Evaluations de la prise en charge multidisciplinaire en hospitalisation complète de l'adolescent obèse : apports de l'étude de la variation du métabolome et recherche de marqueurs précoces du pronostic

Obesity in childhood must be considered as a major issue in Public Health. Since the 1970s, all developed countries must have faced an increasing prevalence of this metabolic disorder. However since the epidemic of obesity has multifactorial causes, and without the availability of a positive benefit/risk balance for chemical drugs and clear-cut indications for bariatric surgery, it is easy to understand that obesity is a complex issue. This complexity induced different schemes of care the comparison of which is made difficult by the absence of clear criteria for judging therapeutic efficacy. This work was aimed to determine the efficacy of a 8-months residential treatment program performed by a multidisciplinary team in the Care Centre “Les Oiseaux”. In order to demonstrate whether the treatment was of benefit for the patients, 1063 of those treated between 1991 and 2007 have been included in a retrospective study. 746 patients returned the questionnaire after 2 years and 185 patients, 5 years later. Among these patients 75 % were actually able to control their weight since they maintained at least half their weight loss. To unveil early parameters of therapeutic efficacy, we have set up a monitoring record of more than 895 clinical, psychological, and biological parameters as well as an accurate recording of the physical activity of adolescents during their stay in the Care Centre. In addition a metabolic profiling of urine samples has been performed. Each parameter was tested for its discrepancy power as well as its practical aspects. Sixteen female adolescents have then been followed for the duration of their stay according to our monitoring program. By multivariate analysis, we deduced that the maintaining of their weight loss was positively correlated with the psychological care, the family involvement, as well as the ability to keep a sufficient physical activity, which was sustained by the recovery of their self-esteem.