The impact of food addiction behaviours on the treatment of overweight students.

The present study evaluated the association of food addiction (FA), the change of the BMI/age z-score and the consumption of ultra-processed foods in overweight students undergoing a 16-month, multicomponent intervention in the school environment. FA was investigated using the Yale Food Addiction Scale for Children, and the dietary assessment was estimated using the semi-quantitative FFQ in overweight 9-11-year-old students (BMI/age z-score ≥ 1) of both sexes at their baseline and after the intervention (n 120). Among the schoolchildren, 33·4 % had FA in at least one of the two assessments. The analysis of mixed-effects models to assess the effect of the intervention and the change of the BMI/age z-score between evaluations showed that the occurrence of FA influenced the maintenance of weight (time#FA, ß = 0·30, 95 % CI 0·05, 0·54, P = 0·016). Weight loss was observed only in individuals who did not present FA (BMI/age z-score = -0·3). When evaluating the effect of the intervention and the dietary variables, we verified a reduction in the consumption of sugary milk-based drinks -71·13 kJ (-17 kcal), P = 0·04 only in non-FA students at the end of the study. FA has been identified as an underlying factor with therapeutic relevance, and an enhanced understanding of FA can open new paths for the prevention and management of obesity.

Food addiction symptoms and metabolic changes in children and adolescents with the double burden of malnutrition.

The double burden of malnutrition (DBM) has been described in many low-/middle-income countries. We investigated food addiction, thyroid hormones, leptin, the lipid/glucose profile and body composition in DBM children/adolescents. Subjects were allocated into groups according to nutritional status: control (C, n 28), weight excess (WE, n 23) and DBM (WE plus mild stunting, n 22). Both the DBM and WE groups showed higher mean insulin concentrations than the control (DBM = 57·95 (95 % CI 47·88, 70·14) pmol/l, WE = 74·41 (95 % CI 61·72, 89·80) pmol/l, C = 40·03 (95 % CI 34·04, 47·83) pmol/l, P < 0·001). WE and DBM showed more food addiction symptoms than the control (3·11 (95 % CI 2·33, 3·89), 3·41 (95 % CI 2·61, 4·20) and 1·66 (95 % CI 0·95, 2·37)). In DBM individuals, addiction symptoms were correlated with higher body fat and higher insulin and leptin levels. These data provide preliminary evidence consistent with the suggestion that DBM individuals have a persistent desire to eat, but further studies are required to confirm these results in a larger study. These hormonal changes and high body fat contribute to the development of diabetes in long term.

Exploring the consumption of ultra-processed foods and its association with food addiction in overweight children.

The present study explored the consumption of ultra-processed foods and its association with food addiction in overweight children. The prevalence of food addiction was investigated using the Yale Food Addiction Scale for Children in overweight 9-11 year-old children (BMI/age ≥1 Z score) of both sexes from two schools (n = 139). Food intake was estimated by a food frequency questionnaire and the food items were classified into 4 categories: minimally processed, culinary ingredients, processed foods and ultra-processed foods (UPF), based on their degree of processing. Among the children, 95% showed at least one of the seven symptoms of food addiction and 24% presented with a diagnosis of food addiction. In analysis of covariance adjusted for age and sex, a tendency of higher consumption of added sugar (refined sugar, honey, corn syrup) and UPF was found among those diagnosed with food addiction. Multiple logistic regression adjusted for sugar, sodium and fat ingestion showed that consumption of cookies/biscuits (OR = 4.19, p = 0.015) and sausages (OR = 11.77, p = 0.029) were independently associated with food addiction. The identification of foods that may be associated with addictive behavior is very important for correctly treating and preventing childhood obesity, which continues to be one of the greatest health problems in the world.

Effectiveness of a 16-month multi-component and environmental school-based intervention for recovery of poor income overweight/obese children and adolescents: study protocol of the health multipliers program.

BACKGROUND: Excess of weight is a serious public health concern in almost all countries, afflicting people of different ages and socioeconomic backgrounds. Studies have indicated the need for developing treatment strategies that intervene directly in the obesogenic environment. This study aims to evaluate the effectiveness of a multi-component and environmental school-based intervention, lasting 16 months, on the recovery of the nutritional status of low-income children and adolescents with overweight/ obesity. METHODS/STUDY DESIGN: The study was conducted by the Center for Recovery and Nutritional Education (CREN) in São Paulo, Brazil. Two schools located in poor neighborhoods were selected for the intervention, between March 2016 and June 2017. The participants were all students aged 8 to 12 years from the two participating schools. At the beginning of the intervention, anthropometric measurements were carried out to assess the nutritional status of the students. For convenience, students from one of the schools were considered as the control group, while those from the other school formed the experimental group. The intervention in the experimental group (n = 438) consists of the following weekly activities at school: psychological counseling in groups, theoretical/practical nutrition workshops, and supervised physical education classes. In addition, theoretical and practical educational activities are held regularly for parents, teachers, and cooks. Students with excess of weight (≥1 body mass index [BMI] -for-age Z score, n = 138) received clinical and nutritional care periodically at the outpatient care at CREN. Students enrolled in the control group (n = 353) participated in psychological counseling groups and theoretical/practical nutrition workshops for 6 months held in the school environment to provide motivation to entire classrooms. In the following 10 months, students with excess of weight from the control group (n = 125) were invited to attend the routine outpatient care at CREN. DISCUSSION: This study is the first to assess the effectiveness of a multi-component and environmental school-based intervention for the recovery of low-income, overweight/obese children and adolescents. If positive, the results demonstrate the feasibility for the recovery of excess of weight in populations of similar conditions and age. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials - ReBEC Primary Id Number RBR-9t2jr8 . Registration Date: Nov. 30, 2016. Retrospectively registered. Protocol version: 3.

High glycemia and resistin normalized in children with double burden of malnutrition: a cross-sectional study.

The coexistence of stunting and excess weight in the same individual is defined as a double burden of malnutrition (DBM) and is associated with noncommunicable diseases. In this study, we evaluated the impact of DBM on adipokine concentrations and metabolic profiles in children compared with weight excess alone. Children were allocated to the weight excess group (n = 23) (height-for-age (HAZ) > 0.0 and < 2.0 Z-score and body mass index-for-age (BMI/A) > 1.0 Z-score) or DBM (n = 22) group (HAZ < -1.0 Z-score (including mild stunting) and BMI/A > 1.0 Z-score). Lipid, glycemic profile, resistin, plasminogen activator inhibitor-1, leptin, and adiponectin concentrations were analyzed. Glycemia was significantly higher in the DBM group compared to the weight excess group (5.05 (4.76-5.31) mmol/L vs. 4.57 (4.35-4.81) mmol/L), although no differences were found in insulin and homeostasis model assessment of insulin resistance (HOMA-IR). Adipokine concentrations did not differ between the groups. However, the DBM group showed higher resistin concentrations normalized by body fat mass than those of the weight excess group (1.44 (0.98-1.93) ng/mL vs. 0.76 (0.55-1.45) ng/mL). Insulin and HOMA-IR showed a negative correlation with adiponectin (r = -0.590 and -0.624, respectively, both p < 0.01). DBM was associated with increased glucose and resistin concentrations adjusted by fat mass compared to that associated with excess weight alone. Therefore, this association between mild stunting and weight excess has deleterious potential for long-term metabolic function, highlighting an additional precaution against weight gain in children, especially in those with stunting.

MULTIDISCIPLINARY AND MOTIVATIONAL INTERVENTION FOR THE TREATMENT OF LOW INCOME BRAZILIAN OBESE ADOLESCENTS: PILOT STUDY. / INTERVENÇÃO MULTIDISCIPLINAR E MOTIVACIONAL PARA TRATAMENTO DE ADOLESCENTES OBESOS BRASILEIROS DE BAIXA RENDA: ESTUDO PILOTO.

OBJECTIVE: To test a multidisciplinary and motivational intervention for the treatment of Brazilian obese and low-income adolescents (Z score>2 BMI-for-age) that used nutritional counseling without dietary control. METHODS: An intervention protocol was developed including periodical nutritional education workshops, individual nutritional counseling guided by the stages of eating behavior of the Trans Theoretical Model of Behavior Change, physical exercise, psychological counseling, recreational activities, and clinical follow-up for 13 months in a sample of 21 adolescents (11-17 years old). RESULTS: The rate of treatment withdrawal (9.5%) was lower than that seen in dietary control studies (30-60%). Initially, 70% of the sample was in the pre-contemplation behavior stage and, in the end, 100% of the remaining adolescents were in the stages of action or maintenance. There was a mean reduction in BMI-for-age (p=0.038) and visceral fat (M±SD=3.67±1.19 and 2.78±0.78 cm, p=0.02, initial and final, respectively). The percentage of fat mass decreased and that of lean mass increased (42±5 and 38±8, p=0.04, 58±6 and 61±8%, p=0.03, respectively). CONCLUSIONS: The intervention seems to be effective in generating a lifestyle change, accompanied by anthropometric profile and body composition improvement. The intervention protocol may offer easy adaptation and low-cost methodology for health services, with high adherence and low abandonment rates.

OBJETIVO: Testar uma intervenção multidisciplinar e motivacional para o tratamento de adolescentes obesos brasileiros e de baixa renda (escore Z>2 IMC-para-idade) que utilizou o aconselhamento nutricional sem controle dietético. MÉTODOS: Desenvolveu-se um protocolo de intervenção que incluiu a realização periódica de oficinas de educação nutricional, aconselhamento nutricional individual com auxílio do modelo transteórico de mudança do comportamento, prática de exercícios físicos, aconselhamento psicológico, atividades recreativas e acompanhamento clínico, durante 13 meses, em uma amostra de 21 adolescentes (11-17 anos). RESULTADOS: A taxa de desistência do tratamento (9,5%) foi menor do que a verificada em estudos de controle dietético (30-60%). No início, 70% da amostra se encontrava no estágio de comportamento denominado pré-contemplação (sem intenção de mudança) e, ao final, 100% dos adolescentes que permaneceram passaram aos estágios de ação ou manutenção (mudaram o comportamento ou mantiveram a mudança por mais de seis meses). Observou-se diminuição média de IMC-para-idade (15%, p=0,038) e de gordura visceral (gordura inicial de 3,67±1,19 e final de 2,78±0,78 cm, p=0,02). O percentual de massa gorda diminuiu e o de massa magra aumentou, quando comparados os valores médios iniciais e finais (42±5% e 38±8%, p=0,04; 58±6% e 61±8%, p=0,03, respectivamente). CONCLUSÕES: A intervenção parece eficaz para gerar mudança de estilo de vida, acompanhada de melhoria do perfil antropométrico e de composição corporal. O protocolo de intervenção pode oferecer metodologia de fácil adaptação e baixo custo para serviços de saúde, com alta adesão e baixa taxa de abandono.

Intervenção multidisciplinar e motivacional para tratamento de adolescentes obesos brasileiros de baixa renda: estudo piloto / Multidisciplinary and motivational intervention for the treatment of low income brazilian obese adolescents: pilot study

RESUMO Objetivo: Testar uma intervenção multidisciplinar e motivacional para o tratamento de adolescentes obesos brasileiros e de baixa renda (escore Z>2 IMC-para-idade) que utilizou o aconselhamento nutricional sem controle dietético. Métodos: Desenvolveu-se um protocolo de intervenção que incluiu a realização periódica de oficinas de educação nutricional, aconselhamento nutricional individual com auxílio do modelo transteórico de mudança do comportamento, prática de exercícios físicos, aconselhamento psicológico, atividades recreativas e acompanhamento clínico, durante 13 meses, em uma amostra de 21 adolescentes (11-17 anos). Resultados: A taxa de desistência do tratamento (9,5%) foi menor do que a verificada em estudos de controle dietético (30-60%). No início, 70% da amostra se encontrava no estágio de comportamento denominado pré-contemplação (sem intenção de mudança) e, ao final, 100% dos adolescentes que permaneceram passaram aos estágios de ação ou manutenção (mudaram o comportamento ou mantiveram a mudança por mais de seis meses). Observou-se diminuição média de IMC-para-idade (15%, p=0,038) e de gordura visceral (gordura inicial de 3,67±1,19 e final de 2,78±0,78 cm, p=0,02). O percentual de massa gorda diminuiu e o de massa magra aumentou, quando comparados os valores médios iniciais e finais (42±5% e 38±8%, p=0,04; 58±6% e 61±8%, p=0,03, respectivamente). Conclusões: A intervenção parece eficaz para gerar mudança de estilo de vida, acompanhada de melhoria do perfil antropométrico e de composição corporal. O protocolo de intervenção pode oferecer metodologia de fácil adaptação e baixo custo para serviços de saúde, com alta adesão e baixa taxa de abandono.

ABSTRACT Objective: To test a multidisciplinary and motivational intervention for the treatment of Brazilian obese and low-income adolescents (Z score>2 BMI-for-age) that used nutritional counseling without dietary control. Methods: An intervention protocol was developed including periodical nutritional education workshops, individual nutritional counseling guided by the stages of eating behavior of the Trans Theoretical Model of Behavior Change, physical exercise, psychological counseling, recreational activities, and clinical follow-up for 13 months in a sample of 21 adolescents (11-17 years old). Results: The rate of treatment withdrawal (9.5%) was lower than that seen in dietary control studies (30-60%). Initially, 70% of the sample was in the pre-contemplation behavior stage and, in the end, 100% of the remaining adolescents were in the stages of action or maintenance. There was a mean reduction in BMI-for-age (p=0.038) and visceral fat (M±SD=3.67±1.19 and 2.78±0.78 cm, p=0.02, initial and final, respectively). The percentage of fat mass decreased and that of lean mass increased (42±5 and 38±8, p=0.04, 58±6 and 61±8%, p=0.03, respectively). Conclusions: The intervention seems to be effective in generating a lifestyle change, accompanied by anthropometric profile and body composition improvement. The intervention protocol may offer easy adaptation and low-cost methodology for health services, with high adherence and low abandonment rates.