Obesity In France Research Articles

Actualités de la pharmacothérapie de l’obésité en 2023: Novelties in obesity pharmacotherapy in 2023

Significant progress have been made in the management of obesity thanks to the emergence of effective drug treatments, combined with dietary advice and regular physical activity. Unlike previous drugs tested, these new therapies allow for significant weight loss without serious side effects. They act primarily by increasing feelings of satiety and reducing food intake without frustration. GLP1 receptor agonists, such as liraglutide and semaglutide, are already recommended therapeutic options for the management of obesity in France. This review examines the mechanisms, efficacy, and side effects of the main drugs currently available on prescription.© 2023 Société francophone nutrition clinique et métabolisme (SFNCM).Published by Elsevier Masson SAS. All rights reserved.

Obesity-related complications, healthcare resource use and weight loss strategies in six European countries: the RESOURCE survey

BackgroundObesity-related complications (ORCs), such as type 2 diabetes (T2D) and cardiovascular disease, contribute considerably to the clinical and economic impacts of obesity. To obtain a holistic overview of health and weight management attempts for people with obesity in Europe, we designed the cross-sectional RESOURCE survey to collect data on comorbidities, healthcare resource use (HCRU) and weight loss strategies from people with obesity in France, Germany, Italy, Spain, Sweden and the UK.MethodsAdults (≥18 years old) with self-reported body mass index (BMI) ≥30 kg/m2 who reported interacting with primary or secondary healthcare services in the past 12 months, but had not been pregnant during this time, were recruited from an existing consumer research panel. All data were self-reported via an online survey (May–June 2021). Weight changes over the past year were calculated from participants’ estimated weights.ResultsOf the 1850 participants in the survey, 26.3% reported that they had ≥3 ORCs from a set of 15 conditions of interest. The most frequently reported ORCs were hypertension (39.3% of participants), dyslipidaemia (22.8%) and T2D (17.5%). Participants in obesity class III (BMI 40 to <70 kg/m2) were more likely to report multiple ORCs than those in lower obesity classes. The presence of multiple ORCs was linked to various types of HCRU, including a significantly increased chance of reporting hospitalization in the past year. Most participants (78.6%) had attempted to lose weight in the past year, but of those who also reported estimated weight changes, 73.4% had not experienced clinically meaningful weight loss of ≥5%.ConclusionsORCs are common in people with obesity, and are linked to increased HCRU. Together with the low reported success rate of weight loss attempts, this highlights an unmet need in Europe for enhanced weight management support for people with obesity.

Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trial

Non-invasive ventilation (NIV) and oxygen therapy (high-flow nasal oxygen [HFNO] or standard oxygen) following extubation have never been compared in critically ill patients with obesity. We aimed to compare NIV (alternating with HFNO or standard oxygen) and oxygen therapy (HFNO or standard oxygen) following extubation of critically ill patients with obesity. In this multicentre, parallel group, pragmatic randomised controlled trial, conducted in 39 intensive care units in France, critically ill patients with obesity undergoing extubation were randomly assigned (1:1) to either the NIV group or the oxygen therapy group. Two randomisations were performed: first, randomisation to either NIV or oxygen therapy, and second, randomisation to either HFNO or standard oxygen (also 1:1), which was nested within the first randomisation. Blinding of the randomisation was not possible, but the statistician was masked to group assignment. The primary outcome was treatment failure within 3 days after extubation, a composite of reintubation for mechanical ventilation, switch to the other study treatment, or premature discontinuation of study treatment. The primary outcome was analysed by intention to treat. Effect of medical and surgical status was assessed. The reintubation within 3 days was analysed by intention to treat and after a post-hoc crossover analysis. This study is registered with ClinicalTrials.gov, number NCT04014920. From Oct 2, 2019, to July 17, 2021, of the 1650 screened patients, 981 were enrolled. Treatment failure occurred in 66 (13·5%) of 490 patients in the NIV group and in 130 (26·5%) of 491 patients in the oxygen-therapy group (relative risk 0·43; 95% CI 0·31-0·60, p<0·0001). Medical or surgical status did not modify the effect of NIV group on the treatment-failure rate. Reintubation within 3 days after extubation was similar in the non-invasive ventilation group and in the oxygen therapy group in the intention-to-treat analysis (48 (10%) of 490 patients and 59 (12%) of 491 patients, p=0·26) and lower in the NIV group than in the oxygen-therapy group in the post-hoc cross-over (51 (9%) of 560 patients and 56 (13%) of 421 patients, p=0·037) analysis. No severe adverse events were reported. Among critically ill adults with obesity undergoing extubation, the use of NIV was effective to reduce treatment-failure within 3 days. Our results are relevant to clinical practice, supporting the use of NIV after extubation of critically ill patients with obesity. However, most of the difference in the primary outcome was due to patients in the oxygen therapy group switching to NIV, and more evidence is needed to conclude that an NIV strategy leads to improved patient-centred outcomes. French Ministry of Health.

Intermittent non-invasive ventilation to prevent post-extubation treatment failure in patients with obesity

Over the past 20 years, the use of non-invasive ventilation (NIV) has increased in acutely ill patients. More recently, the use of high flow nasal cannula (HFNC) has received clinical interest. NIV or HFNC, or both, is used either to avoid endotracheal intubation or to prevent re-intubation in patients at risk for extubation failure. Clinical practice guidelines inform the appropriate use of NIV 1 Rochwerg B Brochard L Elliott MW et al. Official ERS/ATS clinical practice guidelines: noninvasive ventilation for acute respiratory failure. Eur Respir J. 2017; 501602426 Crossref PubMed Scopus (728) Google Scholar and HFNC. 2 Rochwerg B Einav S Chaudhuri D et al. The role for high flow nasal cannula as a respiratory support strategy in adults: a clinical practice guideline. Intensive Care Med. 2020; 46: 2226-2237 Crossref PubMed Scopus (104) Google Scholar Effect of non-invasive ventilation after extubation in critically ill patients with obesity in France: a multicentre, unblinded, pragmatic randomised clinical trialAmong critically ill adults with obesity undergoing extubation, the use of NIV was effective to reduce treatment-failure within 3 days. Our results are relevant to clinical practice, supporting the use of NIV after extubation of critically ill patients with obesity. However, most of the difference in the primary outcome was due to patients in the oxygen therapy group switching to NIV, and more evidence is needed to conclude that an NIV strategy leads to improved patient-centred outcomes. Full-Text PDF

Self-efficacy of participants in a holistic intervention to reduce unemployment and obesity in France and England

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Spatial spillovers, living environment and obesity in France: Evidence from a spatial econometric framework

In 2019, obesity affected 17% of French adults. In this article, we use a unique data set that combines individual-level health and consumption data with living environment data (food, sports and health amenities). We develop a spatial econometric framework to address French health disparities in obesity prevalence across space. We find that regulations on fast food restaurant locations could be a policy instrument to counter the prevalence of obesity. We also establish the existence of spatial spillovers of sports and medical amenities on obesity. This new evidence points to the need to consider a wider context than just the immediate local environment in the fight against the obesity pandemic.

Prevalence of overweight, obesity, and early adiposity rebound in nursery school children in southeastern France

BackgroundThe aim of the present study was to assess the prevalence of overweight, obesity, and early adiposity rebound in nursery school children aged 3.5–4.5 years and to evaluate associations with deprivation. MethodsA cross-sectional study was conducted in the Bouches-du-Rhône department in southeastern France. Data for all nursery school children aged 3.5–4.5 years were collected during systematic medical examinations. The prevalence of overweight and obesity was determined using French, International Obesity Task Force (IOTF), and World Health Organization reference values. A French ecological deprivation index was used to assess associations with deprivation. ResultsAmong 19,295 children included in the study, the prevalence of overweight (IOTF-25 < BMI < IOTF-30) was 9.1% and the prevalence of obesity (BMI > IOTF-30) was 2.6%. Children attending nursery schools in the most disadvantaged areas were 4.3 times more likely to be affected by obesity than those from schools in the most advantaged areas (OR: 4.32; 95% CI: 2.98–6.25, p < 0.001), after adjusting for gender, age group, and school status. Early adiposity rebound was observed in 2131 of 9872 children (21.6%). ConclusionPrograms to prevent childhood overweight and obesity in France should be intensified and take account of major persistent social inequalities. Medical practitioners should learn to systematically assess BMI curve dynamics and early adiposity rebound.

COVID-19: A Lever for the Recognition of Obesity as a Disease? The French Experience.

Despite repeated efforts by the international scientific community, academic societies and the combined actions of patient associations, public authorities have difficulties in admitting that obesity is not just a risk factor but a disease. Could our current experience with the COVID-19 pandemic be a lever to advance the cause of people with obesity? In this crisis, it seems pertinent to report on the French experience with the actions of stakeholders that were able to challenge the status quo in this field.

A FRENCH PARADOX?

The French news media has framed “obesity” largely as a product of corporate greed and social inequality. Yet, France has—like other nations including the United States—adopted policies that focus on changing individual-level behavior. This article identifies several factors—including food industry lobbying, the Ministry of Agriculture’s rivalry with the Ministry of Health and alliance with the food industry, and competition with other policy goals—that favored the development of individual-level policy approaches to obesity in France at the expense of social-structural ones. This case points to the need to more systematically document inconsistencies and consistencies between social problem framing and policies. It also shows that national culture is multivalent and internally contradictory, fueling political and social struggles over which version of national culture will prevail at any given moment.

Impact of Bariatric Surgery on Bone Mineral Density: Observational Study of 110 Patients Followed up in a Specialized Center for the Treatment of Obesity in France.

Bariatric surgery is used to treat severe obesity. We aimed to investigate the incidence of clinically significant bone mineral density (BMD) loss at 6 and 12months after bariatric surgery. Observational study performed in a specialized center for the treatment of obesity at the University Hospital of Reims, France. Surface BMD was measured by dual x-ray absorptiometry (DEXA). A reduction of > 0.03g/cm2 was considered clinically significant. A total of 110 patients were included. A clinically significant reduction in BMD was observed in 62.1% of patients at 6months, and in 71.6% at 12months after surgery. No case of osteoporosis was observed. There were four cases of osteopenia and one fracture post-surgery. BMD loss was related by univariate analysis to the reduction in body mass index (BMI) (p<0.01), weight loss (p<0.01), fat mass (p<0.01), and lean mass (p<0.01). Multivariable analysis found a significant association between the reduction in BMD and the excess weight loss percentage (odds ratio 1.11, 95% confidence interval (1.05-1.18), p< 0.001). There was a clinically significant reduction in BMD at 6months after surgery in over 60% of patients undergoing bariatric surgery. BMD loss is persistent over time and predominantly situated at the femoral level, and strongly associated with weight loss. Systematic vitamin and calcium supplementation, as well as follow-up by DEXA scan seems appropriate. Systematic DEXA scan pre- and post-surgery, and annually thereafter until weight has stabilized seems appropriate.

Differential Associations Between Excess Body Weight and Psychiatric Disorders in Men and Women

The current investigation is the first large-scale population-based study from France that documents the association between excess body weight and common psychiatric disorders, and examines the influence of gender on the association between excess body weight and these disorders. A recent plan has been implemented in France to treat the rising rate of those who are overweight or obese, and we seek to demonstrate whether integrated treatment of excess weight and psychiatric conditions appears as indicated. Data were drawn from a cross-sectional general population survey of 17,237 adults. Past-year psychiatric disorders were assessed using the Composite International Diagnostic Interview-Short Form. Body mass index was used to determine excess weight status. Overall, 3.7% of the sample were underweight, 57% were normal weight, 28% were overweight (35% of men, 22% of women), and 11% were obese (11% of men, 11% of women). Being overweight was more common in men than women, although obesity did not differ by gender. Sociodemographic variables significantly associated with weight status included, age, marital status, education, employment status, income level, and population density. Adjusting for these variables, being overweight was associated with major depression and other disorders among women and inversely associated with drug abuse and dependence among men. Obesity was associated with major depression, panic disorder, agoraphobia, social phobia, specific phobia, and obsessive-compulsive disorder among women. Only generalized anxiety was associated with obesity among men. Past year, mental disorders were more likely associated with being overweight or obese among women as compared with men. The prevalence of these co-occurring psychiatric disorders in the context of the rising rate of obesity in France indicates a clear need for psychiatric assessment and treatment in caring for those with excess weight, especially women. Preliminary reports suggest this need is unmet within the otherwise progressive move in France to assist those struggling with excess weight.

Obesity and handling: Unspoiled ability of lifting but lower aerobic capacities

The rise of the prevalence of obesity in France is more important for blue collars (workers, farmers) than white collars, and these patients are particularly exposed to activities of lifting. The principal objective of this study is to search differences in abilities of maximal lifting, aerobic capacities and endurance of the spinal extensors, which are determinants of ability of lifting, between obese and non obese patients with chronic musculoskeletal pain. A progressive iso-inertial lifting evaluation, a Sorensen test and a cycloergometer exercise test with VO 2 measurement were performed on 321 patients hospitalized in the unit of Physical Medicine and Rehabilitation of the hospital of Château-Renault for rehabilitation for a chronic pain syndrome. The maximum weight lifted during PILE test (in kilogram) was more important in obese patients ( n = 65) than in non-obese patients ( n = 166), and the difference was in the limit of significativity ( p = 0.0472). On the other hand, the maximal weight lifted during PILE test in percentage of body weight was more important in non-obese patients than in obese patients ( p = 0.0397). There was non-significant difference in the relative cardiac cost between obese and non-obese patients for this test. There was no significant difference in the results of Sorensen test and relative cardiac cost of Sorensen test between obese and non-obese patients. On the other hand, the VO 2max and VO 2 at the aerobic threshold (SV1) were significantly lower in obese patients (respectively p = 0.0001 and p = 0.0489). The ability of lifting keeps is unspoiled in obese patients, considering absolute value, but the aerobic capacities are lower than non obese patients, which shows a lower resistance to tiredness in obese patients, probably in relation to insulin resistance of skeletal muscle.

Obésité maternelle et grossesse : évolution de la prévalence et du lieu d’accouchement à partir des données AUDIPOG

The primary objective was to describe the evolution of the prevalence of maternal obesity in France. The secondary objectives were to assess changes in the French regions and the place of birth according to type (public/private) and level of care. Study based population of all births between 1999 and 2009 included in the AUDIPOG database. Our judgment criterion was the body mass index (BMI) divided into classes. Seventy-four thousand and forty-six pregnancies were included. The mean BMI was 22.9±4.5kg/m(2) with an increase between 1999-2001 and 2008-2009 (22.6±4.3kg/m(2) versus 23.1±4.7kg/m(2), P<10(-4)). North was the first region in terms of overweight patients (18%) and obese (10.2%). There was an increase of the birth rate in public maternity, and level II and III regardless of BMI class. Only the class of patients with a BMI ≥40kg/m(2) delivered more frequently in level III with an increase between the first and the last period of the study (20.8% versus 36.8%, P=0.02). The BMI is still increasing with more and more patients with a BMI ≥40kg/m(2) referred to level III. This raises the question of the organization of care and follow-up of these patients.

Obesity in HIV-infected patients in France: Prevalence and surgical treatment options

Increasing rate of obesity was reported in HIV-infected patients in USA. In France, no data are available to date. Bariatric surgery is the best option for morbid obesity in general population but few data exist in HIV-infected patients. We describe the prevalence of obesity in France in HIV-infected patients. The prevalence of obesity is 15.1% in women and 5.3% in men. Moreover, we described our experience and point of view in the management of HIV infected patients with morbid obesity. Prospective studies are needed for an optimal management of HIV-infected patients with morbid obesity.

Household food consumption, individual caloric intake and obesity in France

Using 2 years of home scanned data on household food purchases in France, we show how to infer the profile of average individual caloric intakes according to gender, age, and body mass index of household members. We also infer the individual consumption of macronutrients as carbohydrates, lipids or proteins. We then provide a descriptive analysis of eating in France over a long period of consumption that we compare to nutritional recommendations given by the French National Health and Nutrition Program. The results suggest that French people eat too much fats and proteins and not enough carbohydrates with respect to recommendations. They also show that obese or overweight individuals consume more calories at all ages and their consumption of fat is 20 % higher than normal individuals, meaning that public policies should aim at reducing fat consumption. We also find that the obesity of teenage boys cannot be explained by different food consumption as their dietary intake profiles are similar to other teenagers. Promoting physical activity for boys rather than public policies reducing food consumption could be more efficient.

Overweight, obesity and cancer risks

The prevalence of overweight and obesity is high and has been increasing since the 90s in the population living in France. However a decreasing trend has been observed which remains to be confirmed. Obesity currently concerns from 9 to 17% of adults and 3.5% of children. Overweight and obesity are recognized as cancer risks for certain locations but according different risk increases percentages: endometrial cancer, esophagus, kidney, colon, gallbladder, postmenopausal breast cancer, pancreas and rectum. There is also a moderate increased risk for multiple myeloma, leukemia and non-Hodgkin lymphoma. According to studies, 1.4 to 3% of cancers in men and 2.3 to 6% in women are attributable to overweight and obesity in France. It has been estimated that in 2000 in France, about 2300 cancer deaths were attributable to these risk factors (i.e.1.6% o all cancer deaths) Furthermore, these two factors increase the risks of recurrence, second cancers and overall or cancer mortality. An obesity plan was launched in France over the 2010–2013 period in order to reduce the prevalence of overweight and its consequences on health.

EPODE—A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities

Obesity is a global epidemic: it is estimated that the majority of the world’s adults will be overweight or obese by 2030. It is therefore important to reverse trends toward increasing childhood obesity by interventions at the community level. Ensemble Prévenons l’Obésité Des Enfants (EPODE, Together Let’s Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multistakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.

PDB67 Treatment Patterns and Health Outcomes Among Type 2 Diabetes with Comorbid Obesity in France, Germany, And UK

PDB67 Treatment Patterns and Health Outcomes Among Type 2 Diabetes with Comorbid Obesity in France, Germany, And UK

Derek J Oddy, Peter J Atkins, Virginia Amilien (eds), The rise of obesity in Europe: a twentieth century food history, Farnham, Surrey, and Burlington, VT, Ashgate, 2009, pp. xv, 246, £60.00 (hardback 978-0-7546-7696-6).

Derek J Oddy, Peter J Atkins, Virginia Amilien (eds), The rise of obesity in Europe: a twentieth century food history, Farnham, Surrey, and Burlington, VT, Ashgate, 2009, pp. xv, 246, £60.00 (hardback 978-0-7546-7696-6). - Volume 54 Issue 4

EPODE - A Model for Reducing the Incidence of Obesity and Weight-related Comorbidities.

Obesity is a global epidemic: it is estimated that the majority of the world's adults will be overweight or obese by 2030. It is therefore important to reverse trends towards increasing childhood obesity by interventions at the community level. Ensemble Prévenons l'obésité Des Enfants (EPODE, Together Let's Prevent Childhood Obesity) is a large-scale, coordinated, capacity-building approach for communities to implement effective and sustainable strategies to address this challenge. EPODE comprises four critical components: political commitment, public and private partnerships, community-based actions, and evaluation. The multi-stakeholder approach promoted through the EPODE methodology has already shown encouraging results in preventing childhood obesity in France and Belgium and has reduced the socioeconomic gap in obesity prevalence in France. The EPODE methodology has now been implemented in a number of countries worldwide, and provides a valuable model that may be applicable to other lifestyle-related diseases.