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Résultats d’une intervention pluridisciplinaire en thérapie comportementale, psycho-nutrition et activité physique sur les troubles alimentaires d’adultes en surpoids entre 2016 et 2018 - 13/01/21

Reducing Eating disorders with a multidisciplinary intervention containing cognitive therapy, nutrition and physical exercise in overweighed adults between years 2016 and 2018

Doi : 10.1016/j.amp.2020.12.015 
S. Rasson
 Hôpital privé de la Casamance, 33, boulevard des Farigoules, 13400 Aubagne, France 

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 January 2021

Résumé

Objectifs

Nous avons évalué la sévérité des troubles alimentaires de patients en surpoids avant et après un programme de soins pluridisciplinaires, chez des patients suivis entre 2016 et 2018.

Méthodes

Le programme comportait quatre volets : psychothérapie comportementale, psycho-nutrition, kinésithérapie et activité physique adaptée. L’objectif principal était d’observer les modifications du « Three Factors Eating Questionnaire » (TFEQ) avant et après le programme.

Résultats

Cent soixante-huit patients, dont la majorité avait des compulsions alimentaires (65,5 %), ont poursuivi l’intégralité du programme. Après intervention, le score moyen du TFEQ avait diminué (p<10−4), et ce de manière plus marquée chez les patients hors parcours de chirurgie bariatrique que chez les patients opérés ou en attente de chirurgie. Les facteurs F2 (désinhibition) et F3 (faim) ont également diminué, bien que le facteur F1 (restriction) n’était pas modifié, indépendamment de la prise en charge chirurgicale et de l’IMC.

Conclusions

La sévérité des troubles alimentaires a diminué après le programme sur les compulsions et la perception de la faim. Chez certains patients la diminution de la restriction pouvait induire une augmentation des ingestas. Ce type de programme pourrait être étendu à tous les patients en surpoids.

Le texte complet de cet article est disponible en PDF.

Abstract

Objectives

There is a growing need to build healthcare program addressed to overweighed and obese people suffering from eating disorders. The program named “Surpoids Objectif Forme Training” (SOFT) is dedicated to eating disorders care in overweighed people. In this study we wanted to assess severity of eating disorder before, and after the intervention with measuring Three Factors Eating Questionnaire (TFEQ) score in all patients who attended the program between years 2016 and 2018.

Materials and methods

SOFT is a multidisciplinary intervention organised for outpatients in Hospital La Casamance located in Aubagne, France. For each SOFT intervention lasting 10 weeks, patients were attending 40 sessions: 10 sessions in cognitive therapy in order to understand compulsive eating and to increase emotions skills (to recognize and to face emotions) and alternative behaviours; 10 sessions in psycho-nutrition with working on cognitive flexibility, connection to present and to senses (mindful eating) and recognizing sensations of hunger and satiating; 10 sessions of physiotherapy to get aware of body needs with hypopressive gymnastics and proprioceptive training; 10 sessions in adapted physical activity to encourage daily moderate physical activity and to introduce changes in patients way of living. This study was a prospective cohort study, in which we included all overweighed adults patients suffering from compulsive eating disorder including binge eating disorder and night eating syndrome. We wanted to assess TFEQ score before and after the program. We also measured Body Mass Index (BMI), bioelectrical impedance (muscle and fat mass), waist and hip circumferences, waist-hip ratio, endurance with 6minutes walking test and muscle strength.

Results

Two hundred and one patients were included and 168 followed the entire program. The average BMI in our group was 35kg/m2. Less than 25% of patients were suffering of binge eating disorder but most of patients had compulsive eating (65%). More than 50% of them had a TFEQ score higher than 25 before entering the program (average TFEQ was 25.2). After the program average TFEQ score had decreased from 25.2 to 20.0 (P<10−4), with only 17.9% of patients with a TFEQ score above 25. These results showed improvement of severity of eating disorders with our multidisciplinary intervention. The cognitive restraint factor (F1) was not significantly decreased after intervention (P=0.884), but disinhibition factor (F2) and hunger factor (F3) were significantly decreased (P<10−4 for both) showing less compulsive behaviours and better hunger perception. BMI was also decreased after the intervention from 35.8 to 35.5 (P=0.003). Waist hip ratio decreased from 0.86 to 0.85 (P=0.002) but muscle and fat mass were not significantly changed. Physical activity parameters were also improved, with 586 meters distance in 6minutes walking test instead of 499 meters (P<10−4) and 30 repetitions instead of 25 (P<10−4) in one minute sit-to-stand test.

Conclusions

Most of patients were female, usually more frequent in eating disorders patients. More than 65% of patients had compulsive disorders without BED, which shows probably numerous atypical forms. Severity of eating troubles was decreased after intervention in disinhibition and perception of hunger, but cognitive restriction was increased in some patients, probably because they were trying to lose weight during SOFT program. In the same way, despite of a significant loss of weight, there was no change in muscle and fat mass proportions after intervention. By the way reducing restriction was sometimes inducing increase of intakes in some patients, and as a result no change observed in average body fat mass and muscle mass. After intervention we also noticed that waist circumference, hip circumference and waist-hip ratio were significantly decreased, probably thanks to physical activity targeting posture and improving global physical condition. We observed also best performances in muscle strength (sit to stand test) and in endurance (6minutes walking test). Main limitations in this study were: a non-randomized non controlled study design; lack of long term assessment (which is very important for maintaining weight and avoid medical complications of overweighting) and no assessment of patient's quality of life after intervention as we think this is a great part of motivation to maintain long term changes of way of life. Despite these limitations, we hope that this program could be extended to all patients suffering from obesity and eating disorders with efficiency on eating behaviour. Changes in eating behaviour and in physical activity seem to be the first step to maintain weight at a long term perspective.

Le texte complet de cet article est disponible en PDF.

Mots clés : Compulsion, Programme de soins, Surpoids, Thérapie comportementale et cognitive, Trouble du comportement alimentaire

Keywords : Behavioral and cognitive therapy, Care program, Compulsion, Eating disorder, Overweight


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