Ces obèses qui ne mangent pas

Lavoisier - Tập 9 - Trang 163-170 - 2013
S. Andrieux1, B. Gaudrat1, F. Mariau1, E. Mulliez2
1Unité de nutrition, centre hospitalier d’Arras, Arras, France
2Service de chirurgie viscérale et endocrinienne, centre hospitalier d’Arras, Arras, France

Tóm tắt

L’évaluation du patient obèse est un temps décisif dont l’enjeu est d’établir une solide alliance thérapeutique. Le poids n’étant qu’un symptôme, le temps d’évaluation doit, entre autre, comprendre les causes de la prise de poids et les mécanismes qui pérennisent l’excès de poids. Très souvent, l’évaluation conclut à une discordance entre ingesta et niveau d’excès de poids. Ce phénomène de sous-estimation, décrit il y a une trentaine d’années, est lié à la restriction cognitive des sujets. Cependant, les raisons qui « poussent » le patient obèse « évalué » à ne pas rapporter l’intégralité de ses apports alimentaires apparaissent plus complexes. Les référentiels, les normes et les codes de bonnes pratiques alimentaires semblent verrouiller les représentations du sujet et conditionnent son discours. La culpabilité biaise également l’évaluation en mettant le patient dans une situation inconfortable. Mais surtout, les troubles du comportement alimentaires responsables de la prise de poids, sont aujourd’hui trop méconnus pour être recherchés avec objectivité. Comprendre l’ensemble de ces mécanismes permettrait probablement de faciliter l’établissement d’une bonne alliance thérapeutique et d’améliorer la prise en charge de cette pathologie.

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