Published on
Updated
Reading 3 mins.
in collaboration with
Dr Arnaud Cocaul (Medical nutritionist)
In case of severe obesity, how to make the weight loss of these patients sustainable? What are the new parameters to take into account? On the occasion of the new recommendations of the High Authority of Health, we take stock with Dr Arnaud Cocaul, nutritionist doctor and member of the committee of experts of Doctissimo.
More than eight million people. This is the figure put forward by the Haute Autorité de Santé (HAS) which lists the number of people suffering from obesity in France, i.e. a figure up by 13% compared to 2012. Even more worrying, the severe forms have jumped 66%.
Add criteria to specify the disease
To fight against this scourge, the HAS is publishing new recommendations on June 23 for the care of adults with obesity. The objective is not limited to weight loss but aims to “improve the patient’s health and allow him to return to a lower level of severity”.
For this, she recommends keeping the waist circumference and the BMI, two criteria currently used but to “complete by integrating other parameters, such as the level of severity of the associated pathologies, the functional impact of obesity (shortness of breath, pain, etc.), the psychopathological context, the existence of a disability, eating behavior as well as the impact of the disease on the quality of personal or professional life”.
Very relevant new rules for Dr. Arnaud Cocaul, nutritionist, who “hope that they will be widely followed, especially by doctors”.
Lose weight, yes but not only
The use of different health professionals is also specified, depending on the stage of obesity: the general practitioner first, then a specialist doctor and finally the centers specializing in obesity (CSO) or university hospitals. The new recommendations recall that the objective is not only weight loss, but must also act on comorbidities, risk factors, quality of life or mobility.
For this, the indication of weight must be personalized on a case-by-case basis, after global assessment of the patient, taking into account his age, his comorbidities, his quality of life and his objectives. “Several studies have shown that listening and coaching were the keys to good follow-up of patients who manage their obesity. Unfortunately, there are still many health professionals who do not have the right approach to help their patients, making them feel guilty and stigmatizing their overweight” again denounces the doctor.
No diet but a balanced diet and physical activity
To lose weight gradually and sustainably, the HAS recommends adopting a Mediterranean-type diet, while reducing daily intake, but conversely advises against any kind of restrictive diet.
At the same time, the patient must adopt a balanced diet for optimal care. “It can take the form of relaxation and leisure activities (games, matches, sports, etc.), work or housework. indicates the HAS, which specifies that it will have to last at your choice: 2h30 to 3h per week, for moderate physical activity, 1h15 to 2h30 per week for intense physical activity, or combine the two.
Muscle strengthening is also strongly recommended as well as a limitation of sedentary lifestyle as much as possible, by walking or movement. “To be helped, I recommend that patients approach a hospital endocrinology service, they will be able to direct them to reliable health professionals who can help them in their weight loss.
NO to diets, YES to WW!
No medication, except in special cases
Therapeutic education programs are also set up by HAS, to make patients actors in their lasting change of lifestyle. Finally, the health authority does not mention drug treatment except in a specific case, “in the event of failure of nutritional management (less than 5% weight loss at six months), and if this has been well conducted in terms of eating behavior and patient involvement, a drug treatment can be considered“.