Centre for Obesity and Diabetes

Our medical-surgical obesity and diabetes centre offers personalised treatment to patients suffering from obesity, overweight, eating disorders, nutrition or metabolic disorders, such as diabetes, hypertension and dyslipidemia (cholesterol problems).

Our centre offers excellent services to patients with a global and personalised treatment of all problems related to metabolism, more particularly obesity and diabetes, with an emphasis on the prevention of cardiovascular complications.

This multidisciplinary approach is concretised in practice by bringing together in one place all the internists, endocrinologists, nutrition specialists, pneumologists, cardiologists, surgeons, psychiatrists, anaesthetists, psychologists and dieticians.

Once a month, all the specialists meet in a colloquium to discuss each case confidentially.

Medical services

Dietetics and nutrition

How to eat well?

A diet that combines pleasure and balance is a component of a healthy lifestyle. A balanced diet provides the body with energy and essential nutrients and protective substances, influences physical and mental well-being and helps to prevent illness. To find out how to eat well, you can refer to the Swiss Food Pyramid, which shows a balanced diet in pictures.

The foods on the lower levels are needed by the body in larger quantities, while those on the upper levels are sufficient in smaller quantities. A healthy diet does not require any prohibitions. It is simply the result of combining foods in the right proportions.

In order to find out how a balanced meal is composed, the optimal plate illustrates a balanced main meal (breakfast, lunch and dinner).

It shows the foods that make up a complete meal and the average proportions in which to use each of these foods to make a balanced meal.

These proportions should not be taken literally, as they depend on the nature of the foods on the menu and on individual needs, but they give an average order of magnitude for most adults.

Breakfast, lunch and dinner provide the body with the energy it needs on a regular basis. Those who wish can also eat more small meals during the day. The main meals can be supplemented with snacks (in the morning, afternoon and/or evening).

Snacks provide an energy boost and offer an additional opportunity to vary the food intake. If you don't snack, make sure you supplement your plate with a second vegetable, fruit or dairy product.

The rhythm of eating varies from person to person. Everyone should find his or her own rhythm and avoid continuous snacking.

Source: Swiss Society of Nutrition

Diets

In recent years, the number of people who are overweight has increased steadily. The World Health Organisation even speaks of an obesity epidemic. At the same time, the obsession with being thin has never been greater in our society and the number of miracle weight loss recipes is increasing. But what is the right balance?

The desire to lose weight quickly leads many people to turn to quick fixes. The promises they offer are often very tempting and we unfortunately forget the dangers we face. There are all kinds of diets, weight loss products and services. Low-calorie, high-protein or low-carbohydrate diets, herbal teas, meal replacements and pills of all kinds are just a few examples of weight loss solutions, the number of which is constantly increasing. The vast majority of them ignore the reasons why you gain weight, offer false promises and can be very expensive.

Weight loss diets promise dramatic results in a short time, but is this realistic? Weight loss is often seen in the short term, but the problem lies in long-term maintenance. When our bodies are deprived of food, our metabolism slows down, our mood changes, it is harder to concentrate and we lack energy. We also develop a fixation on food. After returning to a normal diet, appetite increases, we eat more and our body builds up reserves. Thus, all the weight lost can be regained quickly, and even more. On the other hand, many weight loss diets do not promote healthy lifestyle habits and better food choices, which is detrimental to maintaining weight loss.

Many people are concerned about weight loss and end up on diets that are often more harmful than beneficial. Don't be taken in by these miracle formulas but rather follow the path of health by making wise choices that can be advised by a health professional (nutritionist or dietician).

Vegetarian diet

The vegetarian diet is a diet that excludes animal proteins from the diet for ethical, environmental or health reasons. Although there are several variations of vegetarianism, meat, fish, seafood and eggs are often excluded from the diet in favour of plant proteins such as soya, pulses or cereals.

It is known that people following a vegetarian diet have a lower BMI than the average, which is supported by the fact that adopting a restrictive diet such as vegetarianism leads to a better balance of food intake and less consumption of food from the food industry.

Moreover, the vegetarian diet, by excluding meat, helps to fight against cardiovascular disease, which is mainly caused by the saturated fatty acids found in meat. Vegetarians generally have a lower cholesterol level than the omnivorous population because of the absence of fatty meat in their diet. If properly practised, the vegetarian diet is rich in fibre, provided in particular by vegetables and wholegrain cereals, and thus helps to combat constipation, diabetes and transit disorders.

It also reduces the risk of prostate and colon cancer, thanks to an abundance of fruit and vegetables, a low-fat diet and the absence of smoked, charred or nitrite-containing meat.

However, these health effects are not just the result of not eating animal foods. It is important to carefully select a variety of foods to avoid vitamin and mineral deficiencies (daily fruit and vegetables, dairy products or calcium-enriched soy or rice drinks, a portion of tofu, quorn, tempeh or seitan, and regular legumes and cereals).

Calorie management

The conventional wisdom is that metabolism is the only factor to consider when determining body weight. A lean person who indulges in hamburgers and fries and never gains weight might explain this by citing their "fast metabolism", while an overweight person might blame their metabolism for their excess weight.

Metabolism is simply the process by which your body converts your food into energy to perform its functions. In truth, it is the ratio of the number of calories consumed to the amount of energy expended that determines whether your weight stays constant or whether you gain or lose a few pounds.

How do you calculate this magic number?

To start with, think about the activities in your body that require energy. Even if you decided to lie in bed all day without moving, your body would still need energy. Simply breathing, circulating blood throughout the body, and developing and repairing cells all require energy. The number of calories your body consumes to perform these basic activities is called the basal metabolic rate. For most people, these basic activities account for a large proportion of daily calorie expenditure. Physical activity and digesting food require our bodies to expend additional calories.

The basal metabolic rate varies from person to person, and certain factors can influence a person's caloric requirement:

  • Body size: just as an SUV is a bigger gas guzzler than a sedan, larger people have a greater caloric need than smaller people. Therefore, your height and weight will affect the calories you burn.
  • Body composition: muscle requires more energy than fat, so the more muscle mass you have compared to your body fat, the more calories your body will need to function.
  • Age: Metabolism naturally slows down as you get older. In addition, many people lose muscle mass and gain fat as they age, another factor that accounts for a slower metabolism.
  • Gender: Men tend to have more muscle mass than women, hence their slightly higher metabolic rate.

Your daily calorie requirement depends on your basal metabolic rate, the number of calories you burn during physical activity, and the number of calories your body needs to break down food and absorb nutrients.

The calculation is simple. To maintain your weight, you need to expend as many calories per day as you consume. To lose weight, your energy expenditure must exceed your caloric intake, whereas to gain weight, you must reverse the relationship, supplying your body with more calories than it expends.

Rehabilitation and physical activity

A team of 15 physiotherapists at Clinique Générale-Beaulieu is available to ensure optimal rehabilitation following your bariatric surgery.

Weight loss following obesity surgery leads to a reduction in your fat mass, but also in your muscle mass, thus affecting your physical capacities. Functional rehabilitation is a solution to correct these imbalances. Regular physical activity leads to a reduction in fat mass and a maintenance or even an increase in your muscle mass. Physical activity (PA) is an integral part of therapeutic action in the treatment of obesity.

Our physiotherapists are there to inform and encourage you to engage in regular physical activity. Sustainable weight loss is not just about changing your weight, it's about changing your lifestyle, especially in terms of diet and exercise.

To transform these habits, the acquisition of knowledge and skills in these two areas is essential and requires multidisciplinary therapeutic patient education. This can be done with general practitioners, in follow-up care and nutritional rehabilitation centres and in health networks.

Our physiotherapists will work with you, over the long term, with a pre-operative preparation or fitness programme in parallel with what has already been put in place by other health care professionals.

Surrounded by professionals, you will be guided and will avoid any false movements or risks of injury when resuming physical activity.

A balneotherapy pool is also present in the Centre, allowing you to get back into shape surrounded by our professionals in a more efficient manner.

Would you like to contact our physiotherapy department to discuss this? Just one number +41 22 566 29 11

At the Centre Obésité et Diabète Générale-beaulieu you will benefit from

  • Evaluation of body composition
  • Measurement of metabolism at rest and during exercise
  • Evaluation of muscular and articular capacity
  • Personalised and progressive physical activity programme
  • Personalised nutritional advice

Treatment of eating disorders

Eating behaviour

Eating behaviour refers to all the behaviours of an individual with regard to the consumption of food. The main physiological function of this behaviour is to ensure the supply of energy substrates and biochemical compounds necessary for all the cells of the body.

It is a finely regulated behaviour. Its regulation is part of the more general regulation of energy homeostasis, which aims to ensure a situation of energy balance and enables a given level of fat mass to be maintained constant. There is also a qualitative regulation of the choice of nutrients, demonstrated by experiments provoking a protein or ion deficiency which show that the deficient animal orientates its choice towards foods which compensate for this deficiency. However, the latter regulation has not been demonstrated in humans and little is known about the regulatory pathways.

Like all behaviour, feeding behaviour is controlled by the central nervous system (CNS). It is currently accepted that the main control centres for eating behaviour are located in the hypothalamus. Traditional notions of a hunger centre and a satiety centre have been complicated by the progressive discovery of a large number of neuromediators, receptors and neuronal populations. These neuronal circuits receive information on the body's energy status via the nervous system and hormones, enabling us to adapt our intake to our needs with great precision. This physiological regulation is modulated by psychological, social and environmental factors which can disrupt it, explaining the frequency of obesity.

Managing emotions

Our emotions have an important effect on our choice of food and on our eating habits. For example, it has been found that the link between emotion and eating is stronger in obese people than in non-obese people, and in dieters than in non-dieters.

It has also been suggested that emotions are not in themselves the cause of overweight, but rather it is how we deal with these emotions and how we cope with the various factors that have the most influence on the development of overweight.

Not only does what we eat affect how we feel, but how we feel also plays a role in how we eat. Indeed, the difficulty in regulating negative moods has a huge influence on the onset and maintenance of eating disorders.

Emotional regulation refers to how people manage their own emotions, taking into account the circumstances and emotional state of others. Thus, it has been observed that shame and guilt are the emotions that can have an extremely negative impact on eating. As we can see, the link between emotion and eating is more important than we think.

For some people, a strategy of coping with emotions through food can be established. A need to eat is then established in order to manage one or more emotions. This strategy can range from compensatory "snacking" to cases of hyperphagia with much more serious health consequences, or even eating disorders.

Depending on the intensity of the relationship between the management of emotions and food, it is important to turn to a professional in order to ensure effective management.

However, it is also possible to take a close look at the relationship between food and emotions:

  1. Identify the emotion or emotions that lead us to compulsive eating. On your own or with the help of a professional, observe the emotion that seems to be difficult to manage and understand in which situations the emotion-eating mechanism comes into play. To find out which emotion is difficult to manage, you can, for example, note each time you eat what emotion you are experiencing and what the origin of this situation is and its intensity (on a scale that you define beforehand).
  2. Understand and accept this emotion. Once identified, it is necessary to understand and accept this emotion, without value judgement, to understand why it is difficult to live and to put in place a new management strategy.
  3. Find a way to substitute food in the management of your emotions. The relationship between emotional mismanagement and food is a well-oiled unconscious mechanism. Once we have identified the emotions that are difficult to manage, setting up a new mechanism allows us to manage our emotions in a different way: playing sports, setting up a well-being ritual (bathing for example), going for a walk, etc. The aim is not to flee the emotion, but to find another way of managing it.

Motivation for change

Change puts us in uncomfortable situations as human beings. Habits, on the other hand, are more reassuring, which makes them formidable when we adopt bad ones. To succeed in changing, we need to have motivations that we believe in. Motivational interviewing is a method used by some therapists. It aims to reach the client's deepest motivations, enabling him or her to achieve change through close collaboration with the professional.

One of the tools used in motivational interviewing is the Prochaska model. It describes the stages we go through before a change can be effective in our lives. This model includes the following stages:

  • Pre-contemplation: the person does not think they have a particular problem.
  • Contemplation: there is an awareness of the problematic habit, but the person does not want to change it
  • Preparation: the person makes the decision that they will have to change the problematic habit
  • Action: the change becomes real and actions accompany the will to change
  • Maintenance: the person maintains the change and resists the temptation to resume the habit to be changed.
  • Release or relapse: the change becomes a habit that will be maintained for life or will start practicing the habit to be changed again.

This theory is described as a cycle that can only be broken when the release stage is reached. Otherwise, the process must be repeated until the person can reach it. Each stage has its own adapted modes of intervention.

The therapist will take into account the stage the person is at in order to help him or her reach the next stages.

Body image

Body image is made up of three notions: the perception that an individual has of his or her body, the ideal body that this individual imagines and the appearance that he or she gives to his or her body through style of dress, attitude, etc. This image, when it is constructed, is the result of the individual's own experience of his or her body.

This image, when it is constructed, can be influenced by several factors. It can be conditioned for example by environmental or social factors, physical characteristics or by emotions or character traits.

It has been found that a negative perception of one's body image can lead to negative health consequences, such as behavioural problems.

In order to improve self-esteem, the main points to remember are

  • Accepting that there are different body images
  • Realise that the body and mind are one unit
  • Finding a balance between obligation and free time
  • Be aware of the emotions and sensations that the body transmits through the senses.
  • Adopting a healthy lifestyle

A person's satisfaction with his or her body is linked to the overall feeling of self-esteem. This is an essential part of a person's relationship with themselves. As body image development takes place at a young age, more and more public health campaigns are trying to put in place ways to support the development of a positive body image, especially in children and adolescents.

Metabolic and bariatric surgery

Who is the surgery for?

The criteria have been established by the Swiss Society for the Study of Morbid Obesity (SSSMO).

  • You are severely obese with a minimum weight/height ratio (Body Mass Index) of 35 kg/m².
  • You have followed a programme to try to reduce your weight with specialists (doctors, dieticians, psychologists) for a minimum of two years without lasting success.
  • You commit yourself to regular follow-up after the surgery as this is a condition for success.
  • If you meet these conditions, the Federal Social Insurance Office (FSIO) recognises the usefulness of the surgery and covers the costs of preparation for the operation, the operation and the hospital stay and long-term outpatient follow-up (5 years).

However, there are contraindications. Due to the risks of the operation, obesity and diabetes surgery cannot be performed if you have one of these medical problems:

  • Cirrhosis of the liver.
  • Chronic inflammatory bowel disease.
  • Severe kidney failure.
  • Serious psychological disorders.
  • Major eating disorders.
  • Chronic substance abuse (alcohol, cocaine, cannabis, opiates, etc.).
  • Estimated inability of caregivers to provide post-operative follow-up.

Objectives of obesity and diabetes surgery

The medium and long term goals are:

  • Significant and lasting weight loss.
  • Improve or cure associated problems (diabetes, hypertension, dyslipidaemia, sleep apnoea, joint and fertility problems).
  • Improve or cure gastroesophageal reflux and hiatal hernia.
  • Reduce the risk of cardiovascular problems and cancer.
  • Improve quality of life and life expectancy.

What do we expect from you?

Surgery is effective but your contribution to success is essential.

  • You must change your eating habits and improve your physical activity.
  • You must ensure your post-operative medical follow-up (appointments, blood tests, vitamin and trace element supplements)

Your journey before bariatric and diabetes surgery

To ensure that you meet the criteria for obesity and diabetes surgery and that you have no contraindications, you will have several consultations with our specialists. This will be followed by a multidisciplinary discussion to make a final decision on the surgical procedure. The surgical assessment will also be reviewed and the time frame for the operation will be defined.

In consultation you will be assessed by :

  • The endocrinologist/nutritionist
  • The gastroenterologist
  • The pneumologist
  • Psychiatrist
  • Dietician
  • Surgeon
  • The anaesthetist

Depending on your medical problems, additional consultations may be scheduled (cardiologist, angiologist, neurologist, etc.).

You will also have several examinations to do:

  • A blood test.
  • A gastroscopy to exclude stomach diseases.
  • An abdominal ultrasound to detect gallbladder stones.
  • Lung function tests.
  • An electrocardiogram and, if necessary, a cardiac ultrasound and a stress test.
  • A one night sleep recording if sleep apnoea is suspected with, if diagnosed, treatment with an overnight appliance for a period of two months.
  • An electrocardiogram and, if necessary, a cardiac ultrasound and a stress test.

In order to reduce the risks of surgery, it is advisable to stop smoking 2 months before the operation and to follow dietary measures 3 weeks before the operation.

How is obesity measured?

Obesity is measured according to an index defined by the WHO: weight divided by height squared. This is the Body Mass Index (BMI).

Anyone with a BMI of 30 or more is considered obese.

Body Mass Index calculator (table to be put in)

Weight (kg):
Height (cm):
CalculateDelete all

BMI: -

There are 3 stages of obesity:

StageObesityBMI
IModerate≥30
IISevere≥35
IIIMorbid≥40

This calculation is for guidance only and does not replace consultation with a professional to obtain a reliable diagnosis.

Diabetes

Diabetes is a chronic disease that can be accompanied by cardiovascular complications and damage to the nerves, kidneys and eyes. When it occurs in the context of obesity (BMI > 35 kg/m2), bariatric surgery can induce a complete remission in more than 50 % and reduce the risk of complications and mortality. Surgery is therefore more effective than drug treatment.

How is diabetes measured?

Diabetes is defined as an increase in blood sugar levels. When the blood glucose level is equal to or higher than 7.0 mmo/l in the fasting state and/or equal to or higher than 11.1 mmo/l after a meal, the diagnosis is made. The diagnosis can also be made with the HbA1c (blood glucose memory of the last 3 months) if it is equal to or higher than 6.5%.

Diagnosis

Fasting blood glucose

HbA1c

Normal

4.5-5.9 mmol/l

4.5-5.9%

Prediabetes

6.0-6.9 mmol/l

6.0-6.4%

Diabetes

≥ 7.0 mmol /l

≥ 6.5%

At the Centre Obésité et Diabète Générale-beaulieu you benefit from :

  • Comprehensive care
  • Therapeutic education
  • Nutrition
  • Weight management
  • Prevention of complications

High blood pressure

High blood pressure (HBP) is an abnormal rise in blood pressure at rest. Blood pressure is the pressure exerted by the blood on the walls of the arteries. It is expressed in 2 figures:

  1. Systolic pressure (maximum value)
  2. Diastolic pressure (minimum value)

It is expressed in centimetres of mercury (cmHg). Most of the time, the figures you are given do not take into account the unit and you will hear «14/9 blood pressure» for example.

High blood pressure in adults is defined as a systolic pressure usually equal to or greater than 140 mmHg and/or a diastolic pressure equal to or greater than 90 mmHg.

Excess weight (especially abdominal obesity) promotes hypertension.

Conversely, even a small weight loss can lower blood pressure

Obese people have three times more hypertension than non-obese people.

30-40 % of obese people have high blood pressure (abdominal obesity being the main cause). The frequency is particularly high in obese subjects over 45 years of age.

At the Centre for Obesity and Diabetes you will receive:

  • Initial assessment
  • Non-medicinal treatment
  • Medication treatment
  • Therapeutic education
  • Prevention of complications

Hypercholesterolemia

Cholesterol is an important component of the body's cells. Most of it comes from the liver, which makes it from food. But a significant proportion is absorbed directly from foods that contain it (e.g. eggs and dairy products).

Cholesterol is transported in the blood in 2 forms:

  1. HDL or "good cholesterol",
  2. LDL or "bad cholesterol".

At the Centre Obésité et Diabète Générale-beaulieu you will receive :

  • Initial assessment
  • Nutrition
  • Medication treatment
  • Prevention of complications

Obesity, a chronic disease

Obesity has been recognised as a chronic disease since 1997 by the World Health Organisation. It is characterised by a large excess of fat in the body. Obesity can also be of different types and degrees. If the excess weight is less, it is referred to as overweight or abdominal overweight; in more severe cases, it is referred to as morbid obesity, as the patient's life expectancy is reduced. It is the calculation of the overweight or body mass index that determines the type of obesity the patient suffers from.

Obesity can be complicated by many problems such as: type 2 diabetes, high blood pressure, cardiovascular disease, sleep apnoea, dyslipidaemia (cholesterol), joint problems, fertility problems and psychological disorders.

In recent years, the number of overweight adults and children in Switzerland has risen sharply. About 41 % of the adult population are overweight, of which 10 % are obese. About 19 % of children are overweight/obese. Overweight and obesity also generate high costs for society.

Surgery, a solution to be considered

Obesity surgery has proven to be the only effective treatment for severe and morbid obesity. It is offered to people suffering from obesity with a BMI of over 35. Obesity surgery has been shown to be effective in the management of patients with type 2 diabetes. It allows for a reduction or even elimination of anti-diabetic drugs. This surgical effectiveness in the treatment of type 2 diabetes is the basis for the development of metabolic surgery.

In order to benefit from it, patients must meet certain medical criteria and have no contraindications. The patient must be motivated and aware of the benefits, disadvantages and constraints that surgical treatment may entail. In particular, they must be able to modify their eating habits and physical activity after the operation to achieve a satisfactory result.

Obesity and diabetes surgery opens the door to a new life. Following the operation you will experience an improvement in many of the problems mentioned above but also questions about risks and complications, which, to be effectively prevented and treated, require follow-up by our team of doctors, dieticians, psychologists and physiotherapists.

The Centre for Obesity and Diabetes takes care of this disease

The centre is recognised by the Swiss Society for the Study of Morbid Obesity and Metabolic Disorders (SMOB) for the treatment of overweight people. The multidisciplinary approach of its specialists leads them to carry out weekly interventions to reduce weight and contribute to the treatment of type 2 diabetes.

Practical information

Opening hours
The Centre for Obesity and Diabetes is open Monday-Tuesday-Thursday and Friday.
It can be reached by telephone on the following number

 +41 22 404 41 61

Address
Chemin de Beau-Soleil, 22
1206 Geneva
5th floor

The multidisciplinary team

These services are provided by recognised Swiss experts, Professor Jacques Philippe (Endocrinologist and Diabetologist) and Professor Philippe Morel (Surgeon) who are both Swiss specialists certified by the FMH.

Together with the Clinique Générale-Beaulieu, the two professors have set up a multidisciplinary programme that will enable you to receive personalised support in your medical course.

They are accompanied in the care of patients by doctors specialising in nutrition, Dr Dimitrios Samaras, in diabetology, Dr Nicolas Von Der Weid, in pneumology, Dr Laurent Favre, in cardiology, Dr Léonard Mossaz, in psychiatry, Dr Stella Saavedra-Warczyk, in surgery Dr André Mennet, in gastroenterology Dr Alain Vonlaufen and in anaesthesiology by the group of anaesthetists of the Clinique Générale-Beaulieu, as well as by dieticians Lauranne Russanowski and Amel Aït-Abbas.

Find out more about the medical services offered by the Centre for Obesity and Diabetes.

Once a month, all the specialists meet in a colloquium to discuss each case. The patient is at the heart of a multidisciplinary approach.

Clinique Générale-Beaulieu

Prof. Dr. med. Philippe Morel

Specialisation
Visceral surgery, Obesity and overweight
Clinique Générale-Beaulieu

Prof. Dr. med. Jacques Philippe

Specialisation
Diabetology, Endocrinology, Internal medicine, Nutritional counseling View more
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Clinique Générale-Beaulieu

Dr. med. Nicolas Von der Weid

Specialisation
Internal medicine
Clinique Générale-Beaulieu

Dr. med. Dimitrios Samaras

Specialisation
Internal medicine, Nutritional counseling, Geriatrics
Clinique de Genolier

Dr. med. André Mennet

Specialisation
General surgery, Visceral surgery
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Clinique Générale-Beaulieu

Dr. med. Laurent Favre

Specialisation
Pneumology
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Clinique Générale-Beaulieu

Dr. med. Alain Vonlaufen

Specialisation
Gastroenterology and Hepatology
Clinique Générale-Beaulieu

Dr. med. Grégoire Blaudszun

Specialisation
Anesthesiology
Clinique Générale-Beaulieu

Dr. med. Mehdi Hamdani

Specialisation
Anesthesiology

Practical information

Opening hours

The Centre for Obesity and Diabetes is open Monday-Tuesday-Thursday and Friday.
It can be reached by telephone:

 +41 22 404 41 61

or by email :

obesite-diabete@beaulieu.ch

Address

Obesity and Diabetes Centre
Générale-Beaulieu
Chemin de Beau-Soleil, 22
1206 Geneva
5th floor

Access

By public transport :
Bus line 11, stop Clinique Générale
Bus line 3, stop Crêts-de-Champel (Terminus)
Bus line 8, stop Louis Aubert, Route de Florissant

Taxi rank in front of the Clinique Générale-Beaulieu.

By car:
A covered car park (paying) at the Clinic is available.

Restaurant

After a consultation, you can enjoy the clinic's restaurant, the Café-Brasserie Beau-Soleil, located at the foot of the building.