Lo clásico y lo nuevo en el tratamiento del sobrepeso y la obesidad / The classic and the new in the treatment of overweight and obesity

Así como planteamos en la primera entrega de esta serie de artículos de actualización sobre la obesidad, resulta urgente revisar el abordaje tradicional que la comunidad médica le ofrece a las personas con cuerpos gordos. En este segundo artículo desarrollaremos en profundidad diferentes alternativas terapéuticas para los pacientes que desean bajar de peso:plan alimentario, actividad física, tratamiento farmacológico y cirugía metabólica. (AU)

As we proposed in the first issue of this series of articles, it is urgent to review the traditional approach that the medical community offers to people with fat bodies. This second article will develop different therapeutic alternatives for patients who want to lose weight: eating plans, physical activity, pharmacological treatment, and metabolic surgery. (AU)

Medida do equilíbrio de decisões para redução do peso corporal entre pessoas com sobrepeso ou obesidade: uma revisão sistemática / Measuring the balance of decisions to reduce body weight among overweight or obesity people: a systematic review

Abordagens comportamentais têm contribuído para a efetividade do tratamento da obesidade. A avaliação do equilíbrio de decisões (ED) para redução de peso, isto é, o equilíbrio entre prós e contras da mudança de comportamento, é estratégica no tratamento, contribuindo para a pactuação de estratégias para o enfrentamento dos desafios. É necessário, porém, utilizar instrumentos válidos para mensurar o ED. Objetivo: Avaliar a qualidade de instrumentos de avaliação do ED para redução do peso corporal visando qualificar o cuidado da pessoa com obesidade no Sistema Único de Saúde (SUS). Métodos: Realizou-se revisão sistemática da literatura sobre o desenvolvimento e a validação de instrumentos em sete bases de dados seguindo a metodologia Cosmin. Variações dos termos psicometria, obesidade e ED foram combinadas com operadores booleanos. Em duplicada e independentemente, duas pesquisadoras realizaram: extração de dados, avaliação da qualidade e síntese de evidências, sendo as divergências solucionadas por consenso. Esta revisão foi registrada na base internacional Prospero (CRD42020197797). Resultados: Identificaram-se cinco estudos, sendo que três realizaram a tradução e adaptação transcultural do mesmo instrumento. Todos os estudos apresentaram ED em duas dimensões (prós e contras), mas usaram métodos duvidosos ou inadequados, e a maioria apresentou evidências científicas de muito baixa qualidade. Conclusões: Os resultados não sustentaram o uso dos instrumentos existentes nem sua tradução e adaptação transcultural, sendo necessário o desenvolvimento de um novo instrumento. Este estudo, ao disponibilizar um instrumento válido para uso no SUS, poderá contribuir para qualificar o cuidado da pessoa com obesidade e deter o crescimento da obesidade no país.

Introduction: Behavioral strategies have been adding to the effectiveness of obesity treatment. And the assessment of the decisional balance (DB) for weight reduction, that is, the balance between expected losses and gains around the behavioral changes, is strategic for managing obesity. The DB assessment may contribute to the agreement on strategies to face the challenges of the treatment. But, there is a need to use a valid instrument to assess the DB. Objective: evaluate the quality of instruments assessing DB for weight reduction to qualify obesity management in the Sistema Único de Saúde ­ SUS (Unified Health System). Methods: A systematic review of studies about instrument development and/or validation was carried out on seven databases using the Cosmin methodology. Terms related to psychometrics, obesity, and DB were combined with Boolean operators to guide the search. Two researchers performed independently and in duplicate: data extraction, quality assessment, and evidence synthesis, and divergences were resolved by consensus. This review was registered in the international database Prospero (CRD42020197797). Results: Five studies were identified. Three of them reported translations and cross-cultural validity of the same instrument. All analyses presented DB in two dimensions (pros and cons, but used doubtful or inadequate methods. Most of the evidence was very low rate. Conclusions: The results did not support the instrument's use, translations, or cross-cultural adaptation. It is necessary to develop a new tool. By providing a valid instrument for use in SUS, this study could contribute to qualifying the care of people with obesity and stopping the growth of obesity in the country.

Analysis of the impact of different exercise methods on the physical health of obese adolescents / Análise do impacto entre diferentes métodos de exercício na saúde física de adolescentes obesos / Análisis del impacto entre diferentes métodos de ejercicio en la salud física de adolescentes obesos

ABSTRACT Introduction: The unregulated development in the current life pattern has strengthened obesity among adolescents, and this problem is becoming more serious. Objective: Compare the impact of two exercise methods on the physical health of obese adolescents. Methods: 24 obese adolescents (12 females; BMI>30% ± 3%; age concentrated between 10 and 16 years) were selected and divided into group I and group II for a 4-week experimental study, and changes in physical fitness and function were recorded. Results: After four weeks of aerobic exercise control (group I), waist circumference, hip circumference, skinfold thickness, and abdominal fold thickness were significantly reduced in boys (p<0.05), and girls' body shape indicators were significantly altered (p<0.05). After four weeks of aerobic exercise combined with resistance training (group II), the effects of weight, BMI, and body size were significant in boys and girls. Conclusion: Aerobic exercise can effectively improve the physical problems of obese adolescents. Under the same external conditions, the effect of aerobic exercise was shown to be more effective when combined with resistance training in the physical improvement of the analyzed group. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução: O desenvolvimento desregrado no padrão de vida atual fortaleceu a obesidade entre os adolescentes e esse problema está se tornando cada vez mais grave. Objetivo: Comparar o impacto entre dois métodos de exercício na saúde física de adolescentes obesos. Métodos: Foram selecionados 24 adolescentes obesos (12 mulheres; IMC>30% ± 3%; idade concentrada entre 10 e 16 anos) e divididos no grupo I e no grupo II para um estudo experimental de 4 semanas, sendo registradas as alterações no condicionamento e função física. Resultados: Após 4 semanas de controle de exercício aeróbico (grupo I), a circunferência da cintura, circunferência do quadril, espessura da dobra cutânea e espessura da dobra abdominal foram significativamente reduzidas em meninos (p<0,05), e os indicadores de forma corporal das meninas foram significativamente alterados (p<0,05). Após 4 semanas de exercício aeróbico combinado com treinamento de resistência (grupo II), os efeitos do peso, IMC e tamanho do corpo foram significativos em meninos e meninas. Conclusão: O exercício aeróbico pode melhorar efetivamente os problemas físicos dos adolescentes obesos. Sob as mesmas condições externas, o efeito do exercício aeróbico demonstrou-se mais eficaz quando aliado ao treinamento de resistência na melhoria física do grupo analisado. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción: El desarrollo desordenado en el patrón de vida actual ha potenciado la obesidad entre los adolescentes y este problema es cada vez más grave. Objetivo: Comparar el impacto de dos métodos de ejercicio en la salud física de adolescentes obesos. Métodos: Se seleccionaron 24 adolescentes obesos (12 mujeres; IMC>30% ± 3%; edad concentrada entre 10 y 16 años) y se dividieron en el grupo I y el grupo II para un estudio experimental de 4 semanas, y se registraron los cambios en la aptitud física y la función. Resultados: Después de 4 semanas de control de ejercicio aeróbico (grupo I), la circunferencia de la cintura, la circunferencia de la cadera, el grosor de los pliegues cutáneos y el grosor de los pliegues abdominales se redujeron significativamente en los niños (p<0,05), y los indicadores de la forma corporal de las niñas se alteraron significativamente (p<0,05). Tras 4 semanas de ejercicio aeróbico combinado con entrenamiento de resistencia (grupo II), los efectos del peso, el IMC y el tamaño corporal fueron significativos en chicos y chicas. Conclusión: El ejercicio aeróbico puede mejorar eficazmente los problemas físicos de los adolescentes obesos. En las mismas condiciones externas, el efecto del ejercicio aeróbico se mostró más eficaz cuando se combinó con el entrenamiento de resistencia en la mejora física del grupo analizado. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Experimental study of exercise prescription intervention on the university students' health / Estudo experimental de intervenção por prescrição de exercício físico na saúde de estudantes universitários / Estudio experimental de la intervención de prescripción de ejercicio sobre la salud de estudiantes universitarios

ABSTRACT Introduction Disparate to the development of society, health indices in Chinese college students have shown a pronounced decline in recent years. Government concern over this recent challenge has encouraged research for practical solutions, including optimized physical activity protocols. Objective Explore the effects of an exercise intervention on the health of Chinese university students. Methods Full-time university students (80 males and 55 females) were selected and randomly assigned into two groups. Before and after the experiment, the college students' body composition scale and exercise experience were tested, focusing on the relationship between exercise prescription and changes in physical and mental health indicators. Results The body fat percentage of male and female students decreased significantly after the experiment. After eight weeks of the exercise prescription experiment, the weight of male and female college students was controlled or reduced. The suggested exercise prescription achieved a good moderating effect on the weight of the volunteers. There was a significant difference between the two groups, indicating that the experiment had a beneficial effect on vital capacity (p<0.01). Conclusion The suggested exercise prescription proved to be feasible to guide and intervene in the physical exercise of college students aiming at a beneficial impact on the physical health of college students. Level of evidence II; Therapeutic studies - investigation of treatment outcomes.

RESUMO Introdução Díspares ao desenvolvimento da sociedade, os índices de saúde nos estudantes universitários chineses apresentam uma queda acentuada nos últimos anos. A preocupação governamental sobre esse recente desafio tem incentivado pesquisas para soluções práticas, incluindo protocolos de atividades físicas otimizados. Objetivo Explorar os efeitos da intervenção por exercícios físicos na saúde dos estudantes universitários chineses. Métodos Universitários de período integral (80 homens e 55 mulheres) foram selecionados e distribuídos aleatoriamente em dois grupos. Antes e depois do experimento, foi testada a escala de composição corporal e experiência de exercício dos universitários, com foco na relação entre prescrição de exercício e mudanças nos indicadores de saúde física e mental. Resultados O percentual de gordura corporal de estudantes do sexo masculino e feminino diminuiu significativamente após o experimento. Após 8 semanas de experimento de prescrição de exercícios, o peso de estudantes universitários do sexo masculino e feminino foi controlado ou reduzido. A prescrição de exercícios sugerida alcançou um bom efeito moderador no peso dos voluntários. Houve diferença significativa entre os dois grupos, indicando que o experimento teve efeito benéfico sobre a capacidade vital (p<0,01). Conclusão A prescrição de exercícios sugerida demonstrou-se viável para orientar e intervir no exercício físico dos universitários visando um impacto benéfico sobre a saúde física nos universitários. Nível de evidência II; Estudos terapêuticos - investigação dos resultados do tratamento.

RESUMEN Introducción A diferencia del desarrollo de la sociedad, los índices de salud de los estudiantes universitarios chinos muestran un fuerte descenso en los últimos años. La preocupación de los gobiernos por este reciente desafío ha fomentado la investigación de soluciones prácticas, entre ellas la optimización de los protocolos de actividad física. Objetivo Explorar los efectos de la intervención de ejercicio en la salud de los estudiantes universitarios chinos. Métodos Se seleccionaron estudiantes universitarios a tiempo completo (80 hombres y 55 mujeres) y se asignaron al azar en dos grupos. Antes y después del experimento, se analizó la escala de composición corporal de los estudiantes universitarios y su experiencia con el ejercicio, centrándose en la relación entre la prescripción de ejercicio y los cambios en los indicadores de salud física y mental. Resultados El porcentaje de grasa corporal de los estudiantes masculinos y femeninos disminuyó significativamente después del experimento. Tras 8 semanas del experimento de prescripción de ejercicio, el peso de los estudiantes universitarios de ambos sexos se controló o redujo. La prescripción de ejercicio sugerida logró un buen efecto moderador en el peso de los voluntarios. Hubo una diferencia significativa entre los dos grupos, lo que indica que el experimento tuvo un efecto beneficioso sobre la capacidad vital (p<0,01). Conclusión La prescripción de ejercicio sugerida demostró ser factible para guiar e intervenir en el ejercicio físico de los estudiantes universitarios apuntando a un impacto beneficioso en la salud física de los estudiantes universitarios. Nivel de evidencia II; Estudios terapéuticos - investigación de los resultados del tratamiento.

Effect of moxibustion on plaque psoriasis complicated with obesity / 中国针灸

OBJECTIVE@#To observe the clinical efficacy of moxibustion combined with coptis chinensis ointment sealing on plaque psoriasis complicated with obesity.@*METHODS@#A total of 52 patients of plaque psoriasis complicated with obesity were randomized into an observation group (26 cases) and a control group (26 cases, 2 cases dropped off). Coptis chinensis ointment sealing was adopted in the control group. On the basis of the treatment in the control group, moxibustion was applied at ashi point (area of local target lesions), Zhongwan (CV 12) and bilateral Zusanli (ST 36), Fenglong (ST 40), Quchi (LI 11), Tianshu (ST 25), Shangjuxu (ST 37) in the observation group. The treatment was given 30 min each time, once a day for 4 weeks in both groups. The psoriasis area and severity index (PASI) score, obesity related indexes (body mass, waist circumference, body mass index [BMI]), triglyceride, cholesterol, uric acid and plasma glucose were compared before and after treatment, and the clinical efficacy was evaluated in the two groups.@*RESULTS@#After treatment, the PASI scores were decreased compared with those before treatment in the two groups (P<0.01), and the PASI score in the observation group was lower than that in the control group (P<0.05); the body mass, waist circumference, BMI, triglyceride, cholesterol, uric acid and plasma glucose were decreased compared with those before treatment in the observation group (P<0.01, P<0.05), the triglyceride and cholesterol in the observation group were lower than those in the control group (P<0.05). The total effective rate was 53.8% (14/26) in the observation group, which was superior to 20.8% (5/24) in the control group (P<0.05).@*CONCLUSION@#Moxibustion combined with coptis chinensis ointment sealing can effectively improve the clinical symptoms in patients of plaque psoriasis complicated with obesity.

Unidad, individualidad y unicidad de la persona en el balance riesgos/beneficios del uso de las pruebas nutrigenéticas en la práctica clínica / Unity, individuality and uniqueness of the person in the risk/benefit balance of the use of nutrigenetic tests in clinical practice / Unidade, individualidade e unicidade da pessoa no balanço de riscos/benefícios do uso das provas nutrigenéticas na prática clínica

Resumen: En los últimos años se han realizado estudios de asociación del genoma completo, con el objetivo de identificar variantes genéticas asociadas a la interindividualidad de la respuesta a tratamientos dietéticos para la pérdida de peso. Estos esfuerzos de la genómica nutricional contribuyen con los avances de la ciencia de la nutrición 4.0: preventiva, participativa, predictiva y personalizada. Sin embargo, aunque a la fecha se ha descubierto millones de polimorfismos en el genoma humano, estos hallazgos no indican que la presencia de estas variaciones determina un efecto sobre la salud del individuo. Por lo anterior, el uso del perfil nutrigenético para la pérdida de peso conduce a un análisis sobre riesgos y beneficios a la luz de los principios bioéticos centrados en la unidad, individualidad y unicidad de la persona humana. Así, con base en pensadores clásicos como Aristóteles y Tomás de Aquino, pero con la contribución de filósofos contemporáneos, como Robert Spaemman, se define a la persona como sustancia individual de naturaleza racional, desglosando las dimensiones fundamentales para demostrar, por argumentación, que el principio de individualidad no solo incluye la dimensión biológica (naturalismo materialista), sino la unidad de la persona perteneciente a la naturaleza humana.

Abstract: In recent years, whole genome association studies have been conducted to identify genetic variants associated with the interindividuality of response to dietary treatments for weight loss. These nutritional genomics efforts contribute to the advancement of nutrition science 4.0: preventive, participatory, predictive and personalized. However, although to date more than 85 million polymorphisms have been discovered in the human genome, these findings do not indicate that the presence of these variations determines an effect on a personal health. Therefore, the use of the nutrigenetic profile for weight loss leads to analyze the risks/benefits with the bioethical principles focused on the unity, individuality and uniqueness of the human person. Thus, based on classical thinkers such as Aristotle and Thomas Aquinas, but with the contribution of contemporary philosophers, such as Robert Spaemman, the person is defined as an individual substance of a rational nature, breaking down the fundamental dimensions to demonstrate, by argumentation, that the principle individuality not only includes the biological dimension (materialistic naturalism), but the unity of the person belonging to human nature.

Resumo: Nos últimos anos tem se realizado estudos de associação do genoma completo, com o objetivo de identificar variantes genéticas associadas à inter-individualidade da resposta a tratamentos dietéticos para a perda de peso. Esses esforços da genômica nutricional contribuem para os avanços da ciência da nutrição 4.0: preventiva, participativa, preditiva e personalizada. Sem dúvida, ainda que até hoje tenham sido descobertos milhões de polimorfismos no genoma humano, esses achados não indicam que a presença dessas variações determine um efeito sobre a saúde do indivíduo. Assim, o uso do perfil nutrigenético para a perda de peso conduz a uma análise sobre os riscos/benefícios à luz dos princípios bioéticos centrados na unidade, individualidade e unicidade da pessoa humana. Assim, com base em pensadores clássicos como Aristóteles e Tomás de Aquino, porém com a contribuição de filósofos contemporâneos como Robert Spaemman, define-se a pessoa como substância individual de natureza racional, separando as dimensões fundamentais para demostrar, por argumentação, que o princípio da individualidade não somente inclui a dimensão biológica (naturalismo materialista), como também a unidade da pessoa pertencente à natureza humana.

Alternativas fitoterápicas no controle da obesidade / Phytotherapy alternatives in obesity control / Alternativas herbales en el control de la obesidad

Nos últimos anos, a obesidade vem aumentando consideravelmente entre adultos e crianças e, segundo a OMS, estima-se que em 2025 o número de obesos ultrapasse a 2,3 milhões em todo o mundo. O indivíduo obeso apresenta maiores riscos de desenvolver doenças crônicas não transmissíveis, como diabetes, doenças cardiovasculares, dislipidemias e ainda alguns tipos de cânceres. O tratamento para a obesidade é variado e inclui mudanças no estilo de vida como: hábitos alimentares e prática de atividade física, tratamento medicamentoso, cirurgia bariátrica e fitoterápicos com o potencial de auxiliar no tratamento. O objetivo deste trabalho foi realizar uma revisão bibliográfica a fim de avaliar os benefícios da utilização de medicamentos fitoterápicos como auxiliar no tratamento da obesidade, seus principais ativos, mecanismos de ação e sua utilização popular. Dentre as plantas pesquisadas e que demonstraram potencial para atuar no tratamento da obesidade encontram-se Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale e Senna alexandrina. Os principais mecanismos de ação envolvidos no potencial anti-obesidade das plantas medicinais são a capacidade de controle do apetite e ingestão de energia, estímulo da termogênese, inibição da lipase pancreática e redução da absorção de gordura, diminuição da lipogênese e aumento da lipólise. Desta forma, conclui-se que as plantas selecionadas neste estudo apresentaram efeitos positivos nos parâmetros bioquímicos e físicos, podendo ser incluídas nos protocolos como coadjuvantes nos tratamentos de emagrecimento.

In recent years, obesity has increased considerably among adults and children and according to the WHO, it is estimated that in 2025 the number of obese people will exceed 2.3 million worldwide. The obese individual is at greater risk of developing non-communicable chronic diseases, such as diabetes, cardiovascular disease, dyslipidemia and even some types of cancer. The treatment for obesity is varied, including changes in lifestyle such as eating habits and physical activity, drug treatment, bariatric surgery and phytotherapy with the potential to aid in the treatment. The objective of this work was to carry out a literature review, evaluating the benefits of using herbal medicines as an aid in the treatment of obesity, their main assets, mechanisms of action and their popular use. Among the plants researched and that have shown potential to act in the treatment of obesity are Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber officiale and Senna alexandrina. The main mechanisms of action involved in the antiobesity potential of medicinal plants are the ability to control appetite and energy intake, thermogenesis stimulation, pancreatic lipase inhibition and reduction of fat absorption, lipogenesis decrease and lipolysis increase. Thus, it is concluded that the plants selected in this study showed positive effects on biochemical and physical parameters, and can be included in the protocols as adjuvants in weight loss treatments.

En los últimos años, la obesidad ha aumentado considerablemente entre adultos y niños y, según la OMS, se estima que en 2025 el número de obesos superará los 2,3 millones en todo el mundo. Los individuos obesos tienen un mayor riesgo de desarrollar enfermedades crónicas no transmisibles, como la diabetes, las enfermedades cardiovasculares, las dislipidemias e incluso algunos tipos de cáncer. El tratamiento de la obesidad es variado e incluye cambios en el estilo de vida como: hábitos alimenticios y práctica de actividad física, tratamiento farmacológico, cirugía bariátrica y medicamentos a base de hierbas con potencial para ayudar en el tratamiento. El objetivo de este trabajo fue realizar una revisión bibliográfica para evaluar los beneficios del uso de las hierbas medicinales como ayuda en el tratamiento de la obesidad, sus principales activos, mecanismos de acción y su uso popular. Entre las plantas investigadas y que mostraron potencial para actuar en el tratamiento de la obesidad están Camelia sinensis, Citrus aurantium, Hibiscus sabdariffa, Coffea arabica, Ephedra sinica, Zingiber oficinale y Senna alexandrina. Los principales mecanismos de acción implicados en el potencial antiobesidad de las plantas medicinales son la capacidad de controlar el apetito y la ingesta de energía, estimular la termogénesis, inhibir la lipasa pancreática y reducir la absorción de grasas, disminuir la lipogénesis y aumentar la lipólisis. Por lo tanto, se concluye que las plantas seleccionadas en este estudio mostraron efectos positivos sobre los parámetros bioquímicos y físicos, y pueden ser incluidas en los protocolos como coadyuvantes en los tratamientos de pérdida de peso.

Eating disorders in the preoperative phase of bariatric surgery / Transtornos alimentares durante o pré-operatório de cirurgia bariátrica

Introduction: Bariatric surgery is considered the most effective obesity treatment. Obese patients have a high prevalence of eating disorders. Objectives: Evaluate the occurrence of eating disorders and eating patterns in candidates for bariatric surgery and associate eating disorders with sociodemographic and clinical characteristics. Methods: A retrospective study was conducted using electronic charts of candidates for bariatric surgery. Data were collected on sex, age, marital status, schooling, occupation, non-communicable diseases, body mass index (BMI), eating disorders, and eating patterns. Results: Among the 281 patients evaluated, eating disorders were detected in 26.7%; 10.3% had binge eating disorder, 6.6% had bulimia nervosa, and 5.3% had the night-eating syndrome. The specific eating patterns were overeating (46.6%), binge eating during periods of stress (9.3%), eating sweets (4%), and snaking (1.3%). BMI ranged from 35.38 to 59.03 kg/m² (mean: 44.37 ± 5.89). All individuals (100%) had systemic arterial hypertension, and 23.3% had type 2 diabetes mellitus or dyslipidemia. Conclusions: The frequency of eating disorders was low in the sample studied, the most common of which was binge eating disorder. Non-communicable diseases were associated with eating disorders. Among the eating patterns observed, the most frequent was overeating (AU)

Introdução: A cirurgia bariátrica é considerada o tratamento mais eficaz para a obesidade. Pacientes obesos possuem elevada prevalência de transtornos alimentares. Objetivos: Avaliar a presença de transtornos alimentares e padrões alimentares em candidatos à cirurgia bariátrica, associando os transtornos alimentares aos dados sociodemográficos e clínicos. Métodos: Estudo retrospectivo de cunho documental, com base em prontuários eletrônicos de pacientes candidatos à cirurgia bariátrica. Foram obtidas variáveis como sexo, idade, estado civil, nível de escolaridade, ocupação, doenças crônicas não transmissíveis, índice de massa corporal (IMC), transtorno e padrão alimentar. Resultados: Dos 281 pacientes avaliados, foi detectado 26,7% de transtornos alimentares, sendo 10,3% transtorno de compulsão alimentar periódica, 6,6% de bulimia nervosa e 5,3% de síndrome do comer noturno. Os padrões alimentares específicos encontrados foram: glutões (46,6%), compulsivos alimentares em períodos de estresse (9,3%), comedores de doces (4%) e beliscadores (1,3%). O IMC variou de 35,38 a 59,03 kg/m² (44,37±5,89), com 100% do grupo apresentando Hipertensão Arterial Sistêmica e 23,3% com Diabetes Mellitus tipo 2 ou dislipidemia. Conclusões: Constatou-se baixa frequência de transtornos alimentares na amostra estudada, sendo o transtorno de compulsão alimentar periódica o mais observado. Doenças crônicas não transmissíveis foram associadas com a presença de transtornos alimentares. Dentre os padrões alimentares observados, os glutões foram os mais frequentes (AU)

Diagnóstico y tratamiento de la obesidad en adultos mexicanos: cambios entre 2006 y 2018 / Diagnosis and treatment of obesity in Mexican adults: changes between 2006 and 2018

Introducción: A nivel global ha existido un incremento en el peso corporal. Ante ello, se han implementado programas para diagnosticar y tratar la obesidad. Se requiere documentar si dichos programas han propiciado que las personas con obesidad reciban diagnóstico y tratamiento eficaz. Objetivo: Determinar y comparar los cambios entre 2006 y 2018 en las prevalencias de diagnóstico y tratamiento de la obesidad y pérdida intencional de peso en adultos mexicanos e identificar si en este periodo existieron cambios en las disparidades sociales en dichos eventos. Materiales y métodos: Se analizaron las bases de datos de la Encuesta Nacional de Salud y Nutrición de México realizada en 2006 (N=26.738) y 2018 (N= 12.205), Los eventos fueron diagnóstico y tratamiento de obesidad y de pérdida intencional de peso en adultos mexicanos con IMC > 30. Las variables independientes fueron: sexo, edad, índice de masa corporal, nivel socioeconómico y región geográfica. Resultados: De 2006 a 2018, aumentó la prevalencia de personas con obesidad que recibieron diagnóstico (de 20,4% a 51,1%) o tratamiento (de 8,3% a 21,4%). La prevalencia de pérdida intencional de peso también aumentó (de 5,5% a 10,0%), pero esto básicamente ocurrió en las personas con nivel socioeconómico alto. En modelos multivariados se observó que, las mujeres, las personas con mayor IMC y quienes tenían mayor nivel socioeconómico tuvieron mayor probabilidad de recibir diagnóstico y tratamiento. Conclusiones: Aunque en México el acceso a diagnóstico y tratamiento a la obesidad se ha incrementado, la prevalencia de pérdida intencional de peso es baja, además, persisten disparidades socioeconómicas en estos eventos(AU)

Introduction: Worldwide, there has been an increase in body weight. Because of this, programs have been implemented to diagnose and treat obesity. It is required to document whether these programs have led people with obesity to receive effective diagnosis and treatment. Objective: To determine and compare the changes between 2006 and 2018 in the prevalences of diagnosis and treatment of obesity and intentional weight loss among Mexican adults and to identify whether there were changes in the social disparities in these events during this period. Materials and methods: The databases of the National Health and Nutrition Survey of Mexico carried out in 2006 (N=26,738) and 2018 (N= 12,205) were analyzed. The events were diagnosis and treatment of obesity and intentional weight loss in Mexican adults with BMI > 30. The independent variables were sex, age, body mass index, socioeconomic status, and geographic region. Results: From 2006 to 2018, the prevalence of people with obesity who received the diagnosis (from 20.4% to 51.1%) or treatment (from 8.3% to 21.4%) increased. The prevalence of intentional weight loss also increased (from 5.5% to 10.0%), but this was mainly in people with high socioeconomic status, Multivariate regression models revealed that, women, people with a higher BMI, and those with a higher socioeconomic status were more likely to receive diagnosis and treatment. Conclusions: Although in Mexico access to diagnosis and treatment of obesity has increased, the prevalence of intentional weight loss is low,In addition, socioeconomic disparities persist in these events(AU)

Periodized combined training in physically active overweight women over 50 years

Abstract Aim: This quasi-experimental study, analyzes if periodized combined training's influence on plasma cytokine levels, muscle strength, and cardiorespiratory fitness in physically active women with overweight and/or obesity over 50 years. Methods: The sample was composed of 33 physically active women who were randomly allocated to three groups: Non-Periodized (NP) (n = 11); Undulating Periodization (UP) (n = 9); and Flexible Undulating Periodization (FUP) (n = 13). This study was conducted for 17 weeks, which included adaptation (weeks 1-3), baseline testing (week 4), training program (weeks 5-16), and post-evaluation (week 17). The training frequency comprised of three weekly sessions, with 30 min of aerobic exercise and 45 min of strength exercises. The data were analyzed using descriptive statistics and analysis of variance. The level of significance was p ≤ 0.05. Results: No differences were observed in weight parameters, plasma levels of cytokines, and biochemical parameters in any group, before and after the completion of the training period. Participants demonstrated increase in strength of the upper limbs in the UP (p = 0.032) and FUP (p = 0.021) groups, an increase in aerobic fitness in the NP (p = 0.041) and UP (p = 0.005) groups, and an increase in the amount of time of vigorous activity per week in the NP group (p = 0.019). Conclusion: This study shows that periodized combined training in physically active women with overweight and/or obesity over 50 years proved to be beneficial for all groups; although, the UP group exhibited better performance.

Remission of type 2 diabetes depends on prompt comprehensive lifestyle changes upon diagnosis: How can this "Road to Damascus" experience be supported? / 中西医结合学报

Theoretically, a new diagnosis of type 2 diabetes mellitus (T2DM) requires a dramatic change in an individual's way of life. Weight loss and physical activity can lead to remission of diabetes, which has been associated with a lower risk of developing complications. Today, the importance of a healthy lifestyle is further highlighted by data showing that obesity and diabetes increase the risk of severe complications from coronavirus disease 2019. However, remission rarely occurs in reality, probably due to the inability of people with T2DM to adhere to the intensive lifestyle interventions that are necessary. The complexity of contributing factors may explain why making these changes is so challenging and underscore the fact that there is no magical solution for T2DM. Instead, hard work from both patients and health care providers is needed for the conversion to be achieved. This article calls for more research on the underlying reasons why adhering to a healthy way of life is so difficult for people with diabetes and obesity. Clearly defining these barriers would facilitate the planning of effective policies to promote the adoption of appropriate lifestyle changes early in the course of the disease.

Simple obesity of stomach heat and damp obstruction treated with acupoint thread embedding therapy: a randomized controlled trial / 中国针灸

OBJECTIVE@#To explore the therapeutic effect and safety of acupoint thread embedding therapy in treatment of simple obesity of stomach heat and damp obstruction.@*METHODS@#A total of 144 patients with simple obesity of stomach heat and damp obstruction were randomized into an acupoint thread embedding group (72 cases, 3 cases dropped off and 1 case removed) and a sham-embedding group (72 cases, 6 cases dropped off and 3 cases removed). On the base of the lifestyle adjustment, the acupoint thread embedding therapy with PGLA thread was applied to Tianshu (ST 25), Zhongwan (CV 12), Ganshu (BL 18), Shuidao (ST 28), etc. in the acupoint thread embedding group, while in the sham-embedding group, the acupoint selection and operation were all same as the acupoint thread embedding group, but without PGLA thread embedded. In either group, the treatment was given once every 2 weeks, consecutively for 12 weeks and the follow-up was conducted for 3 months after treatment. Separately, before and after treatment as well as in follow-up, the obesity indices (body mass index [BMI], waist circumference [WC], waist-to-hip ratio [WHR] and fat percentage [F%]) were observed in the two groups. Before and after treatment, the indices of blood glucose and insulin (fasting blood glucose [FBG], fasting insulin [FINS] and insulin resistance index [HOMA-IR]), adipocyte factor indices (adiponectin, leptin [LP] and serine protease inhibitor [Vaspin]) and inflammatory factor indices (tumor nercosis factor [TNF-α], interleukin-1β [IL-1β] and interleukin-6 [IL-6]) were observed separately in the two groups. The therapeutic effect and safety were compared between the two groups.@*RESULTS@#After treatment and in follow-up, except WC and WHR in the sham-embedding group, BMI, WC, WHR and F% were all reduced as compared with those before treatment in the two groups (P<0.01, P<0.05), and the values in the acupoint thread embedding group were lower than the sham-embedding group (P<0.01). After treatment, except FBG, LP and Vaspin in the sham-embedding group, FBG, FINS, HOMA-IR, LP and Vaspin were all reduced as compared with those before treatment in the two groups (P<0.01, P<0.05), and adiponectin was increased as compared with that before treatment (P<0.01, P<0.05); the improvements in the acupoint thread embedding group were more significant than the sham-embedding group (P<0.01). After treatment, the levels of serum TNF-α, IL-1β and IL-6 in the acupoint thread embedding group were reduced as compared with the values before treatment and those in the sham-embedding group separately (P<0.01). The total effective rate was 89.7% (61/68) in the acupoint thread embedding group, higher than 19.0% (12/63) in the sham-embedding group (P<0.01). There was no severe adverse reaction reported in the two groups.@*CONCLUSION@#Acupoint thread embedding therapy with PGLA thread can alleviate obesity, regulate glucose metabolism and adipocyte factors activity, improve insulin resistance and inhibit the expression of pro-inflammatory factors in the patients with simple obesity with stomach heat and damp obstruction, and this therapy presents a satisfactory safety in treatment.

Efeitos não-clínicos da atividade física no tratamento de pessoas com diabetes, hipertensão ou obesidade / Non-clinical effects of physical activity in the treatment of people with diabetes, hypertension or obesity

Contexto: As práticas de atividade física são fortes aliadas na redução dos riscos à saúde, bem como no tratamento de doenças. Destaca-se sua relevância no cuidado a pessoas com doenças crônicas não transmissíveis, para as quais é importante investir na qualidade de vida. Esta revisão rápida aborda os efeitos não-clínicos das intervenções de atividade física em pessoas com diabetes mellitus tipo 2, hipertensão arterial sistêmica e sobrepeso/obesidade. Pergunta: Quais são os efeitos não-clínicos de diferentes modalidades de atividade física no tratamento de pessoas com diabetes, hipertensão ou obesidade? Métodos: Seguindo protocolo prévio, foram realizadas buscas por revisões sistemáticas (RS) em oito bases eletrônicas da literatura, em setembro de 2021. Nesta revisão rápida foram incluídas RS publicadas nos últimos 10 anos, com algumas especificações quanto a contexto e população. Apenas o processo de seleção foi realizado em duplicata e de forma independente. A avaliação da qualidade das RS foi feita por um revisor e checada por outro, por meio da ferramenta AMSTAR 2. Os resultados foram reunidos em síntese narrativa conforme similaridade do tipo de atividade física e população. Resultados: De 4.421 relatos encontrados nas bases de dados, 23 RS foram incluídas após processo de seleção e elegibilidade. Na avaliação da qualidade metodológica, uma RS foi considerada de confiança moderada, uma de confiança baixa e as demais de confiança criticamente baixa. As revisões apresentaram resultados de exercícios aeróbicos, anaeróbicos, combinados e de tipo não informado, envolvendo pessoas com diabetes mellitus tipo 2, hipertensão arterial sistêmica e sobrepeso/obesidade. O tipo de atividade mais presente foi de exercícios aeróbicos e a condição mais estudada foi diabetes mellitus tipo 2. Apenas uma RS apresentou informação a respeito da segurança da prática de atividade física, sem ocorrência de eventos adversos. Diversas modalidades de atividade física mostraram promover benefícios não-clínicos no tratamento de pessoas com diabetes, hipertensão e obesidade. Considerações finais: As evidências indicam que pessoas com diabetes ou hipertensão podem ter sua qualidade de vida melhorada com a prática de exercícios, em especial os aeróbicos. Para pessoas com obesidade ou comorbidades, as evidências são menos robustas. É importante levar em consideração algumas incertezas apontadas pelas RS, bem como as falhas metodológicas da maioria dessas RS.

Context: Physical activity practices are strong allies in reducing health risks, as well as in the treatment of diseases. Its relevance in the care of people with non-communicable chronic diseases is highlighted, for whom it is important to invest in quality of life. This rapid review addresses the non-clinical effects of physical activity interventions in people with type 2 diabetes mellitus, systemic arterial hypertension, and overweight/obesity. Question: What are the non-clinical effects of different physical activity modalities in the treatment of people with diabetes, hypertension or obesity? Methods: Following a previous protocol, searches for systematic reviews (SR) were carried out in eight electronic databases of the literature, in September 2021. This rapid review included SRs published in the last 10 years, with some specifications regarding context and population. Only the selection process was carried out in duplicate and independently. The evaluation of the quality of the SRs was carried out by one reviewer and checked by another, using the AMSTAR 2 tool. The results were gathered in a narrative synthesis according to the similarity of the type of physical activity and population. Results: Of the 4,421 reports found in the databases, 23 SRs were included after the selection and eligibility process. In the evaluation of methodological quality, one SR was considered moderately reliable, one of low confidence and the others of critically low confidence. The reviews presented results of aerobic, anaerobic, combined and unreported exercises involving people with type 2 diabetes mellitus, systemic arterial hypertension and overweight/obesity. The most common type of activity was aerobic exercises and the most studied condition was type 2 diabetes mellitus. Only one SR presented information about the safety of physical activity, without the occurrence of adverse events. Several modalities of physical activity have been shown to promote non-clinical benefits in the treatment of people with diabetes, hypertension and obesity. Final considerations: The evidence indicates that people with diabetes or hypertension can have their quality of life improved with the practice of exercises, especially aerobic ones. For people with obesity or comorbidities, the evidence is less robust. It is important to take into account some uncertainties pointed out by the SRs, as well as the methodological flaws of most of these SRs.

Effects of an interdisciplinary weight loss program on fibroblast growth factor 21 and inflammatory biomarkers in women with overweight and obesity

ABSTRACT Objective: To investigate the effects of an interdisciplinary intervention on biomarkers of inflammation and their relationship with fibroblast growth factor 21 (FGF21) concentrations in women with overweight and obesity. Subjects and methods: Thirty-one women were enrolled in a 12-week interdisciplinary weight loss program delivered by a team comprising an endocrinologist, nutritionist and exercise physiologist. Body composition; anthropometric measures; metabolic and inflammatory markers including adiponectin, leptin, and atrial natriuretic peptide (ANP) were assessed at baseline and post-therapy. The homeostasis model assessment of insulin resistance (HOMA-IR) and the homeostasis model assessment of adiponectin (HOMA-AD) were calculated. The participants were divided into two groups: those with increased FGF21, and those with decreased FGF21. Results: The sample comprised women aged 32 ± 5 years with a body mass index of 33.64 ± 3.49 kg/m2. Body weight, waist circumference and leptin concentration were decreased in the whole sample after therapy. However, only the group with an increase in FGF21 concentration presented significant improvements in adiponectin concentration and adiponectin/leptin ratio. Moreover, although there was a reduction of leptin in both groups, it was greater in the increased FGF21 groups. There was a reduction in ANP in the decreased FGF21 group. Conclusions: Changes in FGF21 concentrations were different among the women participating in the weight loss program, with some having increased levels and some reduced levels. Furthermore, improvements in adiponectin and the adiponectin/leptin ratio were found only in the group with increased FGF21 concentration.

Obesidad: epidemia del siglo XXI y su relación con la fertilidad / Obesity: an epidemic of the 21st century and its relation to fertility

En Chile, la obesidad y el sobrepeso han presentado un constante incremento, en las últimas décadas. Cifras del Ministerio de Salud (MINSAL) dan cuenta de un aumento de prevalencia, desde un 61% en 2003, hasta una preocupante estimación de 74% de la población adulta, en 2019 según la Organización para la Cooperación y el Desarrollo Económicos (OCDE). La Organización de las Naciones Unidas para la Alimentación y la Agricultura (FAO por sus siglas en inglés) estimó que 4 millones de adultos chilenos padecían de obesidad en 2019, situando a Chile como el país latinoamericano con el más alto índice de la condición. El porcentaje de la población adulta, en edad reproductiva, que presenta obesidad, se estima en 9 -18% para hombres y 12 -28% para mujeres. El exceso de grasa corporal tiene serias consecuencias adversas, para el potencial fértil y la capacidad reproductiva de las parejas, comprometiendo fecundidad y determinando infertilidad, trastornos de la ovulación, función sexual y peores resultados en técnicas de reproducción asistida y pronóstico obstétrico

In Chile, excess weight and obesity have shown a steady increase over the last decades. Data from the ministry of health (MINSAL) show a rise in prevalence from 61% in 2003 to an alarming 74% of the adult population by 2019 according to the Organization for Economic Cooperation and Development (OCDE). The United Nations Food and Agriculture Organization (FAO) estimates that 4 million adult Chileans suffered obesity in 2019, placing Chile as the country in Latin America with the highest incidence of the condition. The percentage of reproductive age adults that suffer obesity is estimated in 9-18% for men and 12-28% for women. The excess body fat has serious detrimental effects on fertility potential and the reproductive capacity of couples compromising fecundity and causing anovulatory infertility and sexual dysfunction as well as poorer results in assisted reproductive technologies and obstetric outcome

Aspectos generales sobre la diabesidad: fisiopatología y tratamiento / General aspects of diabesity: physiopathology and treatment

Introducción: La estrecha relación que existe entre diabetes mellitus tipo 2 y obesidad ha dado lugar a la creación del término "diabesidad", considerándose la nueva enfermedad del siglo XXI. La dupla entre estas produce grave lesión en el tejido hepático, músculo esquelético y sistema cardiovascular. Es importante un estilo de vida saludable y buena adherencia farmacológica para combatir esta pandemia. Objetivo: Describir aspectos generales acerca de la fisiopatología y el tratamiento de la diabesidad. Método: Se realizó una búsqueda bibliográfica no sistemática en las bases de datos Science Direct, EMBASE, LILACS, Redalyc, SciELO y PubMed. Los criterios de inclusión fueron publicaciones en inglés y español, en las que el título, palabras clave o resumen incluyen información pertinente al objetivo de estudio, periodicidad no mayor de cinco años. En la búsqueda se obtuvieron 50 artículos, de los cuales fueron seleccionados 35. Conclusión: La insulinorresistencia es el factor determinante para la progresión hacia diabetes mellitus tipo 2, en calidad de respuesta del tejido adiposo frente a altos niveles de ácidos grasos libres (lipotoxicidad), consecuencia de la obesidad, obligando al páncreas a secretar grandes cantidades de insulina, que con el tiempo compromete su funcionalidad. En la actualidad, existen diversas alternativas no farmacológicas, farmacológicas y quirúrgicas para el abordaje de la diabesidad, donde la prevención representa un aspecto de vital importancia(AU)

Introduction: The close relation among diabetes mellitus type 2 and obesity has led to the creation of the term "diabesity," considering it the new disease of XXI century. The fusion of these two diseases produces severe lesions in the hepatic tissue, the skeletal muscle and the cardiovascular system. It is important a healthy lifestyle and a good pharmacological adherence to fight this so called pandemic. Objective: Describe general aspects related to the physiopathology and treatment of diabesity. Method: It was carried out a non-systematic bibliographic search in databases like Science Direct, EMBASE, LILACS, Redalyc, SciELO and PubMed. The inclusion criteria were publications in English and Spanish language, with a periodicity of no more than 5 years, in which the title, keywords and abstract included information that will be relevant for the objective of the study. In the search 50 articles were found, of which 35 were selected. Conclusions: Insulin resistance is the key factor for the progression towards diabetes mellitus type 2, as a response of the adipose tissue to high levels of free fatty acids (lipotoxicity), which is a consequence of obesity, and obligates the pancreas to secrete big amounts of insulin that as time goes by compromises its functionality. Nowadays, there are different non-pharmacological, pharmacological and surgical alternatives to address the diabesity, in which prevention represents an aspect of vital importance(AU)

The Effect of Stool Transplantation on Weight Control in Obese Rats / O efeito do transplante de fezes no controle de peso em ratos obesos

Abstract Introduction Obesity is defined as a multifactorial metabolic syndrome in which there is an excessive number of fat cells within the tissues. It is discussed that intestinal microbiota might have a relevant relation with obesity, since it is relevantly altered in obese patients. Objectives To assess the effect of stool transplantation (ST) in the condition of obesity and its outcomes in an experimental model of cafeteria diet by analyzing histology and weight gain. Methods Forty male Wistar rats were randomly assigned to 5 groups: control (CO), control with antibiotics (CO+ATB), obesity (CAF+ATB), stool transplantation (ATB+ ST) and obesity with stool transplantation (CAF+ATB+ST). During the experiment, obesity induction groups received cafeteria diet, whereas the remaining groups had normal diet ad libitum. After 3 months, daily ST was carried out for 8 weeks by gavage procedure. The animals were euthanized, and the small intestine was harvested for further analysis. Results It was observed that before starting the ST, the cafeteria and normal diet groups had significant weight difference (p<0,0001). In the comparison between CAF+ATB and CAF+ATB+ST during the gavage period, the CAF+ATB+ST group presented lower weight gain (p=0.0017). The histopathological evaluation show that the ATB+ST group did not present intestinal crypt distortion. Conclusion Cafeteria diet resulted in an expected weight gain. In relation to the ST, it has been shown that the procedure is effective in reducing weekly weight gain. Apparently, there was no induction of disabsortive syndrome in nonobese animals that received ST.

Resumo Introdução A obesidade é definida como uma síndrome metabólica multifatorial, na qual existe um número excessivo de células de gordura nos tecidos. Discute-se que a microbiota intestinal pode estar relacionada com a obesidade, uma vez que ela é alterada de forma relevante em pacientes obesos. Objetivos Avaliar o efeito do transplante de fezes (TF) na obesidade induzida por um modelo experimental de dieta de cafeteria. Métodos Quarenta ratos Wistar foram distribuídos aleatoriamente em 5 grupos: controle (CO), controle com antibióticos (CO+ATB), obesidade (CAF+ATB), transplante de fezes (ATB+TF) e obesidade com transplante de fezes (CAF+ATB+TF). Durante o experimento, os grupos de indução de obesidade receberam dieta de cafeteria, enquanto os demais grupos tiveram dieta ad libitum normal. Após 3 meses, o TF diário foi realizado por 8 semanas por meio de gavagem intragástrica. Os animais foram sacrificados e o intestino delgado foi colhido para análise posterior. Resultados Observou-se que antes de iniciar o TF, os grupos de dieta de cafeteria e dieta normocalórica apresentavam diferença significativa de peso (p<0,0001). Ao comparar os grupos CAF+ATB e CAF+ATB+TF durante o período de gavagem, o grupo CAF+ATB+TF apresentou menor ganho de peso (p=0,0017). A avaliação histopatológica mostra que nenhum dos animais do grupo TF+ATB apresentou distorções nas criptas intestinais. Conclusão A dieta da cafeteria resultou em um ganho de peso esperado. Em relação ao TF, demonstrou-se que o procedimento é eficaz na redução do ganho de peso semanal. Aparentemente, não houve indução da síndrome disabsortiva em animais não obesos que receberam TF.