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On this World Obesity Day, Professor Jean-Charles Preiser, from the Department of Internal Medicine and expert within the team of the Integrated Obesity Centre at H.U.B, explains the new approaches to managing this chronic disease. Prevention, Comprehensive Assessment and a Tailored Approach At the Integrated Obesity Centre of H.U.B, Professor Jean-Charles Preiser from the Department of Internal Medicine sees patients with very different profiles. Some come because of high blood pressure, others for poorly controlled diabetes, joint pain, or sleep disorders. And then there are those who simply walk in and say, “Doctor, I have a problem with my weight.”“My role,” he explains, “is first to have a global vision. Obesity does not affect just one organ. It can involve the heart, the liver, the joints, the metabolism, and sleep.”Behind the word “obesity” there is often a silent accumulation of complications: diabetes, hypertension, sleep apnoea, fatty liver disease, certain cancers. Sometimes already present. Sometimes still invisible.An assessment to understand, not to judgeThe first step is not treatment, but assessment. Blood tests to detect sometimes asymptomatic diabetes. Blood pressure measurement. Sleep evaluation. Screening for liver damage, sometimes completely silent.“We systematically investigate potential complications. Not to make the file heavier, but to guide treatment,” emphasises Professor Preiser.Today, management has evolved. The options are numerous: structured dietary support; psychological support (particularly in cases of eating disorders); drug treatments; and even bariatric surgery for the most severe cases.“A few years ago, surgery represented a significant share of referrals. Today, drug treatments occupy an increasing place. About one patient out of two benefits from them. Surgery concerns a minority of cases, around 20%,” says Professor Preiser.New generations of medications, notably incretin analogues (GLP-1, GIP), have changed the therapeutic landscape. They are part of the current arsenal, with significant results in many patients. But they are neither automatic nor universal. Their cost remains high and reimbursement is limited to certain situations, particularly in cases of poorly controlled diabetes.“There is no single treatment. There is a strategy tailored to each patient,” he insists.“It’s all because of your weight”: moving beyond shortcutsMany patients arrive with a sense of exhaustion: after hearing consultation after consultation that all their symptoms are related to their weight.Dr Preiser nuances this: “Yes, obesity increases the risk of many complications. But the probability of developing a disease is not strictly proportional to the degree of obesity.”Some people living with severe obesity for years present few complications. Others, with more moderate obesity, develop early metabolic or cardiovascular problems.Why? Genetic background plays a major role. Family history — heart attack, stroke, liver disease, diabetes — guides the level of risk. The association with other factors, such as alcohol consumption or smoking, also changes the picture.The message is clear: obesity is an important risk factor, but it does not explain everything. Each situation deserves individual analysis.A new definition: looking at fat mass, not only weightSince 2025, the definition of obesity has evolved: it is no longer only total body weight that matters, but the proportion of fat mass.“The objective is not to make patients lose muscle or water. What we aim for is a reduction in fat mass while preserving muscle mass,” Professor Preiser reminds us.This approach is particularly important in geriatrics, where muscle loss can worsen frailty and increase the risk of falls. Hence the importance of sufficient protein intake and adapted physical activity, even during drug treatment.Men and women: different risksComplications are not identical depending on sex. In women, obesity can lead to fertility disorders or polycystic ovary syndrome. After menopause, the risk of breast cancer increases in cases of obesity. Knee pain is also more frequent.In men, there is a greater accumulation of cardiovascular risk factors and a higher frequency of certain digestive cancers and prostate cancer.In both cases, screening remains essential. Treating obesity after cancer, for example, can help reduce the risk of recurrence.Increasingly younger patientsThe most striking evolution in recent years concerns the age of patients.“Obesity is increasing among children and adolescents, often against a background of socio-economic and cultural factors. Sedentary lifestyles, accentuated by the COVID period, have played a role. Many obese young people become obese adults,” laments Professor Preiser.Some consult spontaneously, with a desire to understand and act early.Other situations are emerging: women undergoing medically assisted reproduction, where obesity management and fertility treatment occur in parallel. After childbirth, priority may shift to the newborn, pushing maternal health into the background. “These are human realities that must be integrated into care,” the geriatrician points out.The sensitive issue of relapseObesity is a chronic disease. Like any chronic disease, it can lead to relapse.After surgery, very rapid weight loss can lead to deficiencies or malabsorption problems, and weight regain may occur. With dieting alone, the “yo-yo effect” remains the typical failure when recommendations are not adapted to lifestyle or when an eating disorder is not addressed.Regarding recent medications, long-term data are still limited. Doses are adjusted progressively according to individual response and side effects. Discontinuation must be gradual, accompanied by increased physical activity and sufficient protein intake to preserve muscle mass. Strategies can be combined: drug treatment before or after surgery, reintroduction in case of weight regain.“The key is continuity of follow-up,” insists Professor Preiser.Changing the way we look at obesity and its managementSome patients arrive with a clear idea: “I want surgery” or “I want this new medication.” Sometimes they leave with a different proposal after a full assessment.“Our role is to explain that several options exist and that the choice depends on the overall medical evaluation,” Professor Preiser recalls.Obesity is not just a number on a scale. Nor is it a personal failure. It is a chronic, multifactorial disease, influenced by genetics, environment, lifestyle, and social context.Treating it is not only about losing weight. It is about preventing complications, preserving quality of life, rebuilding self-esteem, overcoming emotional wounds and destructive habits and, in the most severe cases, maintaining autonomy.For those living with obesity — or supporting a loved one affected by obesity — the message may be this: solutions exist. They are multiple, personalised, and evolving. And above all, they are built together with the patient, step by step, throughout their care pathway and life journey.Multidisciplinary team-based careAt H.U.B, care is multidisciplinary: internists, endocrinologists, dietitians, psychologists, gastroenterologists, hepatologists, cardiologists, and sleep specialists. This network organisation prevents patients from facing a complex disease alone. Contact the Obesity Centre Pr. Jean-Charles Preiser Also read: The role of dietetics in the multidisciplinary management of obesityIngrid Hanson, a dietitian accredited by the Federal Public Service for Public Health at the Integrated Obesity Center of H.U.B., explains the delicate issue of nutrition for patients who wish or need to lose weight. Discover the interview. 

Surgical complications: what medical management at H.U.B.? After digestive surgery (removal of the esophagus, stomach, bariatric surgery for weight loss, removal of part of the colon), leakage can sometimes occur at the digestive suture (or a fistula if it persists over time). This may lead to a local abdominal infection and other complications.Our endoscopy team has developed a range of techniques to treat these complications endoscopically, sometimes in combination with radiological treatment, in order to avoid reoperation. It is thus possible to temporarily place an oesophago-gastric stent, use vacuum-assisted therapies or place an internal drain to achieve healing. Likewise, after pancreatico-biliary surgery, leakage of bile or pancreatic secretions may occur. Various approaches allow these to be resolved using the different endoscopic techniques available (retrograde/percutaneous cholangiopancreatography, endoscopic ultrasound-guided drainage, etc.).The management of these potential complications requires discussion between the surgical, radiological and endoscopic teams in order to choose the best solution for each patient. The daily availability of all techniques makes it possible to rapidly treat patients who require it. The expertise of the Endoscopy Clinic team, specifically in the management of these complications, as well as its available equipment, make it a renowned centre for this activity, to which many patients are referred by other hospitals.If you suffer from a surgical complication, speak to your doctor. They can contact the physicians of the Endoscopy Clinic to discuss a possible endoscopic treatment by telephone at +32 (0)2 555 32 72. Discover the H.U.B Endoscopy Clinic Endoscopic treatment of surgical complications: what innovations at H.U.B.? Numerous scientific publications have been produced by the members of the department in recent years on this topic (oesophago-gastric stents or double pigtail prostheses to treat leaks after bariatric surgery, ultrasound-guided drainage or retrograde cholangiography for postoperative biliary leaks, for example).In addition, within the department, a new instrument is being developed to automatically cut and resolve post-surgical problems of diverticula and strictures that prevent patients from eating properly (Candy cane syndrome). Studies are ongoing to treat patients who need it using this new instrument.

What is Tuberous sclerosis? Tuberous sclerosis, also known as Bourneville disease,  is a rare genetic disease characterised by the development of benign tumours principally affecting the brain, skin, eyes, kidneys, heart and lungs. The consequences are of variable severity but are potentially serious. There is a high risk of epilepsy and also retarded development, intellectual disability and autism when the brain is affected. There can also be a significant impact on health and quality of life when other organs are affected.  Treatment This disease requires an early diagnosis, in early childhood or even before birth, and monitoring by a specialised multidisciplinary team. This is arranged at the Children’s Hospital in the form of regular and systematic consultations with the various specialists. For the comfort of the children and their families the consultations are held on the same day and take place once a year, although sometimes more frequently depending on the age and particularities of the child. The monitoring begins before birth and continues through the growth years of childhood and into adulthood.   As they reach adulthood a transition consultation can be arranged at the Erasmus Hospital. An early screening for epilepsy, before the appearance of the first symptoms, is proposed systematically so as to avert the consequences. Depending on their individual situation, patients can benefit from innovative treatment in line with international recommendations. Our team cooperates closely with other specialists and paramedical teams  at the Children’s Hospital and with specialist teams, for epilepsy surgery in particular, if the child’s situation requires it. We network with GPs and paediatricians, child therapists (physiotherapists, speech therapists, occupational therapists, psychologists etc.), support services, respite care services, associations and psycho-medico-social centres.    Specific care pathways Our team cooperates closely with national and international centres that care for persons with tuberous sclerosis as well as with parents’ associations to achieve a continuous improvement in patient care and to disseminate information on this rare disease and its treatment.  Our specialists Children's patients (Children's Hospital)The multidisciplinary consultation is organised by the Neuroaediatrics Department (Co-ordinating doctor: Dr Anne Monier; Co-ordinating secretary: Ms Daniela Wayllace).Coordinating doctor and neuropaediatrician: Dr Anne MonierDermatologist: Dr Pamela El NemnomOphthalmologist: Dr Sophie LhoirNephrologist: Dr Khalid IsmailiCardiologist : Dr Hugues DessyGeneticist: Dr Catheline VilainCoordinating secretary: Mme Daniela Wayllace (02 477 39 67)Adult patients (Erasme Hospital)The consultation is organised by the Neurology Department (Cons [dot] Neuro [dot] erasme [at] hubruxelles [dot] be (Cons[dot]Neuro[dot]erasme[at]hubruxelles[dot]be))Neurologist: Dr Chantal Depondt

Le service de pédopsychiatrie du H.U.B, actif à la fois sur les sites d’Erasme et de l’Hôpital des Enfants, a été reconnu par l’INAMI comme Centre de Référence Supra-Régional pour les Troubles du comportement alimentaire (TCA) chez les jeunes  de 0 à 23 ans. Troubles du comportement alimentaire chez les jeunes : une prise en charge multidisciplinaire Ce centre innovant offre une approche multidisciplinaire, coordonnée et spécialisée pour les jeunes souffrant d’anorexie, de boulimie ou d’hyperphagie boulimique, tout en assurant un accompagnement renforcé des familles.Dans cette interview, découvrez les spécificités de ce nouveau centre, les bénéfices pour les patients, et les ambitions portées par les équipes du H.U.B. (Hôpital Erasme et Hôpital des Enfants) Notre centre prend en charge toutes les tranches d’âge, du bébé jusqu’à 23 ans, avec une approche multidisciplinaire, adaptée à chaque situation Judith DEREAU Pédopsychiatre, Responsable médicale du Centre ambulatoire TCA (H.U.B) 1. En quoi le Centre TCA que vous dirigez se distingue-t-il dans la prise en charge des troubles du comportement alimentaire chez les jeunes ?Notre centre a la spécificité de prendre en charge toutes les tranches d’âge, du bébé jusqu’à l’âge de transition (23 ans), avec une longue expérience, tant au niveau de la prise en charge somatique des cas graves que psychiatrique. Nous proposons des soins adaptés à chaque situation : consultations spécialisées multidisciplinaires (avec pluralisme des approches, dont la Family-Based Therapy (FBT) et la thérapie multifamilles), ambulatoire intensif, hospitalisations de jour pour les plus jeunes, hospitalisations complètes… y compris pour les formes atypiques comme l’ARFID, qui est un trouble de l'alimentation sélective sans préoccupation du poids ou de l'image corporelle.2. Quelle est la plus-value du trajet de soins mis en place par l’INAMI pour les patients et leurs familles ?La mise en place du "trajet de soins TCA" il y a un an a permis d'offrir aux patients et aux familles une prise en charge plus lisible, coordonnée et mieux soutenue. Cela a renforcé l’accès aux soins et valorisé le travail en réseau. L'INAMI, qui a aussi prévu un soutien régional avec l’extension de l'offre de soins (équipes ambulatoires de soutien de la première ligne et équipes de traitement à temps partiel), vient maintenant compléter ces dispositifs par des centres suprarégionaux, qui seront tant au service des patients et de leurs familles que des professionnels de 1ère et 2ème ligne pour les trajets de soins complexes.3. Que signifie concrètement pour votre équipe d’être reconnue comme centre de référence suprarégional ?C’est une reconnaissance précieuse de notre expertise. Cela va permettre de clarifier les niveaux d'intervention, de donner une visibilité accrue à notre travail et de développer encore notre offre, pour mieux répondre aux besoins des jeunes, de leurs familles et des professionnels qui le demandent. Avec la désignation du centre, nous allons pouvoir renforcer l'équipe avec l'engagement de collègues.4. Quelles sont les prochaines étapes ou ambitions pour ce centre dans les années à venir ?Nous voulons contribuer à améliorer le travail en réseau, la concertation indispensable et la formation des professionnels prenant en charge les troubles des conduites alimentaires, soutenir les collègues au-delà de Bruxelles, et étoffer l'offre de soins, entre autres en y intégrant des pair-aidants dans nos dispositifs.Infos H.U.B : Centre de Référence Supra-Régional pour les Troubles du comportement alimentaire (TCA) chez les jeunes Pédopsychiatrie - Psychiatrie du bébé, de l'enfant, de l'adolescent et du jeune adulte | Hôpital Erasme  Liens: Convention INAMIBruxelles https://tca-bru.be/BWhttp://www.archipelbw.be/initiatives/trajet-de-soins-tca-et-equipe-emas/Luxembourghttps://matilda-lux.be/trajet-de-soins-tca-troubles-des-conduites-alimentaires/Liègehttps://realism0-18.be/trajet-tca/Hainauthttps://www.rheseau.be/___-emas/

Lupus is an autoimmune disease, which can affect different organs and manifest very differently from one person to another. To better understand this condition, we interviewed Prof. Muhammad Soyfoo, Rheumatologist, and Prof. Frédéric Vandergheynst, Internal Medicine at H.U.B, both specialists in lupus.  Lupus: a disease with highly varied manifestations Lupus is an autoimmune disease. What is an autoimmune disease? Normally, our immune system acts as a shield: it protects us against viruses, bacteria, and other external threats. In an autoimmune disease, this system malfunctions. It can no longer distinguish between what is foreign and what belongs to our body… and starts attacking our own cells. This causes inflammation that can affect one or several organs, such as the skin, joints, or kidneys in the case of lupus. Each autoimmune disease is different, but all are based on the same principle: a defense system that targets the wrong thing. “Each patient is different,” explains Prof. Soyfoo. “Some only have skin involvement, others joint pain, and still others a systemic form affecting multiple organs, with very variable degrees of severity,” he adds. Among the most commonly affected organs are the skin, joints, and kidneys. The severity of the disease is often linked to kidney involvement, which can range from mild urinary abnormalities to rapidly progressive kidney failure requiring dialysis. However, lupus can sometimes present with rarer symptoms, such as neurological disorders, which may delay diagnosis because they are mistakenly interpreted as psychiatric conditions.  Despite this complexity, care is always personalized: “Each patient must be assessed globally and followed by a multidisciplinary team for optimal management,” emphasizes Prof. Vandergheynst.  A diagnosis that can take time The diagnosis of lupus takes on average 3 to 5 years. Yet, as Prof. Vandergheynst points out, the diagnosis itself is not necessarily difficult to establish… provided it is considered.“The main obstacle is thinking about the disease,” he explains. In other words, once lupus is suspected, medical tools generally allow confirmation fairly quickly. These include blood tests, which look for antibodies (proteins produced by the immune system) abnormally directed against the body, and sometimes tissue samples (from the skin or kidneys), analyzed under a microscope to better understand the involvement and choose the most appropriate treatment.  The main obstacles to diagnosing lupus Non-specific symptoms: fatigue, diffuse pain, sensitivity to sunlight, mouth ulcers… common and recurring signs in the general population that do not immediately suggest an autoimmune disease.   A disease that is still insufficiently known: by the general public, but also sometimes by primary care health professionals.  Symptoms that are sometimes minimized: particularly in young women, who are most affected, whose health condition is often attributed to stress or anxiety.   A fragmented view of the disease and its management: because it can affect multiple organs, lupus may be managed by several specialists (rheumatologists, nephrologists, dermatologists, internists, gynecologists) who, if they do not communicate with each other, work in silos and have only a partial view of the disease.  Image The need for coordinated and personalized care At the Brussels University Hospital (H.U.B), lupus care is based on collaboration between several specialists. The entry point varies depending on the symptoms: joint pain, skin rashes, neurological or general symptoms. Then, a multidisciplinary team coordinates to assess organ involvement and propose the most appropriate treatment. “We do not cure lupus, but we can control flares, limit damage, and sometimes achieve prolonged remission,” explains Prof. Soyfoo. Long-term follow-up also includes preventing complications related to treatments, such as the effects of corticosteroids on bones or metabolism, and specific aspects such as pregnancy planning. Image Lupus and pregnancy: a balance to build together Lupus mainly affects young women, often of childbearing age. The question of pregnancy is therefore central… and sometimes difficult to address. Yes, pregnancy is possible with lupus, but it must be carefully planned and closely monitored. What are the risks? When the disease is not well controlled, pregnancy may lead to: Lupus flares: recurrence or worsening of symptoms  Increased risk of preeclampsia: a complication where blood pressure rises and may affect the placenta  Placental problems: the placenta may function less effectively, which can slow the baby’s growth  In about 40% of cases, lupus is associated with antiphospholipid syndrome: the presence of autoantibodies (immune system proteins directed against the body) that increase the risk of recurrent miscarriages or thrombosis (formation of blood clots). Some patients must then take anticoagulants (blood-thinning medications) during pregnancy, requiring close monitoring. Treatments to be adjusted Not all medications used for lupus are compatible with pregnancy. Some are teratogenic: they can cause malformations in the baby. Others may reduce fertility. It is therefore important to plan the pregnancy and adjust treatments in advance. Essential specialized follow-up Coordination between rheumatologists, internists, and obstetricians is crucial to manage treatments safely and ensure a safe pregnancy and delivery for both mother and baby. An intimate decision… sometimes difficult to support Discussing the desire to have a child can be complex. For patients, it can be a source of concern. For doctors, it involves significant responsibility: “We are not here to prevent patients from living their lives. But in some situations, giving our approval — or on the contrary advising against pregnancy — represents an important responsibility,” says Prof. Vandergheynst. In some cases (active disease, severe kidney involvement), pregnancy is strongly discouraged. In others, the decision is more nuanced. The goal is never to punish or make anyone feel guilty, but to enable an informed choice, taking into account risks and the patient’s life plan. Promising advances Treatments for lupus have evolved considerably in recent years. Personalized medicine and biotherapies are opening new perspectives, for example: Hydroxychloroquine: a long-standing, low-cost treatment that effectively reduces the frequency of flares. Targeted biotherapies: medications such as anifrolumab (Saphnelo) or belimumab (Benlysta) act on specific molecules involved in the disease, reducing the use of corticosteroids and improving quality of life. Precision medicine: in the future, treatments could be adapted to the biological profile and molecular expression of each patient, rather than to the disease in general. Personalized medicine is not yet standardized, but it offers great promise with more precise and effective treatments and fewer side effects. Non-invasive biomarkers to monitor kidney involvement could also reduce the need for frequent biopsies.  The impact of lupus on daily life Beyond physical symptoms, lupus profoundly affects daily life. Chronic fatigue, pain, limitations in certain physical activities, and constraints related to sun exposure can be very restrictive. The treatment itself, particularly corticosteroids, can alter physical appearance and affect body image. Lupus also has psychological, social, and professional consequences. Patients may have to reduce their working hours or modify their life plans, including pregnancy planning. Their sexual and emotional life may also be affected by the disease. Listening, therapeutic education, and comprehensive support are essential to help patients cope with these aspects. A complex disease, but one that can be treated Lupus is a complex, variable disease that is often difficult to diagnose. Successful management relies on multidisciplinary care, personalized treatments, and comprehensive patient support. Thanks to recent advances in biotherapies and precision medicine, new perspectives are emerging to improve quality of life and enable everyone to live fully despite the disease.  Interview with our experts Need to contact our specialists? To contact the Rheumatology Department, please send an email to Cons [dot] Rhumato [dot] erasme [at] hubruxelles [dot] beTo contact the Internal Medicine Department, please send an email to Cons [dot] MedIntern [dot] erasme [at] hubruxelles [dot] be