychiatric Profile in Bariatric Surgery on Long-term Weight Outcome.

BACKGROUND: Conflicting results have been reported regarding the predictive value of preoperative psychological assessment and weight outcome after bariatric surgery. This might be attributed to different factors affecting early weight loss and long-term weight loss. Herein, we investigated whether preoperative psychiatric profile was associated with preoperative BMI and with both early (1 year) and long-term (5 years) weight loss after Roux-en-Y gastric bypass (RYGB). METHODS: Prospective observational cohort study of patients undergoing RYGB between 2013 and 2019. Symptoms related to anxiety, depression, eating disorder, and alcohol use disorders were assessed by employing validated, specific psychometric tests (STAI-S/T, BDI-II, BITE, AUDIT-C) prior to surgery. Pre-operative BMI, early weight loss (1 year), and long-term weight evolution (up to 5 years) were registered. RESULTS: Two hundred thirty six patients (81% women) were included in the present study. Linear longitudinal mixed model showed a significant effect of preoperative high anxiety (STAI-S) on long-term weight outcome, after controlling for gender, age and type 2 diabetes. Patient with high preoperative anxiety score regained weight faster than those experiencing low anxiety (each year percent excess BMI loss (%EBMIL) - 4.02%, ± 1.72, p = 0.021). No other pre-operative psychiatric symptoms have been shown to have an impact on long-term weight loss. In addition, no significant association was found between any of the pre-operative psychiatric variables and pre-operative BMI, or early weight loss (%EBMIL) at 1-year post-RYGB. CONCLUSION: Herein we identified high anxiety score (STAI-S) as a predictor for long-term weight regain. Thus, long-term psychiatric surveillance of these patients and the development of tailored management tools could serve as a means to prevent weight regain.

The Influence of a Roux-en-Y Gastric Bypass on Plasma Concentrations of Antidepressants.

PURPOSE: Roux-en-Y gastric bypass (RYGB) involves alterations of the gastrointestinal tract resulting in altered absorption. Patients with obesity have a higher prevalence of depression, and antidepressants are often prescribed. Alterations caused by RYGB could modify drug bioavailability and cause potential subtherapeutic plasma concentrations, increasing the risk of depressive relapse. The aim of this study was to describe the evolution of trough drug dose-normalized antidepressant plasma concentrations before and after RYGB. MATERIALS AND METHODS: This naturalistic prospective case series considers patients with trough plasma concentrations in a 1-year timeframe before and after RYGB. Only antidepressants prescribed to at least three patients were included in the present study. RESULTS: Thirteen patients (n = 12 females, median age 44 years, median BMI before intervention = 41.3 kg/m2) were included. Two patients were treated concurrently with fluoxetine and trazodone; the remaining patients were all treated with antidepressant monotherapy. Therapeutic drug monitoring (TDM) values for duloxetine (n = 3), escitalopram (n = 4), fluoxetine (n = 4), and trazodone (n = 4) before (median 4.7 weeks) and after (median 21.3 weeks) RYGB intervention were analyzed. Compared to preintervention, median [interquartile range] decreases in dose-normalized trough plasma concentrations for duloxetine (33% [- 47; - 23]), escitalopram (43% [- 51; - 31]), fluoxetine (9% [- 20; 0.2]), and trazodone (16% [- 29; 0.3]) were observed. CONCLUSION: This study shows a decrease in plasma antidepressant concentrations following RYGB. TDM before and after RYGB, in addition to close monitoring of psychiatric symptomatology, may help optimize antidepressant treatment after bariatric surgery. These results also highlight the need for prospective studies assessing the clinical evidence available through TDM in these patients.

[Stigmatization of people with obesity: understanding and confronting societal prejudice]. / Stigmatisation des personnes atteintes d'obésité : comprendre et affronter les préjugés sociétaux.

Obesity (BMI ≥ 30 kg/m2) has been officially classified as a disease by the WHO since 2008, yet individuals affected by obesity often face blame and negative stereotypes from society and healthcare providers. This stigmatization can lead to negative impacts on both mental and physical health. This phenomenon can also lead the stigmatized person to internalize the prejudice, considering their fate as deserved. This article aims to provide healthcare professionals with the tools to better understand and care for patients with obesity.

L'OMS reconnaît officiellement l'obésité (IMC ≥ 30 kg/m2) comme une maladie depuis 2008. Pourtant, les personnes touchées par l'obésité font souvent l'objet de reproches et de stéréotypes négatifs de la part de la société et des prestataires de soins de santé. Cette stigmatisation peut avoir des répercussions négatives sur la santé mentale comme physique. Ce phénomène peut aussi conduire le stigmatisé à intérioriser le préjudice, considérant son sort comme normal. Cet article vise à fournir aux professionnels de santé les outils nécessaires pour comprendre et aborder cette question, afin de mieux soigner les patients touchés par l'obésité.

[Interdisciplinary Center for Obesity: a single-entry point for personalized care]. / Centre interdisciplinaire de l'obésité : une porte d'entrée unique pour une prise en charge personnalisée.

Obesity is a chronic disease that seriously affects physical and psychological health. However, its management is insufficiently coordinated. The lack of defined therapeutic strategies is particularly evident since the arrival of new drug treatments. Coordination between the professionals involved- obesity specialists, general practitioners and other caregivers - and the involvement of the patient are all issues at the heart of an evaluation necessary for the construction of a personalized care project. Interdisciplinary centers must guarantee access to information and offer the full range of therapies currently available. An early psychological evaluation allows for the orientation of care, taking into account the vulnerability and resources of patients.

L'obésité est une maladie chronique qui affecte gravement la santé physique et psychologique, mais sa prise en charge est insuffisamment coordonnée. L'absence de stratégies thérapeutiques définies est particulièrement évidente depuis l'arrivée de nouveaux traitements médicamenteux. La coordination entre les professionnels impliqués (spécialistes de l'obésité, médecins généralistes et autres soignants) et l'implication du patient sont autant d'enjeux au cœur d'une évaluation nécessaire pour la construction d'un projet de soins personnalisés. Les centres interdisciplinaires doivent garantir un accès à l'information et offrir l'ensemble des thérapies actuellement disponibles. Une évaluation psychologique précoce permet d'orienter la prise en charge en tenant compte de la vulnérabilité et des ressources des patients.

[Liraglutide in the treatment of obesity : a multidisciplinary approach]. / Liraglutide dans le traitement de l'obésité : une prise en charge multidisciplinaire.

Liraglutide, which has been prescribed for several years for the treatment of type 2 diabetes, is now proposed for the management of patients with BMI between 28 and 35 kg/m2 in the presence of metabolic comorbidity or BMI ≥ 35 kg/m2. Its reimbursement by the health insurance is conditioned on weight loss results and time limited. Careful preparation of the patient and his commitment to lifestyle changes are essential for the success and good tolerance of the treatment. The introduction of this treatment requires a multidisciplinary follow-up to ensure optimal results. The place of liraglutide in the pharmacopeia of obesity, a chronic disease that requires long-term treatment, should be clarified.

Le liraglutide, un analogue du GLP-1 (Glucagon-Like Peptide-1) prescrit depuis plusieurs années dans le traitement du diabète de type 2, est désormais proposé dans la prise en charge des patients avec un IMC entre 28 et 35 kg/m2 en présence d'une comorbidité métabolique ou avec un IMC ≥ 35 kg/m2. Son remboursement par l'assurance obligatoire des soins est conditionné par des résultats de perte pondérale et limité dans le temps. Une préparation attentive du patient et son engagement dans des modifications de l'hygiène de vie sont indispensables au succès et à la bonne tolérance du traitement. L'instauration de celui-ci nécessite un suivi pluridisciplinaire pour permettre un résultat optimal. La place du liraglutide dans la pharmacopée de l'obésité, maladie chronique qui nécessite un traitement de longue durée, devra être précisée.

[Does liraglutide have a place in psychiatry ?] / Le liraglutide a-t-il sa place en psychiatrie ?

The relative risk of developing MetS is higher in patients with severe mental illness (SMI) than in the general population. Similarly, the risk of developing obesity or type 2 diabetes (T2DM) is also higher in patients with SMI. GLP-1 receptor agonists, such as liraglutide, have been shown to be effective in the treatment of T2DM and, more recently, in obesity or overweight associated with at least one metabolic disease. Their psychiatric adverse effect profiles seem to be reassuring, thus not represent a limitation for prescribing in psy chiatry. We aimed to explore the therapeutic usefulness of liraglutide in patients with psychiatric disorders associated with somatic comorbidities such as obesity, T2DM or MetS.

Le risque relatif de développer un syndrome métabolique (SMet) est plus élevé chez les patients connus pour une maladie psychiatrique sévère (MPS) que dans la population générale. De même, le risque de développer une obésité ou un diabète de type 2 (DT2) est également plus important chez les patients souffrant de MPS. Les analogues du GLP-1 (Glucagon-Like Peptide 1), tels que le liraglutide, ont fait leurs preuves pour le traitement du DT2 et, plus récemment, de l'obésité ou de la surcharge pondérale associée à une maladie métabolique. Leurs profils d'effets indésirables sur la santé mentale semblent rassurants, ne représentant ainsi pas de limitation à leur prescription en psychiatrie. Nous questionnons ici l'intérêt du liraglutide chez les patients souffrant de troubles psychiques associés à des comorbidités somatiques telles que l'obésité, le DT2 ou le SMet.

Desensitization of thermal hyperemia in the skin is reproducible.

OBJECTIVE: Local heating increases skin blood flow SkBF (thermal hyperemia). In a previous study, we reported that a first local thermal stimulus could attenuate the hyperemic response to a second one applied later on the same skin spot, a phenomenon that we termed desensitization. However, other studies found no evidence for desensitization in similar conditions. The aim of the present work was to test whether it was related to differences in instrumentation. METHODS: Twenty-eight healthy young males were studied. Two pairs of heating chambers, one custom-made (our study) and one commercial (other groups), were affixed to forearm skin. SkBF was measured with single-point laser-Doppler flowmetry (LDF) (780nm) in one pair, and laser-Doppler imaging (LDI) (633nm) in the other. A temperature step from 34 to 41°C, was applied for 30minutes and repeated after two hours. RESULTS: During the second thermal challenge, the plateau SkBF was lower than during the first thermal and was observed with each of the four combinations of SkBF measurement techniques and heating equipment (p<0.05 for all conditions, range -9% to -16% of the initial value). CONCLUSION: Desensitization of thermal hyperemia is not specific to peculiar operating conditions.