The relative reinforcing value of snack food is a significant predictor of fat loss in women with overweight or obesity.

Reinforcing Relative Value (RRV) of food and impulsivity are associated with energy intake and obesity. This study investigated the degree to which changes in RRV and impulsivity independently or interactively predict changes in body weight and composition in women with overweight or obesity engaged in either fast or slow weight loss programs. Body weight, body composition, impulsivity (Barratt Impulsiveness Scale), and RRV snack (computerized Behavioural Choice Task) were measured at baseline and post-intervention in 30 women with obesity undergoing either slow (n = 14, -500 kcal/day, 20 weeks) or fast (n = 16, -1000 kcal/day, 10 weeks) weight reduction. No group × time effects were noted on body composition, impulsivity, or RRV, so participants from both groups were pooled for analysis. Multiple regression analyses indicated that none of the impulsivity variables predicted weight or fat mass (FM) loss. However, ΔRRV snack predicted ΔFM (r = 0.40, p = 0.046), whereby greater increases in RRV snack were associated with less FM loss. The results indicate that different rates of weight loss do not differentially affect RRV snack or impulsivity traits. However, changes in RRV snack predicted FM loss, suggesting that dietary interventions that either mitigate increases or foster reductions in the RRV snack may yield greater reductions in adiposity. Trial Registration clinicaltrials.gov identifier: NCT04866875. Novelty: No differences in RRV of food were noted between fast and slow weight loss. Weight loss from combined fast and slow groups led to a moderate-sized reduction in total impulsivity. Greater diet-induced increases in RRV snacks were associated with less body fat loss.

Semi-intensive and Intensive Interdisciplinary Treatments Have Similar Effects on Metabolic Syndrome and Selected Inflammatory Markers in Adolescents with Obesity.

BACKGROUND: The purpose of the present study was to compare the impact of semi-intensive and intensive interdisciplinary weight-loss therapies on the treatment of metabolic syndrome (MS) and selected inflammatory markers in adolescents with obesity. METHODS: The study included 166 adolescents enrolled in two groups for 22 weeks: the intensive group (in-person aerobic and resistance exercise three times a week, and psychological and nutritional counselling once a week), or the semi-intensive group (six in-person exercise orientation meetings and six in-person psychological support sessions with an online nutritional and exercise program). Anthropometric parameters, blood pressure, fasting glucose, insulin, lipid profile, triglycerides (TG), leptin and adiponectin were assessed before and after the interventions. RESULTS: Body weight and waist circumference decreased in both groups (P<0.001) and large effect sizes (η2= 0.586 and η2=0.465, respectively) were noted. Significant time and group interactions were found (P=0.001) with medium effect sizes (η2=0.095 and η2=0.105, respectively). The prevalence of MS decreased from 27.9% to 13.1% (P=0.012) and 29.4% to 5.9% (P=0.004) in the semi-intensive and intensive groups, respectively. All MS risk factors decreased significantly over time (P<0.001) and a significant time*group interaction was observed (P<0.05), except for fasting TG (P=0.832) and glucose (P=0.128, η2=0.021). CONCLUSION: The results suggested that both approaches promoted significant clinical improvement in the condition of adolescents with MS and reduced associated risk factors. Studies that consider the cost effectiveness of both treatments are still needed to determine whether semi-intensive care, with its lower financial costs, may be a suitable option to treat obesity and MS in adolescents with obesity.

Early changes in appetite and energy expenditure are not associated to body weight and fat losses in pre-menopausal women living with overweight/obesity.

BACKGROUND: The aim of the study was to investigate whether early changes (1-week) in energy balance-related measures would predict changes in body weight (BW) and fat losses in women living with overweight/obesity. METHODS: BW, body composition (DXA), resting energy expenditure (REE)(indirect calorimetry), olfactory performance (Sniffin' Sticks), appetite and palatability (visual analogue scale) were measured at baseline, after a 1-week of caloric restriction as well as post-intervention (at 10 and 20 weeks) in a group of 30 women living with overweight/obesity. RESULTS: A significant decrease in REE (p = 0.033) was noted after 1 week. Fasting desire to eat (p = 0.004), hunger (p = 0.001) and prospective food consumption (p = 0.001) all increased after 1 week. Similarly, significant increases in AUC SQ for desire to eat (p = 0.01), hunger (p = 0.005) and prospective food consumption (p = 0.001) were noted after 1 week. However, these early changes were not associated to final BW or FM losses at the end of the weight loss intervention. CONCLUSION: Despite significant changes in REE and appetite soon after the onset of a BW loss intervention, these early changes do not seem to predict final BW or FM losses at the end of the program in women living with overweight/obesity.

The rate of weight loss does not affect resting energy expenditure and appetite sensations differently in women living with overweight and obesity.

BACKGROUND: Evidence of metabolic adaptations following weight loss is available in the literature. However, the impact of different degrees of caloric restriction on a comprehensive panel including energy expenditure (EE) and intake (EI), appetite, palatability and olfactory performance remains to be investigated. Accordingly, the purpose of the study was to investigate the changes in resting energy expenditure (REE), appetite, olfaction, palatability and EI in women who were engaged in either a slow (-500 kcal/day, 20-week) or in a rapid (-1000 kcal/ day, 10 weeks) weight loss program. METHODS: Thirty-six women with obesity were randomized to a slow or to a rapid weight loss group. Body composition (DXA), REE (indirect calorimetry), olfactory performance (Sniffin' Sticks), appetite (Visual Analogue Scale) were assessed at multiple time points during the intervention. RESULTS: A total of 30 participants completed the study (slow group n = 14; rapid group n = 16). Body weight decreased by -4.46 (3.99) % (P < .001) and - 6.23 (3.06) % (P = .001) in the slow and rapid groups, respectively. No differences in % weight loss were noted between groups (P = .175). Significant decreases in fat mass (P < .001), REE (P = .035), total EI (P = .001) were observed over time from both groups. However, no significant differences emerged between groups for any of the outcomes. The satiety quotient (SQ) at time 180 min significantly increased for desire to eat (P = .01), hunger (P = .011) and PFC (P = .002), while the area under the curve for postprandial appetite rates were not changed. No differences in palatability and olfactory performance were noted after the intervention. CONCLUSIONS: Our results suggest that different rates of weight loss exert similar effects on REE, appetite, satiety, and EI when weight loss are comparable.

A one-year resistance training program following weight loss has no significant impact on body composition and energy expenditure in postmenopausal women living with overweight and obesity.

Resistance training (RT) has been shown to decrease fat mass (FM), and increase fat-free mass (FFM), which can be a useful for weight loss maintenance. OBJECTIVE: To examine the effects of a 1-year RT intervention on weight loss maintenance following a 6-month dietary weight loss intervention. DESIGN: Following a 6-month dietary weight loss intervention (-6% ±â€¯5.8; 5.05 kg ±â€¯4.45), 70 postmenopausal women living with overweight or obesity were randomized to a control group (n = 34) or a RT group (n = 36) (3×/week first 6 months, 2×/week last 6 months, 70-80% of 1-repetition maximum). Body composition (DXA), abdominal visceral adipose tissue (VAT) and subcutaneous adipose tissue (SAT) (CT scan), resting energy expenditure (EE) (indirect calorimetry), physical activity EE and total daily EE were measured (doubly-labelled water). RESULTS: A total of 54 participants completed the study (control group n = 29; RT group n = 25) and compliance to the RT program was on average 64%. Significant regains were noted for body weight 0.98 (3.71) kg vs. 1.33 (3.94) kg and FM regain 1.32 (2.69) kg vs. 0.81 (3.26) kg in control and RT groups after the 1-year weight maintenance phase. No group differences were noted. Resting EE and total daily EE did not change after the weight maintenance phase, and no differences were observed between groups. Both groups had significantly greater than predicted decrease in resting EE after the 6-month dietary intervention and at the end of the 1-year weight-loss maintenance phase. CONCLUSIONS: Our results suggest that a 1-year RT intervention following a 6-month dietary weight loss intervention does not improve weight loss maintenance, body composition or EE in post-menopausal women living with overweight or obesity.

Weight Loss and Appetite Control in Women.

PURPOSE OF REVIEW: The aim of this review is to describe and discuss weight loss-induced variations in appetite in women and factors responsible for these changes. RECENT FINDINGS: Studies have shown postweight loss increases in fasting and postprandial appetite in individuals engaged in weight loss trials, especially in women. Similarly, appetite-related peptides associated to the homeostatic control of feeding, such as leptin, ghrelin and peptide YY, were also found to be altered in way that promotes increased appetite after weight loss interventions. Sustained caloric deficits also drive increases in the frequency and strength of food cravings, food reward and seem to enhance oro-sensory sensations in women who lost weight. The menstrual cycle has also been to shown to influence caloric intake in women, more specifically food cravings. On the other hand, caloric restriction seems to increase cognitive restraint, decrease habitual disinhibition and susceptibility to hunger among women engaged in weight loss trials. Neural analysis corroborates these results, showing increased activation in brain areas involved in food reward and self-control processing. In conclusion, evidence supports that weight loss increases appetite sensations, and promotes changes in homeostatic and non-homeostatic control of feeding, which collectively seem to upregulate appetite in women.

The effects of partial sleep restriction and altered sleep timing on appetite and food reward.

We examined the effects of partial sleep restriction (PSR) with an advanced wake-time or delayed bedtime on measures of appetite, food reward and subsequent energy intake (EI). Twelve men and 6 women (age: 23 ± 4 years, body fat: 18.8 ± 10.1%) participated in 3 randomized crossover sessions: control (habitual bed- and wake-time), 50% PSR with an advanced wake-time and 50% PSR with a delayed bedtime. Outcome variables included sleep architecture (polysomnography), ad libitum EI (validated food menu), appetite sensations (visual analogue scales), satiety quotient (SQ; mm/100 kcal) and food reward (Leeds Food Preference Questionnaire and the relative-reinforcing value (RRV) of preferred food task). Increased fasting and post-standard breakfast appetite ratings were noted following PSR with an advanced wake-time compared to the control and PSR with a delayed bedtime sessions (Fasting hunger ratings: 77 ± 16 vs. 65 ± 18 and 64 ± 16; P = 0.01; Post-meal hunger AUC: 5982 ± 1781 vs. 4508 ± 2136 and 5198 ± 2201; P = 0.03). Increased explicit wanting and liking for high- relative to low-fat foods were also noted during the advanced wake-time vs. control session (Explicit wanting: -3.5 ± 12.5 vs. -9.3 ± 8.9, P = 0.01; Explicit liking: -1.6 ± 8.5 vs. -7.8 ± 9.6, P = 0.002). No differences in the RRV of preferred food, SQ and ad libitum lunch intake were noted between sessions. These findings suggest that appetite sensations and food reward are increased following PSR with an advanced wake-time, rather than delayed bedtime, vs. CONTROL: However, this did not translate into increased EI during a test meal. Given the increasing prevalence of shift workers and incidences of sleep disorders, additional studies are needed to evaluate the prolonged effects of voluntary sleep restriction with altered sleep timing on appetite and EI measurements.

The effects of sleep restriction and altered sleep timing on energy intake and energy expenditure.

Experimental evidence suggests that sleep restriction increases energy intake (EI) and may alter energy expenditure (EE). However, it is unknown whether the timing of a sleep restriction period impacts EI and EE the following day. Hence, we examined the effects of sleep restriction with an advanced wake-time or delayed bedtime on next day EI and EE. Twelve men and 6 women (age: 23±4years, body fat: 18.8±10.1%) participated in 3 randomized crossover sessions: control (habitual bed- and wake-times), 50% sleep restriction with an advanced wake-time and 50% sleep restriction with a delayed bedtime. Outcome variables included sleep architecture (polysomnography), EI (food menu), total EE and activity times (accelerometry). Carbohydrate intake was greater on day 2 in the delayed bedtime vs. control session (1386±513 vs. 1579±571kcal; P=0.03). Relative moderate-intensity physical activity (PA) time was greater in the delayed bedtime session vs. control and advanced wake-time sessions on day 1 (26.6±19.9 vs. 16.1±10.6 and 17.5±11.8%; P=0.01), whereas vigorous-intensity PA time was greater following advanced wake-time vs. delayed bedtime on day 1 (2.7±3.0 vs. 1.3±2.4%; P=0.004). Greater stage 1 sleep (ß=110kcal, 95% CI for ß=42 to 177kcal; P=0.004), and a trend for lower REM sleep (ß=-20kcal, 95% CI for ß=-41 to 2kcal; P=0.07), durations were associated with greater EI between sleep restriction sessions. These findings suggest that the timing of a sleep restriction period impacts energy balance parameters. Additional studies are needed to corroborate these findings, given the increasing prevalence of shift workers and incidences of sleep disorders and voluntary sleep restriction.

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.

Hypertriglyceridemic waist and metabolic abnormalities in Brazilian schoolchildren.

OBJECTIVE: To identify the prevalence of hypertriglyceridemic waist (HTW) phenotype and its association with metabolic abnormalities in schoolchildren. METHODS: A cross-sectional study, with a sample of 241 students aged 10 to 14 years from public schools (4 schools) and private (2 schools) from Paranavai town, in Parana State, Brazil. Anthropometric variables (weight, height, waist circumference) and levels of triglycerides, total cholesterol, HDL-C, non-HDL and LDL-C were analyzed. In statistical tests of Pearson partial correlation and multivariate logistic regression, considering p<0,05. RESULTS: The prevalence of HTW was 20,7% among schoolchildren, 14,1% in males and 6,6% among females with higher proportions aged 10-12 years old. Multivariate analysis indicated that the students who attended private schools were nearly three times more likely (95% CI: 1,2-5,6), to be diagnosed with HTW compared with those who attended public schools (p = 0,006), and LDL-C was the only metabolic variable positively associated with the outcome (p = 0,001), where the students categorized with elevated serum levels had odds 4,2 times (95% CI: 1,6-10,9) having the HTW compared to students in appropriate levels. CONCLUSION: This study showed higher prevalence of hypertriglyceridemic waist phenotype in students when compared to prospective studies in Brazil and worldwide. It also showed that the only metabolic alteration associated with HTW phenotype was LDL-C (low density lipoprotein).

Improvement on the quality of life in patients who underwent bariatric surgery / Melhora na qualidade de vida de pacientes submetidos à cirurgia bariátrica

The objective of this study is to compare the scores of health related quality of life (HRQOL) of candidates for bariatric surgery with patients that underwent bariatric surgery at different time intervals. A cross sectional study was performed in the city of Maringá and Paranavaí, Paraná, Brazil, with 44 candidates to bariatric surgery and 63 individuals submitted to it. The group of individuals submitted to bariatric surgery was divided into 3 subgroups according to the elapsed time of surgery. (more than 18 months - G2; at least 19 and maximum 36 months - G3 and more than 36 months - G4).The quality of life related to the health of the patients was assessed by the SF-36 and BAROS. The comparison among groups was performed by using parametric and non-parametric statistic tests. The magnitude of the effects of the bariatric surgery by effect size (ES) was also evaluated. The assessment of HRQOL shows differences among the groups, with lower scores observed in group 4 when compared to group 2. A comparison of mean scores of the domains of the SF-36 shows that the groups formed by people who underwent bariatric surgery have average scores significantly higher than those presented by candidates to bariatric surgery (p < 0.05). Though not return to the levels of candidates to bariatric surgery, the scores of the areas "Pain body" and "General health", presented by the groups 2 and 4, as well as those submitted by the groups 2 and 3 for the field "Vitality", suggest a worsening in HRQOL with the passage of time after surgery. The results of this study indicate that people who suffer from morbid obesity have a strong impact on HRQOL and suggest that the implementation of bariatric surgery is able to promote improvements HRQOL important for these people.

O objetivo do presente estudo foi comparar os escores de qualidade de vida relacionada à saúde (QVRS) de candidatos à cirurgia bariátrica (CCB) com os de indivíduos submetidos à cirurgia bariátrica (CB) em diferentes intervalos de tempo pós-cirúrgico. Estudo de corte transversal, realizado nas cidades de Maringá e de Paranavaí - Paraná - Brasil, com 44 CCB e com 63 indivíduos a ela submetidos. O grupo de indivíduos submetidos à CB foi dividido em três (3) subgrupos, de acordo com o tempo decorrido do procedimento cirúrgico (operados em até 18 meses - G2; operados entre 19 e 36 meses - G3 e operados há mais de 36 meses - G4). A QVRS dos pacientes foi avaliada por meio do SF-36 e BAROS. A comparação entre os grupos foi realizada por meio de testes paramétricos e não paramétricos. Avaliou-se também a magnitude dos efeitos da CB pelo tamanho do efeito (TE). A avaliação da QVRS revela diferença entre os grupos: escores inferiores observados no grupo 4, quando comparados aos do grupo 2. O cotejo dos escores médios dos domínios do SF-36 revela que os grupos, formados por pessoas que se submeteram à CB, apresentam escores médios significativamente maiores do que aqueles apresentados pelos CCB (p < 0,05). Embora não retornem aos níveis dos CCB, os escores médios dos domínios "Dor corporal" e "Estado geral de saúde", apresentados pelos grupos 2 e 4, assim como os escores apresentados pelos grupos 2 e 3 para o domínio "Vitalidade", sugerem uma piora na QVRS com o decorrer do tempo pós-cirúrgico. Os resultados do presente estudo indicam que pessoas que sofrem com a obesidade mórbida apresentam forte impacto sobre sua QVRS e sugerem que a realização da CB é capaz de promover melhoras importantes na QVRS dessas pessoas.

Factors associated with bone mineral density in women who underwent bariatric surgery / Fatores associados à densidade mineral óssea em mulheres submetidas à cirurgia bariátrica

To analyze factors associated with bone mineral density (BMD) of candidates and patients admitted to Bariatric Surgery (BS). This study included 61 women who had done or were waiting for BS. Anthropometric variables, body composition and BMD from the femur, femoral neck, lumbar spine and the whole body were measured. The factors associated with changes in BMD, such as smoking, alcohol ingestion, sedentary lifestyle, BS, nutritional supplementation and age were evaluated. The statistical significance was set at 5%. Age and BS were associated with changes in BMD. Among the individuals who had BS done, the rates of osteopenia/osteoporosis were greater in the femur (OR 3.34; CI [1.52 - 1.83]) and femoral neck (OR 3.69; CI [1.34 ­ 2.08]). Subjects older than 50 years also had greater rates of BMD in the lumbar spine (OR 4.12; CI [2.09 ­ 22.33]), the whole body (OR 4.77; CI [1.34 ­ 28.14]), femur (OR 16.94; CI [2.16 - 124.32]) and femoral neck (OR 14.95; CI [1.86 - 110.66]). Patients who have had BS and are over 50 years of age showed higher rates of osteopenia/osteoporosis, which demonstrate the necessity of further studies exploring the effects of BS and its impact on bone metabolism.

Analisar fatores associados à densidade mineral óssea (DMO) de candidatas e de pacientes submetidas à cirurgia bariátrica (CB). Neste estudo transversal foram avaliadas variáveis antropométricas, composição corporal e DMO do fêmur, colo do fêmur, coluna lombar e corpo inteiro, além dos fatores associados às alterações na DMO: tabagismo, consumo de álcool, sedentarismo, CB, suplementação e idade em 61 mulheres com média de idade de 43,97 (± 10,73) anos. Significância pré estabelecida em 5%. A idade e CB apresentaram associação com alterações na DMO. Os sujeitos operados apresentaram maiores chances de apresentar osteopenia/osteoporose no fêmur (RC 3,34; IC [1,52 ­ 1,83]) e no colo do fêmur (RC 3,69; IC [1,34 - 2,08]) e os sujeitos com idade superior a 50 anos apresentaram maiores chances de apresentar alterações na DMO na coluna lombar (RC 4,12; IC [2,09 - 22,33]), no corpo inteiro (RC 4,77; IC [1,34 - 28,14]), fêmur (RC 16,94; IC [2,16 ­ 124,32]) e no colo do fêmur (RC 14,95; IC [1,86 ­ 110,66]). Pacientes submetidos à CB e com idade superior a 50 anos apresentam maiores alterações na DMO, demonstrando a importância de mais estudos que explorem os efeitos da CB e suas repercussões sobre o metabolismo ósseo.

Multidisciplinary program for obesity treatment: Summary of results with adolescents / Programa multiprofissional de tratamento da obesidade: síntese de resultados com adolescentes

This study aimed to evaluate the effects of a multidisciplinary intervention program on the factors: stage of behavior change (SBC), physical self-description (PSD), blood pressure (BP) and physical fitness in obese adolescents. The study was characterized as quasi-experimental type, with 33 adolescents who were evaluated before and after 16 weeks of intervention. The anthropometric and fitness variables, BP were assessed, and we also applied the Stage of Change instrument and PSDQ (Physical Self-Description Questionnaire), in order to measure the SBC and the PSD, respectively. The statistical analysis involved measures of central tendency and dispersion, and the comparison between the initial and final periods was performed by Student's t-test. The comparison between the periods before and after-intervention presented significant differences (p < 0.05) for almost all variables, except for the hip circumference, waist to hip ratio and pull-ups in the adapted bar. The program promoted effective changes in the fat consumption, and habitual physical activity and PSD of habitual physical activity, body fat and appearance. The results are quite promising and evidence the needto expand programs like this, in order to lead to the behavioral change. In this way, the physical education professional has a decisive role on this process.

O objetivo do estudo foi Avaliar os efeitos de um programa de intervenção multiprofissional sobre: estágio de mudança de comportamento (EMC), autodescrição física (ADF), pressão arterial (PA) e aptidão física em adolescentes obesos. O Estudo foi classificado como quase experimental realizado com 33 adolescentes que foram avaliados antes e após 16 semanas de intervenção. Foram avaliadas variáveis antropométricas, de aptidão física, PA e aplicados os instrumentos SOC (Stage of Change) e PSDQ (Physical Self-Description Questionnaire), a fim de mensurar EMC e ADF, respectivamente. A análise estatística envolveu medidas de tendência central e dispersão e a comparação entre os períodos inicial e final foi realizada pelo teste t de Student. A comparação entre os momentos pré e pós-intervenção apresentou diferenças significativas (p < 0,05) para quase todas as variáveis, com exceção da circunferência do quadril, relação cintura quadril e teste de barra adaptada. Com o estudo, foi possível considerar que o programa mostrou interferir no EMC de consumo de gorduras na dieta e atividade física habitual e na ADF de atividade física habitual, gordura corporal e aparência. Os resultados são bastante promissores e apontam para a necessidade de ampliação na abrangência de programas de intervenção com enfoque na mudança do comportamento, tendo o profissional de educação física um papel decisivo nesse processo.

Efeitos de um programa multiprofissional de tratamento da obesidade e de sua cessação sobre a aptidão física relacionada à saúde de adolescentes / Effects of a multiprofessional program for obesity treatment and its cessation on physical fitness related to health in adolescents

O objetivo do estudo foi avaliar os efeitos de um programa multiprofissional de tratamento da obesidade (PMTO) e de sua cessação sobre a aptidão física e composição corporal de adolescentes. Foi conduzido um estudo quase-experimental com 19 adolescentes com excesso de peso de ambos os gêneros e idade entre dez e 18 anos. Os mesmos foram submetidos a 16 semanas de intervenção com foco na mudança do comportamento alimentar e de atividade física. Na sequência, os adolescentes retornaram para avaliação após oito semanas de cessação das atividades. Foram observadas mudanças na aptidão cardiorrespiratória (26,39±6,18 mL/kg/min para 30,99±7,84 mL/kg/min) e gordura corporal (40,67±6,61% para 36,73±7,77%), com o PMTO, porém essas melhoras não se mantiveram após o período de cessação (27,56±7,31 mL/kg/min e 38,09±7,84%, respectivamente). Os resultados demonstraram que 16 semanas são suficientes para promover mudanças na aptidão física e composição corporal, entretanto, estas parecem não ser incorporadas no novo estilo de vida dos adolescentes.

The aim of the study was to evaluate the effects of a multiprofessional program for obesity treatment (PMTO) and its cessation on the physical fitness and body composition of adolescents. We conducted a quasi-experimental study with 19 overweight/obese adolescents of both gender and aged from 10 to 18 years. These adolescents participated of a 16-week intervention focused on the food change and exercise behavior. Subsequently, the adolescents returned for evaluation after eight weeks of cessation of the activities. We observed important changes related to the cardiorespiratory fitness (26.39±6.18ml/kg/min to 30.99±7.84ml/kg/min) and the body fat (40.67±6.61% to 36.73±7.77%), however, changes were not maintained after the cessation period (27.56±7.31ml/kg/min and 38.09±7.84%, respectively). The results showed that 16 weeks of PMTO were enough to improve the physical fitness and the body composition, but did not change the lifestyle of these adolescents in order to maintain the gains promoted by PMTO.

Estágio de prontidão para mudança de comportamento de adolescentes interessados em ingressar no Programa Multiprofissional de Tratamento da Obesidade / Stage of readiness to change of behavior in adolescents interested in joining the Multiprofessional Obesity Treatment Program / Estadio de prontitud para cambio de comportamiento de adolescentes interesados en ingresar en el Programa Multiprofesional de Tratamiento de la Obesidad

Avaliar o estágio de prontidão para mudança do comportamento (EPMC) alimentar e de atividade física de adolescentes e verificar a associação entre as variáveis gênero, faixa etária e classificação do índice de massa corpórea (IMC) com o EPMC. MÉTODOS: Foram avaliados 145 adolescentes entre dez e 18 anos interessados em ingressar no Programa Multiprofissional de Tratamento da Obesidade (PMTO). As avaliações incluíram, além dos EPMC, parâmetros antropométricos. A análise estatística envolveu a aplicação do teste t de Student para amostras independentes e do teste de Mann-Whitney na comparação entre os grupos. O teste do qui-quadrado de tendência foi utilizado para verificar se houve ou não associação entre as variáveis do estudo, sendo significante p<0,05. RESULTADOS: Em relação ao comportamento alimentar (quantidade e tamanho das porções), verificou-se associação entre IMC e o EPMC. Também foi observado que os adolescentes mais velhos apresentaram EPMC mais avançado em relação ao consumo de frutas e verduras. O mesmo se verificou em relação à prática habitual de atividade física. CONCLUSÕES: Há associação entre IMC e o EPMC relacionado ao comportamento alimentar (quantidade e tamanho das porções), do mesmo modo que entre a idade e o EPMC relacionado ao consumo de frutas e vegetais e prática habitual de atividade física. Recomenda-se a realização de estudos experimentais a fim de verificar se o EPMC tem poder preditivo em programas de intervenção destinados ao tratamento do excesso de peso.

To access the stage of readiness to change (SRC) dietary and physical activity behavior in adolescents and verify the association between the variables gender, age, body mass index (BMI) classification and the SRC. METHODS: 145 adolescents aged from ten to 18 years interested in joining the Multiprofessional Obesity Treatment Program were evaluated. Assessments included, in addition to SRC, anthropometric parameters. For independent analysis, Student's t-test was applied and Mann-Whitney test was applied to compare groups. The chi-square was used to verify possible associations between the variables of the study. A p<0.05 value was was considered significant. RESULTS: About the feeding behavior (amount and portion size), there was an association between BMI classification and SRC. The older adolescents showed more advanced stages in relation to consuming fruits and vegetables, and physical activity. The same was shown in relation to routine physical activities. CONCLUSIONS: There was an association between BMI classification and SRC regarding the amount and portion size, as well as between age and SRC related to fruits and vegetables consumption and physical activity. Experimental studies to verify the influence of SRC dietary and physical activity behaviors on the obesity treatment are needed.

Evaluar el estadio de prontitud para cambio del comportamiento (EPMC) alimentar y de actividad física de adolescentes y verificar la asociación entre las variables género, franja de edad y clasificación del índice de masa corporal (IMC) con los EPMC. MÉTODOS: Se evaluó a 145 adolescentes entre 10 y 18 años interesados en ingresar en el Programa Multiprofesional de Tratamiento de la Obesidad (PMTO). Las evaluaciones incluyeron, además de los EPMC, parámetros antropométricos. El análisis estadístico involucró la aplicación de la prueba t de Student para muestras independientes y de la prueba de Mann-Whitney en la comparación entre los grupos. La prueba del chi cuadrado de tendencia fue utilizada para verificar si hubo o no asociación entre las variables del estudio, siendo significante p<0,05. RESULTADOS: Respecto al comportamiento alimentar (cantidad y tamaño de las porciones), se verificó la asociación entre IMC y los EPMC. También se observó que los adolescentes mayores presentaron EPMC más avanzados respecto al consumo de frutas y verduras. Lo mismo se verificó respecto a la práctica habitual de actividad física. CONCLUSIONES: Hay asociación entre IMC y los EPMC relacionados al comportamiento alimentar (cantidad y tamaño de las porciones), del mismo modo que entre la edad y los EPMC relacionado al consumo de frutas y vegetales y práctica habitual de actividad física. Se recomienda la realización de estudios experimentales a fin de verificar si el EPMC tiene poder predictivo en programas de intervención destinados al tratamiento del exceso de peso.

Cirurgia bariátrica no Brasil / Bariatric surgery in Brazil

Revisar os estudos sobre cirurgia bariátrica no Brasil entre os anos de 2005 e 2010. Revisão sistemática realizada na base Scientific Electronic Library Online, utilizando o termo "cirurgia bariátrica". Foram verificadas 52 ocorrências e incluídos neste estudo 18 artigos. Foram destacados: a região de realização do estudo, o delineamento da pesquisa, o tipo de cirurgia, as características amostrais, os parâmetros avaliados, os principais resultados e limitações. Os resultados mais destacados foram a diminuição da prevalência de síndrome metabólica, melhorias de parâmetros clínicos, bioquímicos e psicológicos e a redução ponderal. O tempo de acompanhamento dos pacientes variou entre 11 e 33 meses. Nenhum dos artigos relatou riscos associados à cirurgia, e a principal limitação observada foi o tamanho das amostras. Os resultados apontam melhorias das comorbidades associadas ao excesso de peso e revelam a necessidade de outros estudos sobre cirurgia bariátrica no Brasil

Validação interna do questionário de estágio de prontidão para mudança do comportamento alimentar e de atividade física / Internal validation of the stage of change questionnaire for alimentary and physical activity behaviors

OBJETIVO: Traduzir para a língua portuguesa e adaptar o conteúdo do questionário de avaliação dos estágios de prontidão para mudança do comportamento alimentar e de atividade física proposto por Sutton et al para a aplicação em adolescentes, além de verificar a consistência interna e a reprodutibilidade da nova versão do instrumento. MÉTODOS: A validação de conteúdo foi realizada por um grupo multiprofissional, foi consultado após a tradução e re-tradução do instrumento com o intuito de gerar uma versão coerente, seguida da adaptação cultural realizada por meio de escala Likert, que objetivou analisar a clareza e a relevância, avaliada pelos adolescentes para cada uma das afirmações. A reprodutibilidade e a consistência interna foram analisadas pelo preenchimento do questionário por 32 adolescentes obesos de ambos os sexos, ingressantes em programa de tratamento multiprofissional da obesidade, com idade média de 13,5 (±1,6) anos e peso médio de 86,1kg (±18,8). Para avaliar a consistência interna, aplicou-se o coeficiente Alpha de Cronbach e, para a reprodutibilidade, os coeficientes de correlação de Pearson, Spearman e intraclasse, além do teste t. RESULTADOS: Os resultados revelaram alta reprodutibilidade do instrumento e, no que diz respeito à consistência interna, foram demonstrados bons índices de confiabilidade para todos os domínios, tendo em vista que todos eles apresentaram valores superiores ou bem próximos a 0,70. CONCLUSÕES: O questionário apresentou boa consistência interna e reprodutibilidade para avaliar o estágio de prontidão de mudança do comportamento alimentar e de atividade física em adolescentes obesos. Contudo, para que a validade externa do instrumento seja confirmada, é oportuno que outros estudos sejam realizados.

OBJECTIVE: To translate into Portuguese the contents of the questionnaire for adaptation assessment of dietary and physical activity changes proposed by Sutton et al, to be used with adolescents; and to verify the internal consistency and reliability of this tool. METHODS: The content validation was accomplished by a multidisciplinary group, which was consulted after the translation and back translation of the instrument in order to generate a coherent version, followed by the cultural adaptation performed using a Likert's scale, from which adolescents assessed clarity and relevance of each statement. The reliability and internal consistency of the tool were assessed by a questionnaire applied to 32 obese adolescents of both genders from a multiprofessional program for obesity treatment. They had, on average, 13.5±1.59 years old and 86.1±18.8kg. The Cronbach's alpha coefficient was used to assess the internal consistency, as well as Pearson, Spearman and intraclass correlation coefficients. Also the t-test was used to assess reliability. RESULTS: The results of test and retests revealed the high reliability of the tool. Internal consistency showed good reliability rates for all areas, with all values higher than or near to 0.70. CONCLUSIONS: The questionnaire presented good internal consistency and reliability in obese adolescents. However, it is appropriate to carry out further studies in order to confirm the external validity of the instrument.

Programa de tratamento multiprofissional da obesidade: os desafios da prática / Multiprofessional treatment program of the obesity: the challenges of the practice

O aumento da prevalência da obesidade entre crianças e adolescentes representa um complexo desafio para as famílias e a sociedade, pois, uma vez instalada, predispõe a uma série de comorbidade, além de afetar, deforma expressiva, a qualidade de vida dessas pessoas. Deste modo, a Associação de Obesos de Maringá -AOM, em parceira com o Departamento de Educação Física da Universidade Estadual de Maringá, vem desenvolvendo, há aproximadamente dois anos, o programa Vivendo com Saúde, que atende adolescentes de 11 a 17 anos. O propósito deste trabalho foi descrever as características do programa e dos participantes, comparando-o a outros programas similares. O programa tem duração de 16 semanas por semestre. Até oprimeiro semestre de 2007, foram atendidos 40 adolescentes, dos quais 29 concluíram o programa. A taxa de desistentes é comparável a de outros estudos e representa uma questão a ser trabalhada nestes programas. Outro aspecto comum entre os vários programas analisados e a presente intervenção diz respeito à redução depeso, que costuma ser pequena. No entanto, há evidentes melhoras na aptidão física dos participantes.

The increase in the prevalence of obesity among children and adolescents represents a complex challenge for families and society at large, because once manifested, this condition can lead to several comorbidities and significantly affect the quality of life of those involved. As a result, the Maringá Obesity Association (AOM) incooperation with the Physical Education department at the State University of Maringá have been developing foralmost 2 years a program named “Living Healthy”, which assists youngsters between 11 and 17 years old. The purpose of this study was to describe the characteristics of the program and its participants, comparing it toothers similar programs. The program has the duration of 16 weeks per semester. Up to the first semester of2007, 40 teenagers had been assisted, of which 29 finished the program. The drop-out rate is comparable toother studies, and represents an issue to be dealt in these programs. Another aspect in common with many other analyzed programs has to do with actual weight reduction, which has usually been unsatisfactory. Nonetheless,there have been evident improvements in the physical aptitude of participants.

El aumento del predominio de la obesidad entre niños y adolescentes representa un complejo desafío para lasfamilias y la sociedad, porque una vez que esto se instala puede causar muchas comorbididades, y afecta muy expresivamente la calidad de vida de estas personas. De este modo, la Asociación de Obesos de Maringa –AOM, en sociedad con el Departamento de Educación Física de la Universidad Estatal de Maringa, viene desarrollando, hace aproximadamente 2 años, el programa Viviendo con Salud, que atiende adolescentes de 11a 17 años. El propósito de este trabajo fue describir las características del programa y de los participantes, comparándolo con los otros programas similares. El programa tiene la duración de 16 semanas por semestre. Hasta el primer semestre de 2007, fueron atendidos 40 adolescentes, de estos 29 concluyeron el programa. Latasa de desistimientos es comparable a otros estudios y representa una cuestión a ser trabajada en estos programas. Otro aspecto común entre los varios programas analizados y la presente intervención dice respectoa la reducción de peso, que acostumbra ser pequeña. Sin embargo, hay evidentes mejoras en la aptitud físicade los participantes.