[Recent advances in the management of obesity]

The management of an obese patient aims not only at obtaining a durable weight loss, but also at attenuating various associated risk factors. This latter objective may already be obtained with a rather moderate weight reduction (5-10% of initial body weight). The first step should favour life-style changes (diet and physical exercise), eventually together with a psychological support. In case of insufficient success, a pharmacological approach may be considered, in addition to life-style advices. Pharmacotherapy currently includes drugs that act on the central nervous system to decrease appetite (sibutramine), in the gastrointestinal tract to diminish fat absorption (orlistat) or at both central and peripheral sites (rimonabant). In case of extreme obesity or severe obesity associated with comorbidities, refractory to medical approaches, bariatric surgery may represent the only solution to obtain a major and sustained weight loss, together with a significant improvement of associated risk factors. Gastroplasty, especially laparoscopic gastric banding, has become very popular in our country. However, because of several limitations, it is increasingly replaced by derivative procedures, especially gastric bypass. In all cases, a multidisciplinary, integrated and individualized approach should be recommended, using realistic goals and targeting long-term weight reduction and improved health.