Obesity is a major public health issue, affecting 18.1% of the adult population in France*, or nearly 10 million people (source: Observatoire Français d’Épidémiologie de l’Obésité (OFÉO)).
In response to this challenge, the French National Authority for Health (HAS) has produced recommendations for good medical and surgical practice, as well as guidelines for the care of overweight patients. Their aim is toimprove the management of patients suffering from obesity, by promoting a global and personalized approach to this complex chronic pathology and its associated complications (diabetes, cardiovascular disease, sleep apnea, etc.).
- What are the current HAS* recommendations on the management of obesity?
- How is IHU ICAN helping to speed up medical research into obesity?
Find out how Pr Judith Aron-Wisnewsky (University Professor – Hospital Practitioner – Nutrition Department – Cardiometabolism Pole – Hôpital Pitié-Salpêtrière – INSERM UMRS 1269 NutriOmics – Sorbonne University – IHU ICAN) explains the situation.
Understanding the different levels of obesity management
According to the latest HAS classification, the stage of severity of obesity is based not only on BMI but also on 6 medical parameters, including :
- Medical impact (severity of co-morbidities),
- Functional impact and quality of life,
- The presence or absence of psychological, psychopathological and/or cognitive disorders (causes or consequences of obesity),
- Etiologies of obesity (genetic, secondary…),
- The presence or absence of eating disorders (including binge eating),
- Weight trajectory, taking into account the number of times the patient has been under treatment (whether or not previous treatments were unsuccessful).
There are 5 stages of obesity severity: 1a, 1b, 2, 3a and 3b.
Patients are then managed according to their stage of severity in the 3 levels of referral:
- Level 1: management by the general practitioner (who coordinates obesity management) or advanced practice nurse, with the help of other professionals from the general medical practice: pharmacists, nurses, midwives, psychologists, psychiatrists, occupational physicians, adapted physical activity teachers, masseur-physiotherapists, occupational therapists, sports educators, social workers, etc.
- Level 2: treatment by an obesity specialist, either in private practice or in a public or private healthcare facility ,
- Level 3: treatment by an obesity specialist in a specialized obesity center (CSO) or university hospital, especially for the most complex cases or those that have failed at previous levels.
- In levels 2 and 3, obesity specialists also refer patients to the aforementioned paramedical professionals.
The aim of obesity management is not just to achieve a weight target, but also to improve the patient’s health and quality of life, or even to return to a lower level of management.
If well-managed medical care fails after 6 to 12 months, the patient should be referred to the next level of care, up to level 3.
Care based on a multidisciplinary approach
The French National Authority for Health (HAS) insists on the need for comprehensive management of obesity, combining nutritional, physical activity, medical and psychological (if necessary) interventions.
This multidisciplinary approach is based on several pillars:
- A thorough initial assessment: this evaluates the patient’s profile, including body mass index (BMI) and comorbidities,
- Clinical medical/biological assessment of the impact of obesity and the severity of associated pathologies: diabetes, hypertension, respiratory and sleep pathologies, metabolic steatopathy (MAFLD / MASH), osteoarthritis, renal impairment, cancer screening, oral and dental examination, quality of life and research into eating disorders,
- Personalized nutritional support: we recommend working on hunger and satiety signals, and emotional eating. Restrictive diets are not recommended by the HAS.
- Physical activity as an essential lever: the aim is to integrate exercise gradually and in a way that is adapted to the patient’s abilities, emphasizing its metabolic and psychological benefits.
- Psychological support, if necessary after the initial assessment: eating disorders and the psychological impact of obesity require specific support.
- Follow-up and rehabilitation care (SSR): for patients with severe complications or loss of autonomy, specialized SSR care may be indicated.
- Follow-up and rehabilitation care (SSR): for patients with severe complications or loss of autonomy, specialized SSR care may be indicated.
- Medication management: in the event of failure of well-managed treatment (insufficient weight loss at 6 months), GLP-1 analogues with marketing authorization may be considered, as a 2nd-line treatment after well-managed nutritional management and subject to first prescription by a specialist.
- Bariatric surgery as a last resort: surgery (Y-shaped gastric bypass, sleeve gastrectomy, adjustable gastric band) is reserved for patients with a BMI ≥ 40 kg/m² (or ≥ 35 kg/m² with comorbidities) and after failure of at least 6 months of well-managed medical care. Rigorous preparation and lifelong follow-up are essential to optimize benefits and minimize complications.
IHU ICAN, committed to better management of obesity
At IHU ICAN, we integrate these recommendations into our innovative approaches, combining precision medicine, personalized follow-up with tailored therapeutic strategies , and access to the latest advances in research.
Our researchers are setting up innovative research projects around obesity, such as the OB-MAT project led by Dr Elise Basle, which aims to analyze the impact of maternal obesity on post-natal cardiac development.
IHU ICAN is also stepping up its prevention initiatives aimed at the general public to raise awareness of obesity, by working with organizations such as the Collectif National des Associations d’Obèses (CNAO).
