Le rôle de la pleine conscience dans l'accompagnement de patients obèses : quand, pourquoi et comment intervenir ?

Abstract : Exposure to adverse life events has been associated with adult obesity, and could translate into the appearance of eating disorders. Moreover, exposure to adverse life events has been associated with emotional dysregulation, which would be in turn linked to higher prevalence of eating disorders. Furthermore, mindfulness skills (i.e., non-judgmental awareness of thoughts, emotions, and bodily sensations in the present-moment) have been the object of increased attention in the scientific literature as a means to increase emotion regulation and treat eating disorders in obese patients. The first part of this thesis studies the associations of exposure to adverse life events with eating patterns in obese patients. Two studies have been conducted in this part: the first aiming at assessing the association of exposure to adverse life events with postoperative weight-loss, as well as pre- and postoperative eating patterns; and the second aiming at exploring the role of emotion regulation strategies and mindfulness skills in the association of exposure to adverse life events and eating patterns. The second part studies the effects of mindfulness training on eating patterns and physical activity in obese patients. Three studies have been conducted in this part: a clinical case study, a systematic review and meta-analysis, and a randomized controlled trial (MindOb study). The results of the first part showed that bariatric surgery patients exposed to adverse life events are at risk of losing less weight after surgery, as well as having more dysfunctional eating patterns pre- and postoperative. Moreover, with non-operated obese patients, the results showed that the psychological impact of adverse life events and non-adaptive emotion regulation have been associated with psychological distress, impulsive eating, and binge eating. The results of the second part showed that mindfulness training decreased impulsive and binge eating in non-operated patients. Moreover, results showed that mindfulness training could also increase physical activity in these patients. This thesis highlights the need for providing obese patients with psychotherapeutic techniques increasing emotion regulation. The results suggest that pre-surgery interventions could avoid maintenance or the appearance of dysfunctional eating patterns. Moreover, psychotherapeutic interventions would be more effective in the case of patients either exposed to adverse life events or being diagnosed with binge eating disorder. However, while mindfulness training seemed effective, the optimal intervention design has yet to be identified. In fact, the questions of whether such training should be self-help or guided, daily and long-term or short-term, complementary to medical care and adapted to eating disorders or broader, must still be tested.
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Alexis Ruffault. Le rôle de la pleine conscience dans l'accompagnement de patients obèses : quand, pourquoi et comment intervenir ?. Psychologie et comportements. Université Sorbonne Paris Cité, 2017. Français. ⟨NNT : 2017USPCB250⟩. ⟨tel-02269884⟩

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