Mara Cristina Lofrano-Prado

Quality of life in Brazilian obese adolescents: effects of a long-term multidisciplinary lifestyle therapy.

BackgroundObesity has adverse physical, social, and economic consequences that can negatively affect quality of life (QOL). Thus the aim of this study was to verify the effects of a long-term multidisciplinary lifestyle intervention on QOL, body image, anxiety, depression and binge eating in obese adolescents.MethodsSixty-six obese adolescents (41 girls and 25 boys; BMI: 35.62 ± 4.18 kg/m2) were recruited from the Multidisciplinary Obesity Intervention Program outpatient clinic, and were submitted to a multidisciplinary lifestyle therapy (short-term = 12 weeks and long-term = 24 weeks), composed of medical, dietary, exercise and psychological programs. Validated self-report questionnaires were used to assess symptoms of anxiety Trait/State (STAI); depression (BDI); binge eating (BES), body image dissatisfaction (BSQ) and QOL (SF-36). Data were analyzed by means of scores; comparisons were made by ANOVA for repeated measures, and Tukeys test as post-hoc and Students T test.ResultsLong-term therapy decreased depression and binge eating symptoms, body image dissatisfaction, and improved QOL in girls, whereas, for boys, 24 weeks, were effective to reduce anxiety trait/state and symptoms of binge eating, and to improve means of dimensions of QOL (p < .05).ConclusionA long-term multidisciplinary lifestyle therapy is effective to control psychological aspects and to improve QOL in obese adolescents.

Eating disorders in adolescents: Correlations between symptoms and central control of eating behavior

The aim of this study was to verify the relationship between eating disorders (binge eating and bulimia nervosa) and body image dissatisfaction with BMI, anorexigenic and orexigenic factors in adolescents. Thirty-two adolescents, (13 obese [BMI=36.65±5.68] and 19 non-obese [BMI=22.18±3.11]), aged between 14 and 19y, were recruited. Symptoms of eating disorders were measured by self-report questionnaires (BSQ, BITE and BES). Hormones, cytokines and neuropeptides were determined by Elisa kits (Phoenix peptide). A positive correlation was found between: leptin and BES (r=.724), BSQ (r=.705) and BITE (r=.696); BMI and BES (r=.663), BSQ (r=.525) and BITE (r=.732); the same pattern was observed to insulin and TNF-α. A negative correlation was found in α-MSH and AgRP with BES, BSQ and BITE. Blood levels of hormones and neuropeptides could be the link between obesity and eating disorders in adolescents. However, it is not clear which is the cause and which is the consequence.

Effect of Aerobic Exercise on Hunger Feelings and Satiety Regulating Hormones in Obese Teenage Girls

Exercise is implicated in modifying subsequent energy intake (EI) through alterations in hunger and/or satiety hormones. Our aim was to examine the effects of aerobic exercise on hunger, satiety regulatory peptides, and EI in obese adolescents. Nine obese girls (age: 13-18 years old, BMI: 33.74 ± 4.04 kg/m2) participated in this randomized controlled crossover study. Each participant randomly underwent 2 experimental protocols: control (seated for 150 min) and exercise (exercised for 30 min on a treadmill performed at ventilatory threshold [VT] intensity and then remained seated for 120 min). Leptin, peptide YY(3-36) (PYY(3-36)), and subjective hunger were measured at baseline as well as 30 min and 150 min, followed by 24-hr EI measurement. Exercise session resulted in an acute increase in PYY(3-36) (p < .01) without changes in leptin and/or hunger scores. The control session increased hunger scores (p < .01) and decreased circulating leptin levels (p = .03). There was a strong effect size for carbohydrate intake (d = 2.14) and a modest effect size for protein intake (d = 0.61) after the exercise compared with the control session. Exercise performed at VT intensity in this study appears to provoke a state of transient anorexia in obese girls. These changes may be linked to an increase in circulating PYY3-36 and maintenance of leptin levels.

Alterations in Downstream Mediators Involved in Central Control of Eating Behavior in Obese Adolescents Submitted to a Multidisciplinary Therapy

OBJECTIVE The aim of this study was to verify the effects of a multidisciplinary therapy (24 weeks) on neurohormonal control of food intake, specifically in orexigenic (total ghrelin, agouti-related protein [AgRP], neuropeptide Y [NPY], and melanin-concentrating hormone) and anorexigenic factors (leptin, insulin, and alpha-melanocyte stimulating hormone [α-MSH]), in obese adolescents. METHODS A total of 88 adolescents (38 boys and 50 girls), including 62 obese and 26 normal-weight, aged 15-19 years were recruited. Obese adolescents were submitted to a 24-week multidisciplinary therapy. AgRP, NPY, melanin-concentrating hormone, leptin, insulin, glucose, α-MSH, total ghrelin, and food intake were measured at three stages (at baseline, after 12 weeks, and after 24 weeks). RESULTS At baseline, obese adolescents showed hyperleptinemia (circulating leptin levels, which were, in boys and girls, 40 and 35 times higher than in normal-weight subjects, respectively). After 24 weeks, these values decreased in all obese patients. Our results showed no differences in ghrelin levels between obese and normal-weight adolescents, in both genders. However, obese boys reduced their plasma ghrelin concentration after 24 weeks of therapy (p < .05). The multidisciplinary therapy decreased NPY and AgRP values and increased α-MSH; simultaneously with these changes there was a decrease in total food intake after 24 weeks of therapy. CONCLUSIONS We can conclude that the multidisciplinary therapy was efficient to modulate neurohormonal control of food intake in obese adolescents.

Improvements on Cardiovascular Diseases Risk Factors in Obese Adolescents: A Randomized Exercise Intervention Study

BACKGROUND It is unclear how different exercise intensities affect cardiovascular disease (CVD) risk factors in obese adolescents. The aim of this study was to compare the effects of high-intensity (HIT) vs. low-intensity (LIT) aerobic training on CVD risk factors in obese adolescents. METHODS Forty-three obese adolescents (age: 15.7 ± 1.3 years, BMI: 34.3 ± 4.1 kg/m(2)) participated this study either HIT (corresponding to ventilatory threshold I; N = 20) or LIT (20% below ventilatory threshold I; N = 23) for 12 weeks. All sessions were isocaloric (350 kcal). All participants received the same nutritional, psychological, and clinical counseling. Subjects were assessed in fatness, fitness, lipid profile, and glucose at baseline and after 12 weeks. The CVD risk factors assessed were waist circumference (WC), total cholesterol (TC), high-density lipoprotein (HDL), glucose, and fitness, which were single and clustered analyzed (z scores sum). RESULTS Body mass, Body Mass Index, fatness, and WC were improved (P < .001) in both groups. The sum of z scores (WC + TC + glucose-fitness-HDL) improved in both HIT (12 weeks = -2.16 SD; Cohens d = .45) and LIT (12 weeks = -2.13 SD; Cohens d = .60) without groups differences. Changes in fitness were associated with changes in WC (r = -.48; P = .003). CONCLUSION HIT does not promote any additional improvements in CVD risk factors than LIT in obese adolescents.

Effect of a 12-Week Low vs. High Intensity Aerobic Exercise Training on Appetite-Regulating Hormones in Obese Adolescents: A Randomized Exercise Intervention Study.

Little is known about how the intensity of aerobic training influences appetite-regulating hormones in obese adolescents. Our goal was to assess the effect of low and high intensity aerobic trainings on food intake and appetite-regulating hormones in obese adolescents. Forty three obese adolescents (age: 13-18y, BMI: 34.48 ± 3.94 kg/m2) were randomized into high intensity training (HIT; n = 20) or low intensity training (LIT; n = 23) groups for 12 weeks. All participants also received the same nutritional, psychological and clinical counseling. Pre- and postintervention energy intake (EI) and circulating levels of insulin, leptin, peptide YY3-36 (PYY3-36) and ghrelin were measured. Adolescents in the HIT showed a reduction in total EI and an increase in PYY3-36 (p < .05). Aerobic exercise training performed at ventilatory threshold 1 intensity, reduced EI and augmented PYY3-36 in obese adolescents, compared with LIT. The data suggest that HIT and LIT have differential effects in the regulation of appetite signals and subsequent EI in obese adolescents.

Reasons and Barriers to Lose Weight: Obese Adolescents’ Point of View.

Aims: To identify the reasons why obese adolescents seek weight loss therapy and what barriers they face in losing weight. Study Design:Cross-sectional study.

Aerobic training performed at ventilatory threshold improves liver enzymes and lipid profile related to non-alcoholic fatty liver disease in adolescents with obesity

Background: Despite the positive effects of high-intensity training on weight management and health-related outcomes, it is postulated that high-intensity training may also induce oxidative stress, increasing hepatic damage. Aim: The aim of this study was to compare the effects of low versus high-intensity training on biomarkers related to non-alcoholic fatty liver disease (NAFLD) in adolescents with obesity. Methods: For this study 107 adolescents (15 ± 1 years) with obesity (BMI = 34.7 ± 4.1 kg/m2) were randomized into High-Intensity Training (HIT, n = 31), Low-Intensity Training (LIT, n = 31) or Control Group (CG, n = 45). Adolescents from HIT and LIT received nutritional, psychological and clinical counseling. Blood lipids, Castelli risk index, glucose, insulin and hepatic enzymes were measured at baseline and after 12 weeks. Results: Castelli risk index 1 was reduced in all groups (p < 0.001) with moderate effect size (d) for HIT (d = 0.62) and LIT (d = 0.66). Castelli risk index 2 also decreased (p < 0.001 for all groups; HIT d = 0.65; LIT d = 0.79). High-density lipoprotein increased in all groups (d = 0.25 and d = 0.18 in HIT and LIT), while alanine aminotransferase tended to reduce (p = 0.062) in HIT (d = 0.34) and LIT (d = 0.73) and aspartate aminotransferase decreased (p = 0.024) in both HIT (d = 0.24) and LIT (d = 0.45). There were no changes in glucose, insulin and insulin resistance. Conclusion: Both high and low-intensity training improved biomarkers related to NAFLD. Thus, high-intensity training can be a safe and effective alternative to prevent and treat NAFLD in adolescents with obesity.