[Psychopathology of obesity. Therapeutic contract]

Multiple mechanisms lead to the establishment and maintenance of obesity. A better understanding and analysis of theses factors should help to design improved therapies. The therapeutic constract is based upon the hypothesis that many subjects have an "empathic" type of psychological structure and builds a physician-patient relationship allowing the patient to be supported during its dietary effort and to feel confident enough to express his difficulties, and the physician to better understand his patient and anticipate on an eventual relapse. The ideal weight notion is a key element, as it should not be considered as an established target based upon standards, but rather be progressively adapted between physician and patient.