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Cette dernière méthode est extrêmement riche pour les informations "réelles" qu'elle permet de recueillir mais très lourde et difficile à mettre en oeuvre, 2010. ,
Comme dans tous processus scientifiques, la complémentarité des méthodes est à rechercher ,
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, Malgré la grande hétérogénéité des approches utilisées, plusieurs études randomisées ont montré la supériorité des TCC sur les techniques comportementales quant aux changements de comportements alimentaires, à l'importance de la perte de poids et la prévention de la reprise pondérale, y compris chez l'adolescent, Warschburger P, 2001.
, , 2009.
, Stahre, 2000.
, Cette supériorité des TCC est également présente chez les sujets atteints d'hyperphagie boulimique, Bacon L, 2005.
, , 2009.
, La stratégie de résolution de problèmes (TRP)
, Cette approche pourrait être également intéressante chez les sujets atteints de compulsions alimentaires, 2007.
, la tenue d'un carnet alimentaire permet d'objectiver les comportements alimentaires, les situations ou cognitions déclenchant les prises alimentaires excessives et les conséquences cognitives et émotionnelles qui en résultent
, éléments suivants : -La prise en charge doit être globale : le projet thérapeutique doit prendre en compte les objectifs psychologiques et sociaux pour certains sujets, chez qui l'obésité ne constitue pas un risque vital mais est essentiellement une source de souffrance psychologique, la priorité peut être donnée à la restauration de l'estime de soi, et de l'image du corps, ainsi qu'à la lutte contre le rejet social. -Approches cognitivo-comportementales : elles sont proposées s'il existe des difficultés d'application des mesures initiales, Si l'on se réfère aux recommandations des sociétés savantes en France (ALFEDIAM / AFERO / SNDLF) élaborées en 1998 pour l'ETP du sujet obèse, on retrouve les
Ces recommandations sont en phase avec les éléments développés ci-dessus mais ne décrivent absolument pas de quelles approches cognitivo-comportementales il s'agit. -Les interventions de groupe ont montré leur efficacité tant sur le poids (Gustafson et al., 2009a) que sur la qualité de vie, 2009. ,
L'influence d'un programme de perte de poids chez les mères sur le comportement des enfants a rarement été étudiée ; nous avons retrouvé une seule étude qui montre qu'un programme de 8 semaines permet une perte de poids chez la mère et s'accompagne chez les enfants d'une diminution de la consommation d'aliments gras et de boissons sucrées et d'une augmentation de l'activité physique chez leurs enfants de 1 à 3 ans, -Les interventions chez les femmes permettent de modifier le comportement familial et notamment celui des enfants, et l'obésité de la mère prédit l'obésité des enfants, 2003. ,
Une des difficultés dans ces populations et d'obtenir leur adhésion à ces programmes ,
Ce support peut être apporté par la famille, d'où l'importance d'action visant l'ensemble de la famille, Cette adhésion et la maintenance de ces comportements sont facilitées si les sujets trouvent dans leur entourage immédiat un support social, 1996. ,
, , 2004.
, ses connaissances, ses motivations, ses comportements : (1) Mener des campagnes d'information nutritionnelle
, Limiter l'accès à certains produits (gérer l'aliment-récompense, limiter les distributeurs, limiter les fast-food à proximité des écoles), (11) Agir sur les prix au moyen de taxes et subventions, (12) Promouvoir des aides directes à la consommation, Douze interventions concernent un changement de l'environnement du consommateur
, Un tableau de synthèse présente pour chaque type d'action, leur efficacité (si des évaluations ont été faites)
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