Josiane Aparecida Alves Bianchini

Impact of readiness to change behavior on the effects of a multidisciplinary intervention in obese Brazilian children and adolescents

The obesity epidemic is a global challenge that requires evidence-based intervention to slow the emergence of weight-related illness in children and adolescents. Thus, effective treatments are urgently needed. This study aimed to analyze whether there is relationship between the initial stage of readiness for behavior change (SRBC) and the results obtained through participation in a multidisciplinary program of obesity treatment (MPOT). The study included 113 overweight or obese children and adolescents who participated in an intervention for 16 weeks, in which the categorical variable was the SRBC. The dependent variables included: anthropometric measures of body composition, hemodynamic parameters (e.g., blood pressure values), and health-related physical fitness. Although stages 1 and 2 had greater improvements in flexibility than those in stage 5, and stage 1 had greater percentage changes in abdominal strength than those in stage 5, children and adolescents in the highest stage had greater percentage changes for anthropometric, hemodynamic and cardiorespiratory fitness, suggesting an impact of the stage of change on the effects of a MPOT. This study suggests that SRBC plays a role in obesity treatment in Brazilian children and adolescents and warrants consideration when enrolling patients to intervention.

Effect of water- versus land-based exercise training as a component of a multidisciplinary intervention program for overweight and obese adolescents.

To compare water- versus land-based exercise programs, as part of a multidisciplinary intervention, on physical fitness and health-related quality of life in overweight and obese adolescents. A total of 151 overweight and obese adolescents (age: 13.2±1.8years) were divided into: 1) a water-based intervention (WB; n=28); 2) a land-based intervention (LB; n=57); and 3) a control group (CG; n=66). Anthropometric measures, body composition, flexibility, abdominal strength/endurance, cardiorespiratory fitness and health-related quality of life were assessed prior and by the end of a 16-week intervention. Both the water- and land-based interventions were part of a multidisciplinary program focusing on behavioral changes. Fat Mass (%) was significantly reduced in both intervention groups and a higher progression was observed in the WB group (-9.8±7.2% versus -6.1±6.2%; p<0.05 for pre-to-post changes within-groups). However, LB increased more abdominal strength than WB (69.6±165.8% versus 53.4±83.4%; p<0.05) and significantly increased social (19.7±88.8%), psychosocial (5.1±15.1%) and total score (6.3±14.8%), which was observed in neither WB nor CG. The intervention groups did not change body weight (WB: -1.7±5.3%; LB: 0.1±3.4%; p>0.05 for both groups) and increased (p<0.05) fat-free mass (WB: 4.6±4.0%; LB: 4.4±4.1%), VO2max (WB: 9.3±7.8%; LB: 11.0±13.4%), and physical dimension of quality of life (WB: 9.2±17.2%; LB: 8.9±18.0%) differently of what was observed in CG. The physical dimension improvement observed in the land-based and water-based samples was associated with decreased percentage fat mass (r=0.282 and 0.229; p<0.05). We suggest water- and land-based physical exercises within a multidisciplinary program promote similar improvements in body composition, physical fitness and health-related quality of life in overweight and obese adolescents.

Tratamento multiprofissional da obesidade e sua cessação em adolescentes: efeitos no perfil hemodinâmico

To evaluate the effects of a Multiprofessional Program of Obesity Treatment (PMTO) and its cessation on hemodynamic profile in adolescents. We evaluated 19 excess of weight adolescents aged from 10 to 18 years. Anthropometric measures, resting blood pressure and resting heart rate were included in analysis. Adolescents completed 16 weeks of PMTO with a multiprofessional team focused on promote lifestyle changes in adolescents. The same adolescents returned to evaluation after eight weeks of activities cessation. After PMTO, we observed reducing in heart rate of girls without differences to cessation moment. Boys presented improvement in variables: abdominal circumference, BMI, relative body fat and lean mass after PMTO. After cessation period there was significant increase on body weight. Results evidences the positive impact of PMTO demonstrating different effects according to gender.

Building a response criterion for pediatric multidisciplinary obesity intervention success based on combined benefits

To propose a response criterion for analyzing the intervention success by verifying patient outcomes after a multidisciplinary obesity treatment program in Brazilian children and adolescents. Obese children and adolescents (n = 103) completed a 16-week multidisciplinary intervention (IG) and were compared to the control group (CG) (n = 66). A cluster of parameters (e.g. total domain of HRQoL; BMI z-score; cardiorespiratory fitness; body mass; waist circumference; fat mass; lean mass) were measured pre and post-intervention, and the sum of the median percentage variation and the percentile 25 and 75 were used from IG and CG to determine the responsiveness to the program. We are proposing four ranges in which children and adolescents may be classified after the intervention: (1) CG percentile 50 values or lower are considered non-responsive to the intervention, (2) values greater than CG percentile 50 but lower than IG percentile 50 are considered slightly responsive, (3) values greater than IG percentile 50 but lower than IG percentile 75 were considered as moderately responsive, and (4) values greater than IG percentile 75 were considered very responsive.Conclusions: This criterion may serve as a complementary tool that can be employed to monitor the response to this model of multidisciplinary intervention.What is Known:• The effectiveness of multidisciplinary obesity interventions is usually determined by comparing changes in selected outcomes in the intervention versus versus control group.• There is no consensus about what should be assessed before and after the intervention program, which makes difficult to compare different programs and to determine their rate of responsiveness.What is New:• This study proposes a response criteria to pediatric obesity interventions following a similar model compared to ours based on key variables that presents low cost and high applicability in different settings.