Obesity is an excess of body fat with harmful consequences for health. It is a chronic disease resulting from an imbalance between energy intake and expenditure. It leads to numerous medical, psychological and societal complications.
Obesity is determined on the basis of body mass index (BMI). BMI corresponds to weight (in kg) divided by the square of height (in metres). When the BMI is over 25, we speak of overweight and over 30 of obesity, where there are several grades of severity.
How is obesity treated today?
Epidemiology: obesity worldwide
According to theWHO, in 2016, 39% of adults aged 18 and over were overweight and 13% were obese. The number of people suffering from obesity has tripled in the last 50 years.
In France, obesity affects 17% of the adult population.
The condition is also increasingly affecting children and adolescents. Among the under-18s, obesity affects 16% of boys and 18% of girls.
Causes and risk factors
Obesity has many complex causes.
- They may be genetic in certain rare forms of obesity.
- Diet, psychological and environmental factors are also important causes of the development of obesity.
- More recently, changes in the intestinal microbiota are increasingly being mentioned.
Developments and consequences
Once obesity has set in for a long time, we can speak of a chronic disease. It has many harmful consequences for health and is responsible for the development of other pathologies such as type 2 diabetes, sleep apnoea syndrome, hypoventilation-obesity syndrome, arterial hypertension, cardiovascular disease, kidney damage, etc. Obesity is also associated with an increased risk of cancer, particularly of the breast but also of the uterus, colon and liver. Obesity can also lead to degenerative osteoarticular problems (osteoarthritis), sometimes severe and requiring the fitting of a prosthesis for the joint concerned.
The onset or worsening of gastro-oesophageal reflux is also possible, and the psychosocial repercussions of the disease should not be forgotten.
Finally, obesity is responsible for many deaths every year.
How is obesity treated?
Multi-disciplinary, personalised care must be put in place for each patient, with regular medical monitoring to delay or avoid complications, and even to treat complications that are already present. This care also includes a programme ofadapted physical activity, dietetic follow-up which may involve culinary workshops to work on eating habits, eating patterns and nutritional balance, and treatment of eating disorders (psychologist/psychiatrist).
Medicinal or surgical treatment (sleeve, gastric bypass) may be proposed after nutritional management for patients suffering from the most severe obesity, provided that the indications and contraindications are respected and that optimal preparation has been put in place.
Research into the treatment of obesity
Numerous areas of research in this field are currently underway (non-exhaustive list of examples):
- Changes in adipose tissue during obesity, which are responsible for the development of obesity-related complications and even resistance to weight loss.
- The role of the microbiota in obesity and its complications, and therapeutic means of modulating this microbiota and improving metabolic health.
- The development of new drug treatments for both common obesity and obesity with rare genetic causes.
- The beneficial effects of physical activity in the management of obesity..
The ICAN IHU’s response to the treatment of obesity
Doctors at the IHU have set up an innovative care pathway dedicated to bariatric surgery.
