Obésité de type complexe : à la jonction entre obésité développementale et réactionnelle

Abstract

ContextWhether medical or surgical, the management of obesity faces significant resistance to weight loss. In this context, Bruch's work (1973) on the concepts of developmental and reactive obesity is foundational for clinical practice. However, in the most severe cases of obesity, these concepts can be reductionist and can limit the complexity observed when caring for these patients. These questions are particularly present in hospital services that handle third-level care, especially in Specialized Obesity Centers. ObjectivesUsing a clinical vignette, we will illustrate the utility of the concept of complex obesity and emphasize the therapeutic challenges in the management of patients requiring third-level care, as defined by the Health Authority. MethodIn the context of research on obesity and trauma, we present a clinical vignette of a patient treated in a specialized obesity service. We rely on data collected during clinical research interviews. ResultsThis singular case highlights the challenge regularly faced by clinicians in differentiating developmental and reactive types of obesity. Indeed, listening to the life stories of patients with severe obesity often reveals a construction of this chronic disease through successive layers. Thus, including patients in a single typology would overlook fundamental aspects involved in the onset of their obesity. Faced with this difficulty, we suggest introducing the notion of complex obesity, which would precisely account for situations at the intersection between developmental and reactive obesity. The relevance of developing this third typology becomes clinically meaningful, allowing questioning of the proposed accompaniments, particularly for level 3 interventions. ConclusionThe use of this third typology is now necessary to consider issues of resistance to weight loss and to highlight the complexity of the psychogenic origin of this disease in interdisciplinary exchanges. These reflections also question the relevance of treatments that prioritize urgent weight loss. Thus, we emphasize the importance of focusing on individuals’ intrapsychic functioning of and on promoting long-term historical work. Finally, we propose several perspectives to address the challenges encountered in the transformations of hospital and healthcare institutions in France, and suggest research perspectives to demonstrate the long-term effectiveness of a comprehensive approach to individuals with obesity.