Associations Between ADHD Symptomatology, Motivation for Physical Activity, and Technology Acceptability in Young Adult Women With Obesity.

OBJECTIVE: This study examined the relationships between ADHD symptomatology, the motivations for physical activity (PA) according to self-determination theory, and the acceptability of three PA promotion technologies (active video game, mobile application, and telehealth) according to the dimensions of the unified theory of acceptance and use of technology-2 (UTAUT2). METHOD: A total of 312 women, aged 30.7 ± 7.1 years, followed for obesity with an average body mass index of 34.5 ± 7.8 kg/m², were included in this sub-analysis. RESULTS: Fifty-seven individuals (18.3%) were identified with positive screening symptoms of ADHD. No differences emerged regarding acceptability of technology-based PA. However, individuals with positive screening for ADHD tended to have higher scores for acceptability of active video game on the UTAUT2 dimensions of effort expectancy and hedonic motivation. CONCLUSION: This study suggests that active video game may be more appropriate than other technologies for individuals with obesity and ADHD symptoms.

[Definitions and epidemiology of childhood obesity V. Nègre]. / Définitions et épidémiologie de l'obésité de l'enfant Véronique Nègre.

DEFINITIONS AND EPIDEMIOLOGY OF CHILDHOOD OBESITY. Childhood overweight and obesity are defined using the curves established by the International Obesity Task Force (IOTF). A child is overweight when his BMI is above the IOTF 25 curve (corresponding to a Body Mass Index [BMI] of 25 at the age of 18). He is obese when his BMI is above the IOTF 30 threshold. However, in clinical practice, it is more important to appreciate the evolution of the curve than the level of corpulence itself, as this helps to orientate the diagnosis and better understand the mechanisms of excessive weight gain. Currently, even if a stabilization of the prevalence seems to have been observed between the years 2000 and 2015 in developed countries, this is not the case in the lower income countries. In France, 18% of children are overweight, of which 3 to 4% are obese, with a very marked social gradient. Since 2015, there has been a trend towards a re-increase in severe forms of obesity, particularly among girls and children from families with the greatest socio-economic difficulties. The initial confinement imposed by the Covid-19 pandemic seems to have aggravated this trend.

DÉFINITIONS ET ÉPIDÉMIOLOGIE DE L'OBÉSITÉ DE L'ENFANT. Le surpoids et l'obésité sont définies chez l'enfant grâce aux courbes établies par l'International Obesity Task Force (IOTF). Un enfant est dit en surpoids lorsque sa corpulence se situe au-delà de la courbe IOTF-25 (indice de masse corporelle [IMC] égal à 25 à l'âge de 18 ans) ; il est dit obèse lorsque sa corpulence le situe au-dessus du seuil de l'IOTF-30. Cependant, dans la pratique clinique, plus que le niveau de corpulence lui-même, il est surtout important d'apprécier l'allure évolutive de la courbe, qui permet d'orienter le diagnostic et de mieux comprendre les mécanismes de la prise de poids excessive. Actuellement, même si une stabilisation de la prévalence semble avoir été observée entre les années 2000 et 2015 dans les pays dits développés, il n'en est pas de même dans les pays à revenu plus faible. En France, 18 % des enfants sont en surpoids, dont 3 à 4 % sont en situation d'obésité avec un gradient social très marqué. Depuis 2015, il est observé une tendance à une réaugmentation des formes sévères, particulièrement chez les filles et les enfants des familles les plus en difficulté socio-économique. Le premier confinement imposé par la pandémie de Covid-19 semble avoir aggravé cette évolution.

Metabolic Fatty Liver Disease in Children: A Growing Public Health Problem.

Metabolic-associated fatty liver disease (MAFLD), previously called nonalcoholic fatty liver diseases (NAFLD), is one of the most important causes of chronic liver disease worldwide and will likely become the leading cause of end-stage liver disease in the decades ahead. MAFLD covers a continuum of liver diseases from fatty liver to nonalcoholic steatohepatitis (NASH), liver fibrosis/cirrhosis and hepatocellular cancer. Importantly, the growing incidence of overweight and obesity in childhood, 4% in 1975 to 18% in 2016, with persisting obesity complications into adulthood, is likely to be harmful by increasing the incidence of severe MAFLD at an earlier age. Currently, MAFLD is the leading form of chronic liver disease in children and adolescents, with a global prevalence of 3 to 10%, pointing out that early diagnosis is therefore crucial. In this review, we highlight the current knowledge concerning the epidemiology, risk factors and potential pathogenic mechanisms, as well as diagnostic and therapeutic approaches, of pediatric MAFLD.

Effects of technology-based physical activity interventions for women after bariatric surgery: study protocol for a three-arm randomised controlled trial.

INTRODUCTION: A recent meta-analysis provided proof of efficacy for mobile technology to increase physical activity or weight loss in the short term. Videoconferencing may also be effective, especially as it reduces the barriers related to face-to-face physical activity interventions. Both technologies seem particularly interesting for bariatric surgery management, but their long-term effects on physical activity maintenance are unknown. Moreover, the mechanisms underlying their effectiveness, such as technology acceptability and motivational processes, have not been examined.The objectives of this study are to determine the effects of two technology-based (mobile technology and videoconferencing) physical activity programmes after bariatric surgery compared with standard care and to assess the contribution of acceptability and motivational mechanisms in explaining these effects on physical activity, physiological measures and health indicators. METHODS AND ANALYSIS: One hundred and twenty young women who have undergone bariatric surgery in the last 3-6 months will be included. The volunteers will be randomly assigned to one of three arms: CONTROL (standard care), ACTI-MOBIL (mobile technology) or ACTI-VISIO (videoconferencing). The primary outcome is the distance travelled during a 6 min walk test relativised according to Capadaglio's theoretical distance. Secondary outcomes are behavioural measures of physical activity, physiological measures, health indicators, technology acceptability and motivational concepts. Data will be collected at baseline (T0), 3 months (T3) and 6 months (T6). The technology groups will receive a physical activity programme for 12 weeks (between T0 and T3). A mixed model approach will be used to analyse the change in outcomes over time for each group. ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the French East 1 Protection of Persons Ethics Committee (number: 2020.A00172-37) and the French National Commission for Information Technology and Civil Liberties (number: UCA-R20-034). The results will be disseminated through conference presentations and peer-reviewed publications. TRIAL REGISTRATION NUMBER: NCT04478331.

Acceptability of technology-based physical activity intervention profiles and their motivational factors in obesity care: a latent profile transition analysis.

OBJECTIVES: This study aimed to: (a) identify the acceptability profiles for three technology-based physical activity interventions (TbPAI) in obesity treatment (active video games, mobile applications, telehealth), (b) examine the issues of consistency or change in these profiles for the same individual across technologies, and (c) determine whether acceptability profiles are related to motivational factors. METHODS: Three hundred and twelve women (Mage = 30.7, SD = 7.1 years; MBMI = 34.5, SD = 7.8 kg/m²) using obesity services were recruited for this cross-sectional survey. They completed an online survey including sociodemographic data and measures related to physical activity: level, stage of change, motivation, and general causality orientations. The women read descriptions of the three technologies and rated their acceptability. We used a latent profile transition analysis (LPTA) approach. RESULTS: A 2-class model (high and low acceptability) best described the profiles for each technology. Intra-individual analysis revealed that the profiles exhibited both changes and stability across TbPAI. Women with high scores on impersonal orientation were more likely to be in the high acceptability telehealth profile, whereas those reporting high scores on control orientation were more likely to be in the high acceptability active video games profile. Women with high scores on control orientation and low scores on impersonal orientation were more likely to be in the high acceptability mobile applications profile. CONCLUSIONS: Results showed that the causality orientations were factors related to the TbPAI acceptability profiles, suggesting that clinicians should consider these psychological characteristics in TbPAI counseling.

Comparison between type A and type B early adiposity rebound in predicting overweight and obesity in children: a longitudinal study.

Early adiposity rebound (EAR) predicts paediatric overweight/obesity, but current approaches do not consider both the starting point of EAR and the BMI trajectory. We compared the clinical characteristics at birth, age 3-5 and 6-8 years of children, according to the EAR and to its type (type A/type B-EAR). We assessed the children's odds of being classified as overweight/obese at age 6-8 years, according to the type of EAR as defined at age 3-5 years. As part of this two-wave observational study, 1055 children were recruited and examined at age 3-5 years. Antenatal and postnatal information was collected through interviews with parents, and weight and height from the health records. Type A and type B-EAR were defined in wave 1 according to the BMI nadir and the variation of BMI z-score between the starting point of the adiposity rebound and the last point on the curve. At 6-8 years (wave 2), 867 children were followed up; 426 (40·4 %) children demonstrated EAR. Among them, 172 had type A-EAR, higher rates of parental obesity (P < 0·05) and greater birth weight compared with other children (P < 0·001). Odds for overweight/obesity at 6-8 years, when adjusting for antenatal and postnatal factors, was 21·35 (95 % CI 10·94, 41·66) in type A-EAR children and not significant in type B-EAR children (OR 1·76; 95 % CI 0·84, 3·68) compared with children without EAR. Classification of EAR into two subtypes provides physicians with a reliable approach to identify children at risk for overweight/obesity before the age of 5 years.

The transtheoretical model (TTM) to gain insight into young women's long-term physical activity after bariatric surgery: a qualitative study.

BACKGROUND: Over the long term, people who have undergone bariatric surgery (BS) remain overly sedentary with inadequate physical activity (PA). The purpose of this study was to apply the transtheoretical model (TTM) to (1) explore in-depth how PA is experienced years after BS and (2) identify the barriers to and facilitators of PA involved at each stage of change (SOC). METHODS: Seventeen women with a mean age of 32.5 ± 3.3 years and a percentage of total weight loss of 29.6 ± 12.4 were interviewed at a mean of 9.4 ± 3.6 years after BS. Interviews were audio-recorded, transcribed verbatim, and analyzed using thematic analysis. RESULTS: The distribution of barriers to and facilitators of PA differed with the SOC. In progressing from the precontemplation and contemplation stages to the preparation stage, the women experienced changes in their decisional balance, supported by processes of self-reevaluation and environmental reevaluation. In shifting from preparation to the action and maintenance stages, they experienced intrinsic motivation and self-liberation processes. The relapse stage was associated with a decrease in self-efficacy to cope with life constraints. CONCLUSIONS: This study presents an in-depth theory-based exploration of the dynamics of long-term engagement in PA after BS in young women, with clinical implications for providing them with better guidance toward a more physically active lifestyle.

Short-term and long-term positive outcomes of the multidisciplinary care implemented by the French health networks for the prevention and care of paediatric overweight and obesity.

BACKGROUND: The nine French regional health networks for the prevention and care of paediatric obesity offer a 2-year program of multidisciplinary primary care (medical, dietetical, psychological, adapted physical activity) based on multicomponent lifestyle interventions. OBJECTIVES: To assess the short-term and long-term impact of care management. METHODS: The impact of the multidisciplinary care was assessed by changes in the body mass index (BMI) Z score during the period of the care, and at least 2 years after the end. Anthropometric data were collected at baseline and at the end of the care either through a digital medical file or through direct phone contacts with the referring. Long-term outcomes were assessed through studies relative to post follow-up evaluation. RESULTS: At the end of the period of the care in a network, 72.9% of 6947 children had decreased their BMI Z score from 3.6 ± 1.0 DS at baseline to 3.3 ± 1.1 DS at the end. The four studies relative to long-term evaluation showed a pursuit of the decrease of BMI Z score during the 5.1 years after the beginning of the care. CONCLUSIONS: The care provided by regional French networks for prevention and care of paediatric obesity induce a reduction of BMI that continues afterwards.

Prenatal education of overweight or obese pregnant women to prevent childhood overweight (the ETOIG study): an open-label, randomized controlled trial.

BACKGROUND: We aimed to evaluate whether pre and perinatal education of pregnant women would reduce childhood overweight. METHODS: Four French centers included women at ≤21 gestational weeks (GWs) with body mass index (BMI) >25 kg/m2 before pregnancy. Patients were randomized to a control group (routine care including at least one dietary visit) or an intervention group (2 individuals (26 and 30 GW) and 4 group sessions (21, 28, 35 GW, 2 months postpartum)) aimed at educating the future mother regarding infant and maternal nutrition. The primary objective was to reduce post-natal excessive weight gain in the infant from birth to 2 years (NCT00804765). This project was funded by a grant from the National Programme for Hospital Research (PHRC-2007 French Ministry of Health). RESULTS: We included 275 women (BMI: 32.5 kg/m2). The rate of post-natal excessive weight gain was similar in the intervention (n = 132) and control (n = 136) groups by intention to treat (ITT: 59.1% vs 60.3% respectively, p = 0.84) in available data (AD, n = 206) and by per-protocol analysis (PP, n = 177). Two years after delivery, normalization of maternal BMI and number of infants with BMI < 19 kg/m2 were not significantly different in the interventional group in ITT and in the control group. Although not significantly different in ITT, normalization of maternal BMI was more frequent in AD (n = 149: 12.9% vs 3.8%, p = 0.04) and 2-year-old infant BMIs were less likely to be >19 kg/m2 in the intervention group in AD (n = 204: 0% vs 6.8%, p = 0.014) and PP (n = 176: 0% vs 6.4%, p = 0.03). CONCLUSIONS: An education and nutritional counseling program for overweight women, starting after 3 months of gestation, did not significantly change post-natal excessive weight gain of infants or prevent overweight in mothers and children 2 years after delivery.

Cardiometabolic risk is associated with the severity of sleep-disordered breathing in children with obesity.

BACKGROUND: The alarming progression of pediatric obesity is associated with the development of sleep-disordered breathing (SDB), and both exhibit similar adverse cardiometabolic health outcomes. Physical activity level (PAL) may counteract sleep and metabolic disturbances. The present study investigates i) the association between the metabolic syndrome in childhood obesity and SDB, ii) the impact of SDB severity on cardiometabolic risk scores and PAL in children with obesity. METHODS: Maturation status (Tanner stages), anthropometric (height, weight, body mass index, waist circumference, body adiposity index) and cardiometabolic characteristics (systolic and diastolic blood pressure, lipid and glycemic profiles) were assessed in 83 obese children (mean±SD, age: 10.7±2.7years). PAL and SDB were investigated with a step test and interviews, and an overnight sleep monitor, respectively. The presence or absence of metabolic syndrome (MS) was established and continuous cardiometabolic risk scores were calculated (MetScoreBMI and MetScoreWC). RESULTS: Obese children with (61.4%) and without (38.6%) MS present similar SDB. SDB severity is associated with increased insulin concentrations, MetScoreBMI and MetScoreWC (p<0.05) in obese children. There is no association between SDB and PAL. CONCLUSIONS: In a context where no consensus exists for SDB diagnosis in children, our results suggest the influence of SDB severity on cardiometabolic risk factors. Further studies are needed to explore the association between PAL and both metabolic and sleep alterations in obese children.

Validation of a new scale to measure perceived exertion in obese adolescents: the Childhood Obesity Perceived Exertion (Cope-10) Scale.

BACKGROUND: The aim of this study was to validate a measurement scale for perceived exertion, named the Childhood Obesity Perceived Exertion Scale (COPE-10), by evaluating concurrent validity, reliability and sensitivity in obese adolescents. METHODS: Thirty obese adolescents (BMI 36.2±0.8 kg.m-2), aged 14.2±0.3 years, performed two incremental exercise tests (maximal followed by submaximal) before and after a multidisciplinary obesity management program. To standardize workload, physiological variables [heart rate (HR), ventilation (E) and gas exchange (O2)] and perceived exertion (RPE) were modelized (fHR, fVE, fVO2, fRPE). At a rank of 6 on the COPE-10 Scale (RPE6) and at fixed second ventilatory threshold (VT2), we determined respectively the associated power (WPRPE6, WPVT2) and HR (HRRPE6, HRVT2). RESULTS: During maximal exercise, we observed significant correlations between fRPE and each of fHR (r=0.88 ; r=0.91), fVE (r=0.93 ; r=0.94) and fVO2 (r=0.87 ; r=0.89) before and after management respectively, indicating the concurrent validity of the COPE-10 Scale to estimate exercise intensity in obese adolescents. During submaximal exercise, we observed intraclass correlation coefficients of 0.77 before and 0.86 after management, showing reliability. After management, WPVT2 and WPRPE6 increased significantly (+23W and +21W ; P<0.001), and there was a significant correlation between HRVT2 and HRRPE6 (r=0.90), illustrating the scale's sensitivity to change. CONCLUSIONS: The COPE-10 Scale is a valid tool to measure perceived exertion in obese adolescents. This inexpensive and non-invasive instrument could be widely used in rehabilitation programs for obese youths.

[Early assessment of overweight for preventing obesity]. / Dépister précocement le surpoids pour éviter l'obésité.

The overweight child should be detected as soon as possible to avoid the occurrence of a more severe obesity, source of early complications. Thus, it is essential to carefully follow the BMI curve in all children with particular attention to the age of the early adiposity rebound (between 1 and 5 years). Early rebound indicates predisposition, and represents a risk factor for later obesity. The announcement is not harmless and should avoid unnecessary judging or blaming the family outside rare situations of abuse. Overweight results from an energy imbalance favored by many risk factors often entangled. These predisposing factors are specific to the child (especially genetic and epigenetic origin) and environmental. Among these environmental factors, those occurring during pregnancy and the nutritional education (too permissive or too restrictive) represent targets for primary prevention.

Evaluation of cardiorespiratory fitness using three field tests in obese adolescents: validity, sensitivity and prediction of peak VO2.

OBJECTIVES: Evaluation of cardiorespiratory fitness in obese adolescents is necessary to develop personalised retraining programmes. We aimed to measure cardiorespiratory fitness using 3 field tests, and to evaluate their validity and sensitivity compared to values obtained by laboratory tests. DESIGN: Longitudinal interventional study in obese adolescents admitted to a rehabilitation centre for a 9-month programme of obesity management. METHODS: A 12-min walk/run test, an adapted 20 m shuttle walk-run test (starting speed 4 km h(-1), increments of 0.5 km h(-1)min(-1)) and a 4-level submaximal cycle ergometer test were performed to estimate respectively distance covered in 12 min, maximum speed and maximal aerobic power. RESULTS: Thirty adolescents aged 14.2 ± 1.6 years were included. After 9 months intervention, we observed a significant reduction in body mass index, and an increase in peak VO2 and field test results. We observed significant correlations between pre- and post-intervention values of peak VO2 and distance covered in 12 min (r=0.70 pre; r=0.82 post), maximum speed (r=0.80 pre; r=0.83 post) and maximal aerobic power (r=0.71 pre; r=0.84 post). Multiple linear regression made it possible to estimate peak VO2 based on results from the 3 field tests using prediction equations specific to a population of obese adolescents. CONCLUSIONS: These field tests, including the adapted 20 m shuttle walk-run test, adequately assess cardiorespiratory fitness in obese adolescents, and are sensitive to changes over time. Predictive equations including BMI are useful in clinical practice to predict peak VO2 in these patients.

Effects of an in-patient treatment program based on regular exercise and a balanced diet on high molecular weight adiponectin, resistin levels, and insulin resistance in adolescents with severe obesity.

Adiponectin, the most abundant hormone produced by adipose tissue, circulates in 3 isoforms, including high molecular weight (HMW) adiponectin. The latter has been suggested to be a better predictor of metabolic disturbances and insulin resistance associated with obesity. This study investigated changes in total and HMW adiponectin, resistin, and homeostasis model assessment (HOMA) during a 9-month in-patient treatment program based on physical exercise and a balanced diet in 32 severely obese adolescents. Total and HMW adiponectin, resistin, and HOMA were measured at baseline (month 0) and during the program (months 3, 6, 9). In addition, a control group of 15 teenagers served as a reference for the baseline assessments. At baseline, HMW adiponectin was more markedly decreased in obese adolescents than total adiponectin, and both were lower than in controls. Conversely, resistin and HOMA were higher in obese adolescents. During the program, there was a significant change in body composition and improved insulin sensitivity among obese teenagers. In addition, HMW adiponectin and the ratio of HMW-to-total adiponectin increased throughout the study, whereas total adiponectin only increased up until the sixth month. On the contrary, resistin did not show any significant change. In obese adolescents, a long-term combination of aerobic exercise and a balanced diet, inducing change in body composition and improved insulin sensitivity, markedly increased HMW adiponectin compared with total adiponectin, without any change in resistin concentrations. Our results thus suggest that the determination of HMW adiponectin could be more useful than measurement of total adiponectin in clinical settings.