2024-02-28 13:41:16
As World Obesity Day approaches on March 4, the High Authority for Health (HAS) is offering two care pathways for overweight and obesity, in children and adolescents on the one hand, in adults on the other hand. How to prevent these situations? What measures should be put in place? Now complete, this work aims to facilitate the organization and implementation of care as well as support for people affected by this chronic illness with multiple repercussions.
In France, 4% of children and adolescents aged 6-17 and 17% of adults are obese.[1]. By integrating excess weight[2] this prevalence increases to 17% and 49% respectively. Obesity is almost four times more common among socially disadvantaged people, and more so among women. This complex and multifactorial chronic disease has a significant impact on quality of life, itself causes other diseases (type 2 diabetes, cardiovascular diseases, etc.) and reduces life expectancy.
Faced with this major public health issue, it is essential to improve prevention and personalize care and support for people. This requires in particular the right sequence of care, at the right time and by the right professionals. This is the objective of the care pathways offered by HAS. It now completes the care pathway for overweight and obesity in adults, including new recommendations on pre- and post-bariatric surgery management. The specific route for children and adolescents was updated in 2023, specifying the biological examinations to be carried out.
This work is aimed at all the professionals involved, but also at the regional health agencies (ARS) responsible for leading the obesity sector in the region.
Modify lifestyle habits and personalize the objective
Supporting changes in lifestyle habits constitutes the first modality of care, whatever the complexity of the situation: diet, daily physical activity, sedentary lifestyle[3], rhythms of life, etc. This support must be co-constructed with the patient and adapted to their situation by anticipating possible psychological, social, professional or academic difficulties. Therapeutic education sessions led by health professionals and resource patients can be offered upon diagnosis of overweight or obesity. Psychological or even psychiatric support can also be provided if necessary. Objectives: train the patient, (re)give him confidence and facilitate his commitment to the care project.
Finally, it is important to support these new lifestyle habits over the long term, whether or not they are associated with surgical or medicinal treatment.
Avoiding interruptions in care: coordination of all for global monitoring
Consultation and coordination of professionals involved in the care pathway should make it possible to better care for the patient, provide better support and avoid any disruption in care, particularly if obesity leads to other illnesses.
The general practitioner, on the front line, knows his patient. Its intervention is summarized in four actions, the 4 Ds: Screen, Diagnose, Discuss, Decide together. Depending on the case, he can rely on a team of city professionals, such as the dietician, the nurse, the adapted physical activity professional, the psychologist or even the social worker. Eight sheets describe the role of each professional in the process: how to intervene and when.
In situations of complex or severe obesity, the general practitioner may call on a doctor specializing in obesity, a specialized hospital team or a specialized obesity center (CSO). He remains the coordinator and monitors his patient at each stage of the journey, particularly in the context of bariatric surgery.
While we have observed an increase in the number of bariatric surgeries in France in recent years, the HAS points out that this practice is not indicated in all situations. It should be used as a last resort and should not be performed on children except in exceptional cases. It involves preparation of at least six months, specific regular monitoring following the intervention and lifelong monitoring of the state of health while maintaining changes in lifestyle habits. However, today only 50% of operated patients benefit from a two-year follow-up. After five, ten, fifteen years, this percentage decreases.
Be attentive to any form of stigma and self-stigma « Through this process, we offer solutions to prevent and support situations of stigma and self-stigma that may be reported. This involves raising awareness among professionals. We know that a simple look can sometimes affect the doctor-patient relationship, as can the choice of words and the environment in which it is received. It is essential to adopt a posture of non-judgment and listening towards people who are overweight or obese, I am thinking in particular of adolescents. Patient engagement in their care depends on it. » Professor Lionel Collet, president of HASPanorama of HAS work on overweight and obesity
[1] Body mass index greater than or equal to 30
[2] Body mass index greater than 25 and less than 30
[3] Sedentary lifestyle corresponds to the time spent sitting or lying down without other physical activity between getting up and going to bed, as well as the static standing position.
Press release, HAS, February 28, 2024
1709149582
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