Catherine Chamay-Weber

Insulin secretion response during oral glucose tolerance test is related to low cardiorespiratory fitness in obese adolescents.

Abstract Background: The obesity paradox refers to a category of subjects who may be less prone to develop co-morbidities, such as type 2 diabetes. Cardiorespiratory fitness (CRF) has been identified as one of the key factors. We aimed at exploring the difference in insulin metabolism between fit and unfit obese adolescents. Methods: We recruited 22 obese adolescents and assessed CRF during an incremental treadmill test. According to a cut-off at 80% of predicted maximal oxygen consumption (VO2max), subjects were separated into low or normal CRF. Body composition was determined by densitometry. Serum levels of insulin were measured sequentially during an oral glucose tolerance test and insulin secretion responses were calculated. Results: Compared to adolescents with normal CRF, the ones with low CRF had higher insulin resistance indices (p=0.023) and insulin secretion response (p=0.010), independently of the body mass index z-score. Conclusions: Interventions in obese adolescents should focus on the maintenance or improvement of CRF to at least 80% of predicted VO2max. Indeed, this cut-off was significantly related to insulin secretion responses, independently of the adiposity level. A CRF above the proposed cut-off may prevent the development of insulin resistance.

Obesity Management in Adolescents: Comparison of a Low-Intensity Face-to-Face Therapy Provided by a Trained Paediatrician with an Intensive Multidisciplinary Group Therapy.

Objective: This study aimed to compare the effects of a low-intensity face-to-face therapy provided by a trained paediatrician to an intensive group therapy provided by a multidisciplinary team on the BMI of adolescents with obesity. Methods: This longitudinal cohort study included 233 adolescents aged 11-18 years (mean 13.1 ± 1.7 years). Patients and their parents choose either a low-intensity face-to-face therapy or an intensive group therapy (total 88 h). Results: At baseline, the mean BMI was 29.4 ± 4.9 kg/m2. Within groups changes of BMI z-scores were significant at the end of follow-up both in the face-to-face (-0.2 ± 0.5) and the group therapy (-0.24 ± 0.5). There was no difference among groups. Younger age (12-14 years), gender, follow-up duration as well as BMI z-score at inclusion were significantly related to BMI z-score changes, independently of the type of intervention. As expected, the face-to-face therapy was far less expensive than the group therapy (USD 1,473.00 ± 816.00 vs. USD 6,473.00 ± 780.00). Conclusion: A low-intensity face-to-face therapy resulted in similar changes of the BMI z-score of adolescents than an intensive multidisciplinary group therapy. This approach could be easily disseminated in primary care settings with a specific training in obesity care.

Screening Obese Adolescents for Binge Eating Disorder in Primary Care: The Adolescent Binge Eating Scale

Objective To investigate the performance of a simple and developmentally appropriate 10‐item questionnaire (Adolescent Binge Eating Scale) for the prediction of binge eating disorder (BED) diagnosis in adolescents seen for obesity. Study design We evaluated the performance of the questionnaire in comparison with a clinical interview, in a population of adolescents being seen for obesity. The χ2 or Fisher exact tests were used. Results There were 94 adolescents aged 12‐18 years (59.6% girls) who completed the study. The questionnaire demonstrated a good association with the clinical interview and distinguished different levels of risk for having a BED: participants who responded positively to questions 1 or 2 and had more than 6 positive answers to the 8 additional questions had a high risk of subclinical and clinical BED (83.3%); participants with 3 or fewer positive answers had a low risk of clinical BED (4%). Conclusions The Adolescent Binge Eating Scale questionnaire is a potential screening tool to identify adolescents with obesity at high risk of BED and guide referral to a specialist to clarify the diagnosis and provide adequate care.