1.2.4. Proposed Therapy for Obese Patients with FA

So far, no psychological therapy has been validated in the management of FA in obese patients. In our opinion, this should be included in multidisciplinary programs combining empathic approaches and social support interventions, to help patients in coping with their daily life struggles and social stigma. In our center (Nutrition Department, CHU Rennes), all obese patients with BMI ≥35 are able to lose weight by following a one-year psychobehavioral program, including six multidisciplinary consultations (nutritionist physician, dietician, and nurse specialized in therapeutic education), in order to manage or prevent ED. This program includes at each meeting with the patient: motivational interview, advice for physical activity, and food education. In addition, all patients have two psychological consultations to help them consider the importance of emotions and stress in their eating behavior, but they are not psychotherapy sessions. All the patients expected to be eligible for obesity surgery participate in this program for an average of one year before obesity surgery.

In conclusion, as the prevalence of FA is high in obese patients, especially in patients referred for obesity surgery (40%), it is a relevant issue for the clinical practice of obesity care. Future studies should assess whether dedicated management of FA is associated with better outcomes, especially after obesity surgery. Given the prevalence of FA in the general population, public health policies should help in screening early and managing FA before it leads to obesity, which is a burden worldwide (Figure 1).
