Cette étude vise à évaluer à l’aide d’une analyse factorielle, les liens qui peuvent exister entre les composantes psychologiques, psychopathologiques, certaines composantes socio-développementales et la sévérité de l’obésité ainsi que la compliance au traitement dans une population d’adolescents souffrant d’obésité sévère hospitalisée pour une perte pondérale. Nos résultats ont mis en évidence qu’une plus grande sévérité de l’obésité s’associait à des facteurs d’environnement défavorisant (troubles mentaux dans la famille, carences, maltraitance) et à la présence d’un profil psychopathologique. De plus, ces mêmes modalités étaient associées avec une compliance familiale et individuelle moins importante. Nous avons de ce fait, discuté l’idée que l’obésité pourrait se concevoir comme ayant une fonction adaptative que ces sujets auraient trouvé face aux expériences familiales traumatiques vécues. Mais si l’obésité a une fonction adaptative, la perte pondérale aurait de ce fait des implications psychologiques plus profondes, rendant sa prise en charge et son évolution plus complexes.

The prevalence of paediatric obesity is high in most countries. Added to this, the degree of paediatric obesity is also on the rise. It is however to be noted that although the psychological causes of the problem are well known, they remain difficult to assess. Facing the great number of adolescents suffering from severe obesity, who are looking for treatment and failing to find one, this survey aims at facts-finding and analyses of the psychological and psychopathological origin and associated severity of obesity, and of the parameters that can lead to a successful treatment.

This survey has been carried out among 125 adolescents suffering from grade 2 obesity. To lose weight, the adolescents were treated during 1 year at the boarding dietary department of the “Institut Médical Pédiatrique Clairs-Vallons” in Belgium. The evaluation consists in a type CFTMEA-R-2000 psychopathological diagnosis including previous traumatic factors, taking into consideration the information regarding weight, weight evolution over one year and a quality assessment of the compliance of the patient with the treatment. These data have been submitted to the SPADN statistical program in order to carry out an analysis taking into account the various connections.

Our results have underlined that the severity of the obesity in our population can be coupled with pathological family environment factors such as mental illness, care deficiencies, child abuse and, as a result, the presence of a psychopathological diagnosis. The same can be said in cases of lesser compliance with the treatment by the patient and his family, although in the short term the weight loss is greater. Likewise, a less severe obesity and a better compliance with the treatment can be coupled with the absence of both psychopathological diagnosis and pathological family environment.

In our sample population, the psychological and psychopathological factors tend to be linked with a more severe obesity, and less good compliance with the treatment on both individual and family accounts. As a result, obesity could be considered as a way for the patient to adapt him/herself or compensate in front of traumatic family experiences. The isolation from the family seems therefore indispensable for any change in the adolescent, but then raises the problem of long term care after hospitalisation. If obesity is an adaptation process, the loss of weight could then have deeper psychological implications, implying a more complex follow-up of the patient.