[Treatments of massive obesity]

Treatment of massive obesity aims at somatic, psychological and social targets and therefore requires a multidisciplinary team co-ordinated by a physician. Treatment usually begins by taking care of the most worrying somatic and metabolic problems (cardio-respiratory and metabolic disorders) and by correcting the diet. It is then enhanced by a psychological assistance provided by the treating team and, in certain cases, by a psychotherapist. Massive obesity is a chronic, recurrent and severe disease. Its treatment is prolonged and implies numerous constraints (diet, drugs, treatment of a possible sleep apnoea syndrome) which are difficult to tolerate in the long term. This type of management resembles that of other chronic diseases, such as complicated diabetes. From dietetics to the most technical medicine, from the doctor-patient relationship to psychotherapy, the therapeutic methods are numerous, and the burden of using them in a coherent manner falls on the physician.