The problem of obesity currently affects almost the entire planet.

In the world

According to a WHO press release dated March 1 ^, 2024, in 2022, 1 in 8 people worldwide were living with obesity . A new study published in The Lancet shows that in 2022, more than 1 billion people worldwide were living with obesity. Obesity among adults has more than doubled globally since 1990, and obesity among children and adolescents (aged 5 to 9) has quadrupled. The data also shows that 43% of adults were overweight in 2022.

It should be noted that overweight and obesity rank fourth^among risk factors for death, after high blood pressure, dietary risks, and smoking. Indeed, as a chronic, multifactorial, and progressive disease ranging from simple to severe and/or complex obesity, it is a major risk factor for the most common pathologies (cardiovascular diseases, type 2 diabetes, etc.). The psychological and social consequences, such as low self-esteem, depression, and stigmatization, are significant and detrimental.

• World Health Organization (WHO)
• Access to the Lancet Study

In France

By 2024, nearly half of the French population (48.8%) will be overweight and/or obese. 18.1% of adults in metropolitan France and its overseas departments and territories will be obese, representing almost 10 million people. In metropolitan France, the obesity rate will reach 17.9% (LCO EFEO 2024 study).

The call for projects conducted by the Regional Health Agencies following the instruction of July 29, 2011 relating to the implementation of the National Nutrition and Health Plan 3 and the obesity plan made it possible to identify 37 centers specializing in the management of severe obesity, centers present in metropolitan France and overseas.

• The 42 specialized obesity centers

The CSOs intervene in the third-level as defined by the French National Authority for Health (HAS). Details on the three levels of appeal follow.

To make healthcare services accessible and understandable for patients with obesity, these specialized centers are entrusted with two missions, carried out within the framework of national specifications. They operate as third-level regional referral centers:

• 1st mission^​ : to ensure multidisciplinary care for severe and/or complex obesity
  Based on:
  • specific skills: medical teams (nutritionists, endocrinologists, pediatricians, psychiatrists…), paramedical teams (dieticians, adapted physical activity professionals, psychologists, nurses, …) and surgical teams (team of surgeons and anesthesiologists specializing in bariatric surgery).
  • and a suitable technical platform.

• Second^This mission : to organize the obesity care pathway within the region.
  is achieved through a process of facilitating and coordinating the multidisciplinary stakeholders involved in managing the disease, including healthcare facilities, private practitioners, social care providers, and associations, in conjunction with networks and general practitioners, and under the auspices of the Regional Health Agencies ( ARS).
  This work requires creating momentum and formalizing partnerships by implementing actions that are not directly related to patient care but aim to organize services and disseminate expertise (awareness campaigns, information sessions, training, dissemination of best practice guidelines, etc.).

Furthermore, obesity centers are involved in research. In this context, the Obesity Center (CSO) at the Caen Normandy University Hospital can rely on:

• The Clinical Research and Innovation Department of the Caen Normandy University Hospital
• on the so-called "integrated" center (CIO) of the Lille University Hospital
• on the FORCE (French Obesity Research Center of Excellence) , which is a French network of excellence in clinical research on obesity and associated pathologies.

Several medications are intended for people with obesity. Their aim is to help the patient lose weight.

The medications currently authorized for marketing (MA) in the treatment of obesity are GLP-1 analogs that mimic the action of digestive hormones, thus affecting appetite and gastric emptying, often resulting in weight loss. They are available in the form of a pre-filled pen containing a solution for subcutaneous injection

• liraglutide (Saxenda®)
• semaglutide (Wegovy®)
• tirzépatide (Mounjaro®)

These weight-loss medications are prescribed only under certain conditions. These medications must be used in conjunction with lifestyle changes to maximize their effectiveness and prevent weight regain.

These are not miracle cures; their effects are limited and wear off after the treatment ends. Each medication has its advantages and risks, which should be discussed with your doctor to choose the most suitable one for your needs. Sustainable weight loss requires long-term lifestyle changes (a balanced diet and regular physical activity, etc.), and medications should be seen as a support to the weight loss process, not a replacement for healthy lifestyle habits.

These medications are called "second-line treatment," meaning that medical care alone will be systematically offered before drug treatment can be considered in case of failure.

• National CSO website
• Health Insurance website: Obesity and Medications
• National position statement on drug treatments for obesity (DTO) and their practical implementation

The probability that a child who is obese will remain so in adulthood varies according to studies from 20 to 50% before puberty, and from 50 to 70% after puberty.

It is recommended to systematically monitor body mass index in all children and adolescents:

• regardless of their age;
• regardless of their apparent build;
• whatever the reason for the consultation;
• at least 2 or 3 times a year.

some warning signs to look out for:

• Early adiposity rebound (the earlier it is, the higher the risk of becoming obese).
• Continuous upward trend in the BMI since birth.
• Rapid change of BMI curve lane upwards.

If the waist circumference/height ratio is > 0.5, the child has excess abdominal fat associated with an increased cardiovascular and metabolic risk.

The goal of care is to improve quality of life and prevent complications in adulthood.

Regular and prolonged follow-up for a minimum of 2 years is recommended.

It is recommended that the following be taken into account:

• either based on the principles of therapeutic patient education;
• takes into account diet, physical activity and sedentary behavior, the balance of lifestyle rhythms, psychological and socio-economic aspects;
• involves the parents and/or adults responsible for the child or adolescent;
• obtain the support of the child or adolescent and their family, taking care not to make them feel guilty, hurt them or stigmatize them.

3 levels of support:

• First^resort : uncomplicated overweight. Local care provided by the usual doctor.
• Second^recourse : complicated overweight or simple obesity. Multidisciplinary care organized on a territorial scale, involving specialized professionals.
• Third^recourse : obesity + severe comorbidities / disability. Care organized on a regional scale and coordinated by a specialist doctor and team.

Areas of focus:

Always in contact with the attending physician, whether pediatrician or general practitioner:

• dietetic
• physical activity
• psychological
• therapeutic stays in SMR according to various modalities (day hospitals, stays of varying lengths)
• Bariatric surgery is performed in certain very limited indications and only in specialized centers

The pediatric department of the Caen Normandy University Hospital

Medical and paramedical consultations

• Multidisciplinary consultations including pediatrician, dietician, and/or psychologist
• Joint transition consultations: pediatrician and adult nutritionist within the pediatric department to optimize the adult handover
• day hospital (HDJ) offers a comprehensive assessment of obesity and its complications, with a proposed care plan tailored to the needs of the child and/or family, in collaboration with the referring physician. This may involve follow-up by the university hospital team and/or through the NPO (Normandy Pediatric Obesity) and/or at a pediatric medical and rehabilitation center (SMR) specializing in nutrition, or with private practitioners providing dietary, psychological, and physical activity support.

Useful links :

• National CSO website
• The "Mission: Get Back on Track" (MRTC) programprovides children aged 3 to 12 who are overweight or at risk of becoming so with early, multidisciplinary support (dietary, psychological, and physical activity). This support is fully reimbursed by the French National Health Insurance (Assurance Maladie) with no upfront costs for families and no additional fees. You will find an explanatory video presentation of the program and a list of participating organizations, updated monthly.
• The "My Psychological Support" program allows anyone aged 3 and over who is anxious, depressed, or experiencing distress to benefit from 12 psychological support sessions with a partner psychologist, with 60% of the cost covered by Health Insurance.

The Caen Normandy Specialised Obesity Centre is a referral centre for children, adolescents and adults suffering from severe and/or complex obesity, residing in the Manche – Orne – Calvados departments.

For assessment and follow-up in other regions, contact the Specialized Obesity Center in your area. You can consult the interactive map of CSOs.

Several programs exist to support overweight or obese children and adolescents.

At this age, even in cases of diagnosed obesity, weight loss is not recommended because excess weight has a protective effect against chronic diseases. The French National Authority for Health (HAS) advises against excessive weight loss. The primary objective becomes maintaining mobility and muscle mass, as weight loss significantly increases the risk of malnutrition, sarcopenia (muscle loss), and loss of independence in older adults.

Please find below the possible referrals for your patient depending on the referral pathway (surgical or medical) and their medical situation.

For guidance towards the surgical pathway at the CSO Caen Normandie:

• Telephone: 02.31.06.32.21
• Email: chirdig-sec@chu-caen.fr

For guidance towards the medical field at the CSO Caen Normandie:

• Referral questionnaire to download, complete, and give to your patient. They can then return it to us at the following email address: obesite-sec@chu-caen.fr