It’s a “fight of a lifetime”, underlines Professor Pierre-Louis Druais, general practitioner, vice-president of the CRPPI, during the presentation to the press Works of the High Authority for Health (HAS) for comprehensive care in the face of overweight and obesity. Obesity, which affects 17% of adults in France, is a chronic disease “complex and multifactorial”. As a reminder, according to the WHO, “overweight and obesity are defined as abnormal or excessive accumulation of fat, which is detrimental to health. A person is considered overweight when their body mass index (BMI) is greater than 25 and is obese when it is greater than 30″. Obesity impacts quality of life with the onset of diseases such as type 2 diabetes or reduced life expectancy and can also lead to stigma.
Obesity and stigma: how to spot it and how to act?
“Social stigma refers to the reactions of individuals towards overweight or obese people, whether in everyday life or in the healthcare environment”, specifies the High Authority of Health. To this can be added the“self-stigma which makes relationships with others even more difficult”, adds Marie Citrini, user-expert, member of the recommendations, relevance, pathways and indicators commission (CRPPI). “It can lead to both physical and psychological consequences such as a loss of self-esteem, self-confidence, depressionsuicidal thoughts, withdrawal from social life, avoidance of care, loss of motivation”underlines the HAS.
But then how to react? The HAS plan calls on health professionals to ask the patient for “self-narrative” narrative “to actively access the lived experience of the person being cared for”, the aim being to identify its various consequences, whether psychological, economic or even behavioral. Likewise, specialists insist to health professionals on “the quality of his listening and communication”as well as sufficient consultation time.
Obesity: what is the doctor’s treatment?
Professor Pierre-Louis Druais, recalls the importance of posture “neutral and caring” of the general practitioner, emphasizing the fact of “do not send messages likely to create a break with the patient”. It is for the purpose “to improve prevention and personalize care and support for people” that the HAS recommends “the right sequence of care, at the right time and by the right professionals”.
Initially, this involves support for the modification of lifestyle habits of the patient, in taking into account their personal situation And “anticipating possible psychological, social, professional or academic difficulties”. Another point put forward by the authors, the importance of therapeutic education in order to educate the patient about their illness and offer them psychological follow-up if necessary. The aim being to “train the patient, (re)give him confidence and facilitate his commitment to the care project”.
For this support, the doctor is not alone and can surround himself with a doctor specializing in obesity, a specialized hospital team or a specialized obesity center (CSO), depending on the complexity of the case.
Obesity: HAS recalls the importance of continuity of care
Finally, the HAS emphasizes the need for continuity of care, particularly for cases of obesity leading to other illnesses. To do this, the general practitioner is “in the first line”, its action can be summed up in “four Ds” namely:
- Screen
- Diagnose
- Discuss
- Decide with the patient.
Also, faced with the increase in the number of bariatric surgery (modifies the anatomy of the digestive system editor’s note) in France, the authors point out that it “is not indicated in all situations” and to remember that she “must be used as a last resort and should not be performed on children, except in exceptional cases”. After this operation, medical monitoring is essential. Yet, “Today, only 50% of operated patients benefit from a two-year follow-up. After five, ten, fifteen years, this percentage decreases,” notes the HAS.
Sources:
- Press conference “Overweight and obesity: HAS will present its work for global care” – 02/28/2024
- Care pathway guide: adult overweight and obesity – Haute Autorité de santé