Interventions psychologiques auprès des patients obèses candidats à la chirurgie bariatrique : intérêt des ateliers psychoéducatifs à composante psychologique au sein d’un programme d’éducation thérapeutique du patient

Abstract

A multidisciplinary team working in the visceral surgery department of the Robert Picqué Army Training Hospital (HIARP) and the Bagatelle Protestant Health Center (MSPB) has set up a therapeutic education program for patients obese candidates for bariatric surgery. The intervention of the psychologist during the medical and surgical course of the patients are done in three stages: pre-operative clinical evaluation, animation of psycho-educational workshops and post-operative psychological support in support or for psychotherapeutic aim. In this interview, psychologist Laurent Brulin and dietician Hélène Lordon develop the first two axes and report on the benefits of the psycho-educational workshops observed in patients. The medico-psychological course of the patient candidate for bariatric surgery is marked by the recommendations of the Authority for Health (HAS), punctuated by medical, psychological and paramedical consultations. Post-operative psychological consultations seek to creat a therapeutic alliance, to reveal the subjective etiology of obesity in connection with traumatic life events, to assess the psychological, social and family repercussions linked to weight loss, to identify the motivations for change, as well as the correct application of medical and dietetic recommendations aimed at maintaining a healthy life style. Among the obese population, eating disorders, of which there are several clinical descriptions, are frequent. They question the primary or secondary nature of a mood disorder and refer to attachment bond problems characterized by emotional and affective or addictive disorders. The therapeutic education program participates in the process for the surgical project, promotes understanding of the disease and develops self-care or psychological skills. Educational workshops with a psychological component promote the psychic maturation of the bariatric surgery project thought individual and collective speaking times. The group's cohesion contrasts with the feeling of isolation, stigma and social discrimination felt. On a psychological level, the psychologist's interventions in three specific works hop aims at differentiating between self-esteem and body image, then putting patients’ expectations regarding the effects of bariatric surgery. Emotional expression, introspection, psychic elaboration, inter-subjective sharing of personal experiences are favored. After the intervention, the obese patient benefits from long-term support by the dietician and the surgeon, as well as psychological consultations at his request, promoting psychic rearrangements linked to the modification of the body image and tending to strength then the self esteem.