Regimes amaigrissants: lesquels conseiller/deconseiller? [Hypocaloric diets: which ones to advise/avoid?]

A hypocaloric diet, whatever the proposed type, is an inadapted treatment to chronic disease, like obesity. All diets are inefficient on the long term. The weight loss is generally small, about 1-2 kg a year. The results are the same, independently of the type of diet, and the patient's compliance is clearly the main key to succeed. About 80% of patients regain weight the first month following the diet, and only 1% can keep the obtained weight a year later. Nearly half of the patients involved in a diet program give up before the end. Finally, because of risks of macro and micro nutriments deficiency, certain diets are to be avoided and hypocaloric diet shouldn't be proposed

Nutrition--obesite. [Nutrition--obesity]

The gastric pacemaker is a new obesity treatment, which pleases by its simplicity and obvious lack of complications on the nutritional level. Its long-term efficacy is however to be confirmed and the criterions of the patients' selection to be defined. The rimonabant is a selective antagonist of the cannabinoid CBI receptor, able to reduce the quantity of the total food intake, and especially the greasy one. The first results on the short term look promising. The multiplication of food pyramids is the consequence of the scientific knowledge development in the nutritional field. On this basis, new pyramids are adapted, depending on the therapeutic objectives (weight loss, cardiovascular risk) and allowing either quantity or quality food. The taking charge of patients in group and according to the therapeutic education criterions makes easy a relation between the medical team and patients and allows these latters a better awareness of their disease and its long term treatment

Edulcorants: entre mythe et réalité [Sweeteners: between myth and reality]

As the prevalence of obesity and diabetes are continually increasing, the use of "false sugars" otherwise known as sweeteners, and their associated health issues are being more and more discussed. A higher sugared power, less calories as well as a moderated or non-existent effect on blood sugar would lead to believe that sweeteners are helpful. However, we CANNOT say that they are THE solution as they can contain calories, may have some undesired effects, and moreover they ease the conscience without actually allowing a weight loss with their sole use. They are to be used with judgment, wittingly and especially when comparing sweetened products. The sweetener myth is often far from reality. It is therefore important to give our patients the means to analyze their dietary intake with regard to their sweeteners ingestion

Comment faciliter la consommation de protéines après un bypass gastrique [How to facilitate protein consumption after gastric bypass?].

After a gastric bypass, covering protein needs is impossible. This deficit is co-responsible for several postoperative complications so it is essential to inform, prepare and train every patient candidate for such an intervention. To increase protein intake, it is important to work on two different aspects: on the one hand on food sources, targeting the richest food and, on the other hand, on food tolerance so that these foods can be consumed. In fact, gastric bypass induces not only a reduction in gastric volume, but also reduces the passage from the stomach to the intestine. Changes in feeding behavior are much needed to improve food tolerance

Lorsque le patient obèse ne perd pas de poids ou continue a en prendre... [When the obese patient can't lose any weight or keeps putting some on].

The traditional obesity treatments have proven to be ineffective in the long-term. The presence of eating disorders frequently explains this phenomena. Eating educational and behavioral aspects must be addressed in a practical way so that patients could gradually become aware of their behavior towards food as well as internal sensations associated with hunger, satiety, craving and pleasure. Finally, the link between emotions and compulsive eating behaviors during and between meals is an essential aspect that the general practitioner can help the patient to understand. A specialized psychological treatment can then be considered when the patient shows sufficient motivation and consciousness

Prise en charge pluridisciplinaire des syndromes de dumping après chirurgie bariatrique [Multidisciplinary management of dumping syndromes after bariatric surgery]

Dumping syndromes are a frequent complication of gastric or bariatric surgery and include early and late dumping. Early dumping is a consequence of rapid delivery of hyperosmolar nutrients into the bowel. Late dumping is the result of a reactive hypoglycemia induced by a hyperinsulinemic response. These syndromes are becoming increasingly prevalent with the rising incidence of bariatric surgery. Effective management of these complications requires multidisciplinary collaboration. First line management of early and late dumping syndrome involves specific dietary and behavioral modifications which generally improve the quality of life of patients

Effect of physical exercise on glycogen turnover and net substrate utilization according to the nutritional state.

To determine the metabolic effects of a single bout of exercise performed after a meal or in the fasting state, nine healthy subjects were studied over two 8-h periods during which net substrate oxidation was monitored by indirect calorimetry. On one occasion, exercise was performed 90 min after ingestion of a meal labeled with [U-13C]glucose [protocol meal-exercise (M-E)]. On the second occasion, exercise was performed after an overnight fast and was followed 30 min later by ingestion of an identical meal [protocol exercise-meal (E-M)]. Energy balances were similar in both protocols, but carbohydrate balance was positive (42.2 +/- 5.1 g), and lipid balance was negative (-11.1 +/- 2.0) during E-M, whereas they were nearly even during M-E. Total glycogen synthesis was calculated as carbohydrate intake minus oxidation of exogenous 13C-labeled carbohydrate (calculated from 13CO2 production). Total glycogen synthesis was increased by 90% (from 47.6 +/- 3.8 to 90.7 +/- 5.4 g, P < 0.0001) during E-M vs. M-E. Endogenous glycogen breakdown was calculated as net carbohydrate oxidation minus oxidation of exogenous carbohydrate and was increased by 44% (from 35.8 +/- 5.6 to 51.7 +/- 6.6 g, P < 0.004) during E-M. It is concluded that exercise performed in the fasting state stimulates glycogen turnover and fat oxidation

Compliance to dietary advice directed towards increasing the carbohydrate to fat ratio of the everyday diet.

OBJECTIVE: To assess the effects, on food intake, body weight and body composition, of compliance to advice aiming at increasing the carbohydrate to fat ratio of the everyday diet without imposing voluntary restriction on the amount of food consumed. DESIGN: Eight moderately overweight women (body mass index > 27 kg/m2, relative body fat mass > 30%) received dietary advice during a 2 month period. Additionally, each evening the subjects had to consume a meal artificially enriched with 13C-glucose in order to assess their compliance from the 13CO2 enrichment in expired air. MEASUREMENTS: Dietary intakes, body weight, body composition and individual compliance. RESULTS: The energy derived from fat decreased from 44 +/- 1% to 31 +/- 1% and the proportion of carbohydrate increased from 38 +/- 2% to 50 +/- 1%, whereas the absolute carbohydrate intake remained constant (182 +/- 18 g/d). Energy intake decreased by 1569 +/- 520 kJ/d. There was a net loss of fat mass (1.7 +/- 0.7 kg, P = 0.016) with fat free mass maintenance. Dietary compliance ranged from 20 to 93% (mean: 60 +/- 8%) and was positively correlated to the loss of body fat mass. CONCLUSION: Advice aiming at increasing diet's carbohydrate to fat ratio induces a loss of fat mass with fat-free mass maintenance