[Are PUFAs n-3 really important in diet?]

If cardiovascular secondary prevention as well as COPD benefit from PUFAs supplementation, mainly in our societies where n-3 lack is close to n-6:n-3 misbalance, the usefulness of these supplements in many diseases (inflammatory or psychiatric for instance), is not yet established despite numerous randomised controlled studies and meta-analysis. The only counter indication to their prescription now is the presence of an implantable defibrillator. Their effect on prostate cancer remains doubtful. PUFAs n-3 marine sources should be free of pollution.

[Are food preferences affected by body mass index, age, sex or tobacco?]

In recent decades the percentage of energy derived from dietary fat has increased. The aim of this study was to explore the relationship between food taste preferences, BMI, age, gender and smoking habits. A computerized questionnaire using a hedonic scale (range 0 to 8) to quantify the liking for sweet and savoury, lean and fat foods, was filled by 233 adults: 171 normal weight (131 women, 40 men) and 62 overweight subjects (BMI > 25 kg/m2 42 women, 20 men). The majority of the subjects had a general preference for savoury lean food irrespective of their BMI or gender. Similarly, preference for sweet lean food was not influenced by the magnitude of the BMI. In contrast, overweight subjects had a preference for sweet fat food (p = 0.05) as well as for savoury fat food (p < 0.05). At any age or BMI, men preferred sweet fat food (p < 0.01). This was not the case for women. Overweight men over forty preferred savoury fat food, in contrast to overweight women of the same age (p < 0.01). The same difference existed between normal weight smokers and non-smokers. This study demonstrates that fat food preference plays a potential role in the development of obesity.

[Handicaps of massive obesity]

Massive obesity results in psychological--internal, relational, behavioural and psychosocial--handicaps due, to a great extent, to a society which encourages the occurrence of obesity but does not tolerate those who present with this condition. As the weight increases, the quality of life diminishes. Moreover, the mental performances of very obese individuals seem to be inferior to those of subjects with normal weight. Treatments which include a restrictive diet are the sources of depressive symptoms related to the chronic restriction. So far, only those patients who were operated upon, and particularly those who underwent gastroplasty, enjoy a dramatic improvement in their quality of life. As for those massively obese subjects who are not concerned with this solution, long-term supporting measures should be developed.

Long-term Result of Treatment of Prader-Willi Syndrome by Scopinaro's Bilio-pancreatic Diversion. Study of Three Cases and the Effect of Dextrofenfluramine on the Postoperative Evolution

The Prader-Willi Syndrome shortens the life of patients due to the morbid obesity which it entails. The compulsive hyperphagia associated with it makes a dietetic treatment or a gastroplasty difficult. This study presents the case histories of three patients suffering from the Prader-Willi syndrome who were operated on by means of a Scopinaro's bilio-pancreatic diversion. Following a marked reduction the first year, the weight loss stabilized and then tended to diminish. The observation of three cases which continued for two and a half to six years did not reveal any considerable metabolic problems. The deficiency of iron, vitamins D and B12 as well as folic acid had to be made up by supplementation. These results are comparable with the most favorable ones in the literature. Even if the effect on the weight loss is not spectacular, the operation manages to hold off the development of the obesity, inexorable for those with the Prader-Willi syndrome, and prevents lethal complications, without having notable side effects. Lifting coercive dietary measures improves the quality of life.

[Judicious use of anorectics]

Physicians treating adipose patients often hesitate to include drugs. Considering new developments in obesity research and drug-therapy, this attitude should be discussed. Anorectics of the amphetamine-group and analogues (derivates) react with the noradrenergic system and induce appetite-suppression. Fenfluramine in the d-1 configuration and isomeric dextro-rotation influence release of serotonin, reduce intake of food and increase sensation of saturation. In addition, various eating behavior disorders like nibbling and addiction to sweets are discussed. Use of Dextro-fenfluramine for these special situations is discussed as well as its side effects, duration of drug intake and form of application. Importance of concomitant therapeutic means like hypocaloric diet and personal attendance are emphasized.

[Obesity: indications for surgery]

Over the last thirty years, successive surgical techniques have been tried to find an answer to the problems caused by extreme obesity. The advantages and disadvantages of jejuno-ileal, bilio-pancreatic and gastric bypass, of gastroplasty as well as of intragastric balloons and of plastic surgery for the treatment of obesity are discussed. The necessity of long-term follow-up studies, allowing a better evaluation of surgical the impact of obesity on treatment for morbidity and mortality rates, remains extremely important.