Intervenciones de terapia ocupacional en el manejo de sobrepeso y obesidad: revisión sistemática exploratoria / Occupational therapy interventions for the management of overweight and obesity: scoping review

Introducción: Existe limitado conocimiento sobre las características y evidencia disponible de intervenciones de terapia ocupacional en el manejo y reducción de la obesidad y sobrepeso, traduciéndose en una limitada consideración en políticas y programas de salud. Objetivo: Caracterizar las intervenciones de terapia ocupacional en sobrepeso y/u obesidad. Métodos: Revisión Sistemática Exploratoria (Scoping Review) en las bases de datos EBSCOhost, Embase, PubMed, PsychInfo, Scielo y Scopus, de estudios publicados a junio 2020. Se usó estructura PRISMA ScR, incorporando artículos que cumplieran los criterios: a) Evaluasen una intervención de terapia ocupacional en sobrepeso y/u obesidad, b) Informasen resultados cuantitativos, y c) Publicados en revista con evaluación de pares. Resultados: Cinco estudios fueron incluidos en la revisión. Cuatro utilizaron un diseño cuasi experimental (pretest-postest, sin grupo de comparación), y un estudio utilizó un diseño mixto con estudio pretest-postest adicionando estudio cualitativo. Las intervenciones son heterogéneas y sus resultados atribuibles no fueron significativos en el desenlace reducción de peso corporal. Se relevan resultados favorables en otras dimensiones, como la resignificación del uso de tiempo libre y el aprendizaje de hábitos saludables. Discusión: Las intervenciones de terapia ocupacional refieren protocolos de intervención heterogéneos, asociados a programas de manejo de sobrepeso y obesidad. Los estudios disponibles proporcionan evidencia limitada su efectividad, y sus potenciales desenlaces son más consistentes con dimensiones psicosociales por sobre dimensiones morfológicas como el peso corporal. Se requiere con urgencia investigación experimental que permita establecer la acción de terapia ocupacional en estos problemas de relevancia para la salud pública.

Introduction: The knowledge about the characteristics and available evidence of occupational therapy interventions in the management of obesity and overweight is scarce, with also limited scalability of occupational therapy in health policies and programs. Objective: To characterize occupational therapy interventions for the management of overweight and/or obesity. Method: Scoping Review. EBSCOhost, Embase, PubMed, PsychInfo, Scielo and Scopus databases were included, with studies published from inception to June 2020. PRISMA ScR guidelines were used. Criteria for article selection included interventions that: a) Evaluated an occupational therapy intervention in overweight and/or obesity, b) Reported quantitative results, and c) Were published in a peer-reviewed journal, d) Full text available in English, Spanish, and Portuguese. Results: 5 studies were included in the review. Four studies corresponded to quasi-experimental design (pretest-posttest, no comparison group), and one study used a mixed-method design with a pretest-postest study adding a qualitative component. Interventions found were heterogeneous and changes were not significant for the outcome weight reduction. Significant results were found in other dimensions, such as resignification of the use of leisure time and the incorporation of healthy habits. Discussion: Occupational therapy interventions include heterogeneous protocols embedded in larger overweight and obesity management programs. Available studies provide limited evidence of their effectiveness, and their potential outcomes are more consistent with psychosocial dimensions than morphological ones, such as body weight. Experimental research is remarkably needed to establish the action of occupational therapy in these problems of public health relevance.

Impact of Physical Training Programs on Physical Fitness in People With Class II and III Obesity: A Systematic Review and Meta-Analysis.

BACKGROUND: Physical training, regardless of the presence of concurrent weight loss, provides numerous health benefits for individuals who are overweight and obese and have or are at risk for cardiovascular disease. PURPOSE: The purpose of this review was to identify different types of physical training programs (aerobic, resistance, or combined), with or without counseling/diet modifications, and their impact on physical fitness in individuals who have class II and III obesity. DATA SOURCES: Medline and Medline In-Process, EMBASE, the Cochrane Central Register of Controlled Trials, the Cochrane Database of Systematic Reviews, Web of Science, LILACS, CINAHL, SPORTDiscus, PEDro, and PubMed were searched up to June 2017. STUDY SELECTION: This review had the following inclusion criteria: body mass index of ≥35 kg/m2 and age 18 years or older; supervised physical training program; randomized controlled trial; physical fitness outcome (muscular strength, muscular endurance, cardiovascular endurance, and/or flexibility); in English or Portuguese; and available full-text article. DATA EXTRACTION: Three reviewers independently extracted data, assessed study risk of bias using the Cochrane tool, and discussed disagreements until consensus was reached. DATA SYNTHESIS: Of the 9460 identified articles, 26 were included and 8 were used in a meta-analysis. The meta-analysis showed improvements in walking speed and maximal oxygen uptake but not knee extension strength in the intervention groups. The Cochrane risk-of-bias score indicated that the majority of the data were from randomized controlled trials with a low or unclear risk of bias. LIMITATIONS: The large variability of outcomes and interventions made comparisons difficult. CONCLUSIONS: A combination of aerobic exercise and resistance exercise, in addition to diet modifications, may improve cardiovascular and muscular endurance in individuals with class II and III obesity. However, conclusions must be interpreted with caution because of the heterogeneity in interventions and outcome measures among the studies and an unclear risk of bias in several studies.

ß2 adrenergic interaction and cardiac autonomic function: effects of aerobic training in overweight/obese individuals.

PURPOSE: To verify the influence of different volumes and intensities of aerobic exercise on cardiac autonomic function (CAF) through heart rate variability (HRV) analysis as well the influence of ß2 adrenergic receptor (ADRB2) variants in overweight/obese individuals. METHODS: 70 physically inactive adults were randomly allocated into the following 16-week training: 1-high-intensity interval training (HIIT) (n = 25, 1 × 4 min bout at 85-95%HR peak, 3×/week), 4-HIIT (n = 26, 4 × 4 min bouts at 85-95%HR peak, interspersed with 3 min of recovery at 50-70%HR peak, 3×/week), and moderate continuous training (MCT) (n = 19, 30 min at 60-70%HR peak, 5×/week). Before and after the exercise training, anthropometric, BP, cardiorespiratory fitness, and HRV measures were evaluated. R-R intervals recorded for 10 min in a supine position at pre- and post-intervention were used to analyze HRV in the plot-Poincare indexes (SD1, SD2), and frequency-domain (LF, HF, LF/HF). Full blood samples were used for genotyping. RESULTS: 4-HIIT and MCT showed positive outcomes for almost all variables while 1-HIIT had a positive influence only on SBP and SD2 index. No associations were observed between isolated ADRB2 variants and changes in HRV. In the analysis of the interaction genotypes, all groups responded positively for the SD1 index of HRV and only the H1 (GG and CC) and H2 (GG and CG + GG) groups presented increases in the RMSSD index. Furthermore, there was an increase in the LF index only in the H3 (CC and AA + AG) and H4 (AA + AG and CG + GG) groups. CONCLUSIONS: ADRB2 variants and aerobic exercise training are important interacting variables to improve autonomic function and other health variables outcomes in overweight or obese individuals.

Respostas musculoesqueléticas e cardiorrespiratórias do Deep Water Running em obesos: revisão de literatura / Deep Water Running Musculoskeletic and Cardiorrespiratory Responses in Obese: Review

O Deep Water Running (DWR) é um método bastante difundido para o condicionamento cardiovascular e reabilitação em atletas. Contudo, nos últimos anos, foram realizadas investigações científicas sobre o DWR em populações especiais. Porém, ainda existem poucas evidências sobre as respostas musculoesqueléticas e cardiorrespiratórias em indivíduos obesos. O objetivo foi realizar um estudo de revisão sistemática de literatura referente às respostas musculoesqueléticas e cardiorrespiratórias, mediante ao treinamento em água funda em obesos. Trata-se de uma revisão de literatura de 2009 a 2019, por meio de levantamento de artigos científicos nas bases de dados eletrônica PubMed, e Scielo. Para tanto, foram utilizadas as seguintes palavras-chave: aquatic, deep water running, water-based, head-out aquatic, physical activity, obesity, overweight, também foram aplicados os operadores boleanos "and" e "OR". Foram encontrados 11 estudos de ensaios clínicos, cujos temas estavam relacionados com as variáveis de interesse do presente estudo. Baseado na literatura científica selecionada, conclui-se que a técnica de DWR é uma estratégia de treinamento e reabilitação física extremamente indicada para potencializar a força e resistência muscular, melhorar a capacidade funcional, cardiorrespiratória e qualidade de vida em obesos.

Deep Water Running (DWR) is a widely used method for cardiovascular conditioning and rehabilitation in athletes. Although, in recent years, scientific investigations have been conducted on DWR in special populations. However, there is still little evidence on musculoskeletal and cardiorespiratory responses in obese individuals.The objective was to perform a systematic review on musculoskeletal and cardiorespiratory responses, through deep water running in obese patients. It is a systematic reviewfrom 2009 to 2019, by means of a survey of scientific articles in the electronic databases PubMed, and Scielo. The following keywords were used: aquatic, deep water running, water-based, head-out aquatic, physical activity, obesity, overweight, and boolean operators "and" and "OR". Were found 11 clinical trial studies, whose themes were related to the variables of interest of the present study. Based on the selected scientific literature, it is concluded that the DWR technique is a strategy of training and physical rehabilitation extremely indicated to potentiate muscular strength and endurance, improve functional capacity, cardiorespiratory capacity and quality of life in obese patients.

The effect of newly initiated exercise training on dynamic thiol / disulphide homeostasis in sedentary obese adults.

We studied dynamic thiol/disulphide homeostasis, an indicator of oxidative stress, to investigate the effects of newly initiated exercise training on sedentary obese adults. Seventeen sedentary obese adults and 15 normal-weight controls were included in the sample for this study. The obese adults were given a physical exercise training program that lasted twelve weeks. Before and after the exercise training program, blood samples were collected, and serum thiol/disulphide parameters were measured by using a novel technique. Before the start of the exercise training, it was observed that thiol/disulphide homeostasis was impaired, and this impairment was positively correlated with body mass index in sedentary obese adults because of the higher reactive oxygen species production in adipose tissue. However, while the obese participants' body mass index significantly decreased, the thiol/disulphide homeostasis parameters in the obese adults did not change over time as calculated at the baseline and compared to the calculation after the twelve weeks of exercise training. Despite a decrease in body mass index that occurred after the twelve weeks of exercise training, there was a lack of improvement in the obesity-induced impairment of thiol/disulphide homeostasis, which suggests that a newly initiated exercise training program may lead to oxidative stress.

Increase in Protein Intake After 3 Months of RYGB Is an Independent Predictor for the Remission of Obesity in the First Year of Surgery.

INTRODUCTION: Although bariatric surgery promotes dietary changes, many questions regarding their effect on weight loss remain unanswered. OBJECTIVE: The aim of this study was to evaluate changes in dietary intake and predictive factors of obesity remission in the first 12 months after RYGB. METHODS: Fifty-one patients (mean 39.34 ± 9.38 years, 68.7% women) who underwent RYGB were included in this study. Dietary intake was evaluated through a 24-h dietary recall and subsequently classified by NOVA, macronutrients and calories. The predictive factors for obesity remission within 12 months after RYGB were evaluated by Cox regression. RESULTS: At baseline, 62.7% of the patients presented severe obesity; mean excess weight loss was greater than 80% after 1 year of surgery and about 70% of the patients were no longer diagnosed with obesity. An increase in percentage of calories from protein was observed at 3 and 12 months after surgery. The caloric contribution of ultra-processed foods was low at 3 months after surgery while that of unprocessed or minimally processed foods was high at 3 and 12 months after surgery. From the Cox regression analysis, preoperative BMI (HR, 0.78; 95% CI, 0.69-0.88) and age (HR, 0.94; 95% CI, 0.89-0.99) showed an inverse association with obesity remission. Also, Δ protein (at 3 months-baseline) showed a positive association with obesity remission (HR, 1.06; 95% CI, 1.01-1.12). CONCLUSION: Lower preoperative BMI, lower age, and higher protein intake at 3 months after surgery may favor remission of obesity in up to 12 months compared with baseline.

Autonomic responses induced by aerobic submaximal exercise in obese and overweight adolescents.

BACKGROUND: Graded exercises tests are performed in adult populations; nonetheless, the use of this type of assessment is greatly understudied in overweight and obese adolescents. OBJECTIVE: To investigate heart rate autonomic responses to submaximal aerobic exercise in obese and overweight adolescents. METHODS: We recruited 40 adolescents divided into two groups: (1) overweight group comprising 10 boys and 10 girls between Z-score +1 and +2 and (2) obese group comprising 10 boys and 10 girls above Z-score >+2. Heart rate variability was analysed before (T1) and after exercise (T2-T4) on treadmill at a slope of 0%, with 70% of the maximal estimated heart rate (220 - age) for 20 minutes. RESULTS: Heart rate in the overweight group was: 93.2±10.52 bpm versus 120.8±13.49 bpm versus 94.6±11.65 bpm versus 93.0±9.23 bpm, and in the obese group was: 92.0±15.41 bpm versus 117.6±16.31 bpm versus 92.1±12.9 bpm versus 91.8±14.33 bpm. High frequency in the overweight group was: 640±633.1 ms2 versus 84±174.66 ms2 versus 603.5±655.31 ms2 versus 762.6±807.21 ms2, and in the obese group was: 628.4±779.81 ms2 versus 65.4±119.34 ms2 versus 506.2±482.70 ms2 versus 677.9±939.05 ms2; and root mean square of successive differences in the overweight group was: 37.9±18.81 ms versus 10.9±8.41 ms versus 32.8±24.07 ms versus 36.7±21.86 ms, and in the obese group was: 38.7±23.17 ms versus 11.5±8.62 ms versus 32.3±16.74 ms versus 37.3±24.21 ms. These values significantly changed during exercise compared with resting values in overweight and obese groups. Moreover, we also reported no significant difference of resting parasympathetic control of heart rate between obese and overweight adolescents. CONCLUSION: There was no significant difference of autonomic responses elicited by submaximal aerobic exercise between overweight and obese adolescents.

Dynamic hyperinflation and exercise limitations in obese asthmatic women.

Obese individuals and patients with asthma can develop dynamic hyperinflation (DH) during exercise; however, no previous study has investigated DH as a factor associated with reduced exercise capacity in obese asthmatic women. The aim of the present study was to examine the occurrence of DH and exercise limitations in obese asthmatics. Obese grade II [obese group (Ob-G); BMI 35-39.9 kg/m2; n=36] and nonobese [nonobese group (NOb-G); BMI 18.5-29.9 kg/m2; n=18] asthmatic patients performed a cardiopulmonary test to quantify peak V̇o2 and a submaximal exercise test to assess DH. Anthropometric measurements, quadriceps endurance, and lung function were also evaluated. A forward stepwise regression was used to evaluate the association between exercise tolerance (wattage) and limiting exercise factors. Fifty-four patients completed the protocol. The Ob-G (n = 36) presented higher peak V̇o2 values but lower power-to-weight ratio values than the NOb-G (P <0 .05). DH was more common in the Ob-G (72.2%) than in the NOb-G (38.9%, P < 0.05). The Ob-G had a greater reduction in the inspiratory capacity (-18 vs. -4.6%, P < 0.05). Exercise tolerance was associated with quadriceps endurance (r = 0.65; p<0.001), oxygen pulse (r = 0.52; p=0.001), and DH (r = -0.46, P = 0.005). The multiple regression analysis showed that the exercise tolerance could be predicted from a linear association only for muscular endurance (r = 0.82 and r2 = 0.67). This study shows that dynamic hyperinflation is a common condition in obese asthmatics; they have reduced fitness for activities of daily living compared to nonobese asthmatics. However, peripheral limitation was the main factor associated with reduced capacity of exercise in these patients.NEW & NOTEWORTHY This is the first study to investigate the occurrence of dynamic hyperinflation (DH) in obese asthmatics. Our results demonstrate that obese asthmatics present a higher frequency and intensity of DH than nonobese asthmatics. We also show that physical deconditioning in this population is linearly associated with cardiac (O2 pulse), respiratory (DH), and peripheral muscle (resistance) limitation. However, multiple linear regression demonstrated that peripheral muscle limitation may explain the exercise limitation in this population.

Resistance training improves inflammatory level, lipid and glycemic profiles in obese older women: A randomized controlled trial.

The main purpose of the present study was to investigate the effect of resistance training on inflammatory levels, lipid and glycemic profile in obese older women. Thirty-eight obese older women (68.2±4.2years, and 41.0±6.2% of body fat) were randomly assigned to one of two groups: A training group (TG, n=19) that performed 8weeks of RT; or a control group (CG, n=19) that did not perform any type of exercise. The RT program consisted of 8 whole-body exercises for 3 sets of 10-15 repetition maximum (RM) carried out 3 times a week. Anthropometric, body composition (DXA), muscular strength (1RM), and blood sample measurements were performed pre- and post-training. After the intervention period, the TG demonstrated significantly (P<0.05) lower values than CG for interleukin-6 (TG=3.3±1.2pg/mL vs. CG=3.8±1.4pg/mL), tumor necrosis factor alpha (TG=3.1±1.5pg/mL vs. CG=3.5±1.8pg/mL), C-reactive protein (TG=1.8±1.4mg/L vs. CG=3.2±1.8mg/L), low-density lipoprotein (TG=85.1±11.0mg/dL vs. CG=148.7±0.1mg/dL), glucose (TG=90.8±11.1mg/dL vs. CG=97.9±6.9mg/dL), trunk fat (TG=12.7±3.5kg vs. CG=14.1±4.3kg), and total body fat (TG=37.5±5.7% vs. CG=43.1±5.6%). Furthermore, TG presented significantly (P<0.05) higher values for high-density lipoprotein (TG=58.3±15.4mg/dL vs. CG=55.2±11.8mg/dL). These results suggest that 8weeks of RT promote improvements on inflammatory levels, and the lipid and glycemic profile in obese older women. These findings further support the important role of RT in healthy aging.

Water aerobics is followed by short-time and immediate systolic blood pressure reduction in overweight and obese hypertensive women.

One exercise training session such as walking, running, and resistance can lead to a decrease in blood pressure in normotensive and hypertensive individuals, but few studies have investigated the effects of exercise training in an aquatic environment for overweight and obese hypertensive individuals. We aimed to assess the acute effects of a water aerobics session on blood pressure changes in pharmacologically treated overweight and obese hypertensive women. A randomized crossover study was carried out with 18 hypertensive women, 10 of them were overweight (54.4 ± 7.9 years; body mass index: 27.8 ± 1.7 kg/m(2)) and eight obese (56.4 ± 6.6 years; body mass index: 33.0 ± 2.0 kg/m(2)). The water aerobics exercise session consisted of a 45-minute training at the intensity of 70%-75% of maximum heart rate adjusted for the aquatic environment. The control group did not enter the pool and did not perform any exercise. We measured systolic blood pressure (SBP) and diastolic blood pressure (DBP) before, immediately after, and every 10 minutes up to 30 minutes after the aerobic exercise or control session. Overall (n = 18), DBP did not change after the water aerobic exercise and control session, and SBP decreased at 10 and 20 minutes postexercise compared to the control session. Among overweight women, SBP decreased at 10 and 20 minutes postexercise. In contrast, among obese women, SBP decreased only at 10 minutes postexercise. SBP variation was -2.68 mm Hg in overweight and -1.24 mm Hg in obese women. In conclusion, the water aerobics session leads to a reduction in SBP, but not in DBP, during 10 and 20 minutes postexercise recovery. Thus, it may be safely prescribed to overweight and obese women.

Are cardiovascular and metabolic responses to field walking tests interchangeable and obesity-dependent?

PURPOSE: To investigate if cardiovascular and metabolic responses to the six-minute walk test (6MWT) and incremental shuttle walking test (ISWT) are in agreement with cardiopulmonary exercise testing (CPX) and determine if both submaximal tests are interchangeable in obese and eutrophic individuals. METHOD: Observational and cross-sectional study included 51 obese women (ObG) and 21 controls (CG) (20-45 years old). Subjects underwent clinical evaluation, CPX, the 6MWT and ISWT. We applied Bland-Altman plots to assess agreement between walking tests and CPX. Correlation analysis assessed relationships between key variables. RESULTS: There was an agreement between CPX and both the 6MWT [oxygen uptake (VO2 mL kg(-1) min(-1)) = 6.9 (CI: 5.7-8.1), and heart rate (bpm) = 37.0 (CI: 33.3-40.7)] and ISWT [VO2 (mL kg(-1) min(-1)) = 6.1 (CI: 4.9-7.3), and heart rate (bpm) = 36.2 (CI: 32.1-40.3)]. We found similar cardiovascular and metabolic responses to both tests in the ObG but not in the CG. Strong correlations were demonstrated between 6MWT and ISWT variables: VO2 ( r = 0.70); dyspnoea (r = 0.80); and leg fatigue (r = 0.70). CONCLUSIONS: 6MWT and ISWT may both hold interchangeable clinical value when contrasted with CPX in obese women and may be a viable alternative in the clinical setting when resources and staffing are limited. Implications for Rehabilitation Obesity is a worldwide epidemic, with high prevalence in women, and it is associated to impaired cardiorespiratory fitness and functional capacity as well as high mortality risk. Assessing oxygen uptake by means of cardiopulmonary exercise testing is the gold standard method for evaluating and stratifying cardiorespiratory fitness, however it is not ever applied due to costs and staffing. Walking field tests may be a cost-effective approach that provides valuable information regarding the functional capacity in agreement to metabolic and cardiovascular responses of cardiopulmonary exercise testing.

Differences in body posture, strength and flexibility in schoolchildren with overweight and obesity: A quasi-experimental study.

BACKGROUND: Body posture and its components have been widely discussed, given the high prevalence of musculoskeletal disorders in children and adolescents. Among children and adolescents with overweight and obesity issues, these changes can be pronounced. OBJECTIVES: This study sought to investigate whether a global exercise routine could result in positive changes in the angles and distances measured in postural assessments and in the number of abdominal and flexibility exercise repetitions performed by children and adolescents with overweight or obesity. METHODS: A quasi-experimental design including an experimental group (EG) and a control group (CG) was used. The primary outcome variables included ratings of body posture (using SAPO software) and measures of abdominal muscle strength (number of sit-ups) and flexibility. The EG received an interdisciplinary intervention the included 48 sessions of global postural exercises performed three times a week. RESULTS: Of the 46 schoolchildren evaluated (EG, n = 23 and CG, n = 23), significant changes were observed in the EG from pre-to post-test in the thoracic angle (p = 0.001) and abdominal muscle strength (p = 0.016) for boys and in the thoracic angle (p = 0.010), abdominal muscle strength (p = 0.003) and flexibility (p = 0.010) for girls. CONCLUSIONS: Overall, the exercise program led to changes in the angle and distance measurements obtained in postural evaluations and contributed to increases in the number of repetitions of abdominal and flexibility exercises, indicating improvements in the EG group's body posture and health indicators.

Factores que se relacionan con la adherencia al tratamiento de la obesidad en un dispositivo grupal: estudio exploratorio / Factors associated with adherence to treatment of obesity in a group device: an exploratory study

Objetivo: explorar los factores que obstaculizan y/o facilitan el tratamiento de la obesidad en adultos participantes de un dispositivo de abordaje grupal. Métodos: estudio cualitativo mediante grupos focales y entrevistas individuales, realizado entre 2010 y 2011 en Buenos Aires, Argentina, con pacientes del Programa Saludable del Hospital Italiano. Resultados: los factores asociados al éxito fueron: 1) la aceptación de la obesidad como condición crónica cuyos resultados del tratamiento aparecerán en el largo plazo; 2) la búsqueda de objetivos globales de bienestar y no de descenso de peso; 3) el compromiso con el grupo y con la actividad física; 4) el cumplimiento del plan y el registro alimentario; 5) el desarrollo de habilidades para cambiar hábitos y soportar presiones del contexto. Conclusiones: es necesario optimizar intervenciones motivacionales para que los pacientes puedan redefinir sus objetivos terapéuticos y sostener cambios de su estilo de vida.

Objective: to explore the factors that impede and / or facilitate the treatment of obesity in adult participants of a device group approach. Methods: qualitative study using focus groups and individual interviews, conducted between 2010 and 2011 in Buenos Aires, Argentina, with patients from the Hospital Italiano Healthy Program. Results: factors associated with success were: 1) the acceptance of obesity as a chronic condition whose treatment results appear in the long term; 2) the search for global objectives of well-being and not of weight loss; 3) commitment to the group and physical activity; 4) compliance with the plan and dietary record; 5) development of skills to change habits and withstand pressures of context. Conclusions: it is necessary to optimize motivational interventions so that patients can be able to redefine their therapeutic goals and sustain changes in their lifestyle.

[Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity]. / Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad.

BACKGROUND: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). AIM: To evaluate the impact of PASAF on nutritional status and metabolic parameters. PATIENTS AND METHODS: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. RESULT: We evaluated 526 subjects aged ≥18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was <50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥5% of their initial weight. CONCLUSIONS: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

Evaluación de un programa ministerial para manejo del síndrome metabólico en adultos con sobrepeso y obesidad / Evaluation of a program for management of metabolic syndrome in adults with overweight and obesity

Background: The Chilean Ministry of Health developed a healthy lifestyles intervention directed to adults with overweight and cardiovascular risk factors, called "Program on Healthy Eating and Physical Activity" (PASAF). Aim: To evaluate the impact of PASAF on nutritional status and metabolic parameters. Patients and Methods: We analyzed databases from three primary care centers belonging to a municipality of Metropolitan Santiago. We selected adults enrolled in the PASAF during three years (2007-2009). The program lasted four months and included an assessment of anthropometric and metabolic parameters at baseline and at the end, eight workshops with a nutritionist, seven with a psychologist and 32 sessions of physical activity. Result: We evaluated 526 subjects aged ≥ 18 years (93% females), of whom 85.6% attended the last appointment for assessment. Analyzing available data, attendance to workshops was < 50% of the scheduled sessions. Weight, body mass index and waist circumference decreased significantly (median: -1.4 kg, -0.6 kg/m² and -3 cm, respectively). The median weight loss was 1.8% of initial weight and 17.1% of participants experienced a decrease ≥ 5% of their initial weight. There were significant improvements in lipid levels and blood pressure among participants with lower initial excess weight. A reduction in fasting blood glucose was observed only among subjects who lost ≥ 5% of their initial weight. Conclusions: The PASAF modestly reduced nutritional parameters. Correction of metabolic parameters was especially effective in less obese subjects. The attendance to workshops was low.

Reganho de peso após o segundo ano do Bypass gástrico em Y de Roux / Regained weight after the second year of the gastric Bypass and Y ofRoux

Introdução: a obesidade é uma doença grave e inúmeros são os tratamentosrealizados para a perda e manutenção de peso. Tendo emvista a magnitude dessa doença, a cirurgia bariátrica é consideradaa ferramentamais eficaz no controle e no tratamento da obesidadesevera.Estudos mostram que a cura da obesidade não se resumeapenas ao ato cirúrgico, pelo contrário, é o início de um período deum a dois anos de mudanças que devem estar associadas às terapiasauxiliares como a reeducação alimentar, atividade física programadae mudança nos hábitos de vida.Objetivo: analisar na literatura os fatores interferentes no reganhode peso dos pacientes que se submeteram ao Bypass gástrico em Yde Roux após dois anos de cirurgia.Metodologia: trata-se de uma revisão da literatura de artigos científicosoriginais e de revisão, publicados em revistas indexadas nasbases de dados Lilacs, Medline (National Library of Medicine), Scieloe Pubmed, nos idiomas inglês e português, com ênfase nos últimosdez anos.Resultados: o bypass gástrico em Y de Roux é considerado uma cirurgiametabólica, pois além do efeito restritivo e disabsortivo ocorremtambém alterações neurais e hormonais, como a diminuiçãoda grelina e aumento do peptídeo-YY (PYY) e peptídeo glucagon--símile 1 (GLP-1) que contribuem para a diminuição do apetite conferindomaior eficiência a esse tipo de procedimento. A recuperaçãodo peso pode ocorrer devido a processos de adaptações fisiológicasno trato gastrointestinal. Os possíveis mecanismos envolvidos noreganho de peso são: aumento do consumo energético...

Introduction: the obesity is a serious disease and there are manytreatments that offer loss weight as well as its maintenance. Owingto magnitude of this disease, the bariatric surgery is considered themost appropriate and effective treatment in the control of severeobesity. However, research show that cure obesity is not only a surgicalprocedure, but the beginning of a period between one and twoyears of changes, which must be associated with ancillary therapiessuch as nutritional education; starting a physical activity programand changes in daily habits.Objective: bibliographic analysis about the factors interfering inthe regain weight of patients that underwent to the gastric Bypassand Y of Roux, two years after surgery.Methodology: this paper brings a bibliographic review from readingof original scientific papers published in magazines indexedin databases - Lilacs, Medline (National Library of Medicine), Scieloe Pubmed in English and Portuguese languages, with emphasis inthe last ten years.Results: the gastric bypass in Y of Roux is considered a metabolicsurgery because beyond the restrictive and disabsorptive effect,also occur hormonal and neural changes such as decreased ghrelinand increased peptide-YY (PYY) and peptide glucagon-símile1 (GLP-1) - that contribute to decreased appetite, and resulting ina more efficient process in this type of procedure...

Effects of water-based exercise in obese older women: impact of short-term follow-up study on anthropometric, functional fitness and quality of life parameters.

AIM: In this study, the effects of a short-term follow-up intervention by water-based exercise (WE) on indicators of obesity in frail obese older women were investigated. METHODS: A total of 28 obese older women (body mass index ≥30 kg/m(2)) aged between 60 and 75 years voluntarily took part in the study. The WE program consisted of 60-min sessions, three times a week, over 12 weeks. Training was carried out on three different days, with a 1-day rest between sessions. Each training session included a 10-min warm-up period; 45-min endurance training and a 5-min cool-down/relaxation. Anthropometric parameters, aerobic strength and muscle strength were evaluated by functional tests and quality of life. RESULTS: No alterations in any anthropometric parameters were found after the WE program. However, an improvement in all functional parameters (time to walk 800 m 16±1 vs 10±1 min; chair test before 21±1 vs 35±1 repetitions; and arm flexion 21±2 vs 32±1 repetitions) and self-reported quality of life (physical 68±3 vs 87±2 points; psychological 62±3 vs 82±2 points; social 63±3 vs 82±2 points; and environmental 63±3 vs 77±4 points) was found after WE. CONCLUSION: The WE program was not successful in reducing anthropometric parameters in obese older women, but it was useful in improving aerobic capacity, muscle strength and quality of life.

Exceso de peso y preguntas frecuentes sobre la alimentación del niño con cáncer / Overweight and frequently asked questions about feeding the child with cancer

Durante el tratamiento del niño con cáncer, es posible requerir el uso de corticoides, los cuales como efecto adverso tienen el aumento en el apetito, que unido al sedentarismo de estos niños, incrementan de peso y pueden concurrir en sobrepeso y obesidad, malnutrición que es tan dañina como la desnutrición. Es necesario un control y seguimiento estricto por parte del pediatra y nutricionista infantil en estos niños con malnutrición.

During the treatment of children with cancer, may require the use of corticosteroids, which have the adverse effect of increased appetite, which together with the inactivity of theses children, increased weight and may attend overweight and obesity, malnutrition that is as harmful as malnutrition. It is necessary to control and closely monitored by the pediatrician and infant nutritionist in these children with malnutrition.

The prevalence of overweight and obesity and its determinants in children with and without disabilities.

OBJECTIVES: To compare the prevalence of overweight and obesity and nutrition and physical activity behavior between primary school children with and without disabilities. STUDY DESIGN: Body weight and height were measured in 4072 children from regular primary schools in the city of Zwolle, the Netherlands, and in 85 children from a school for children with disabilities. Furthermore, parents completed a questionnaire on the child's nutrition and physical activity behavior. A χ(2) analysis was used to test categorical variables between groups, and analysis of variance was used for continuous variables. RESULTS: The prevalence of overweight and obesity among disabled children was 30.6% and 10.6%, respectively, which is three and six times higher than in nondisabled children (P < .001). Furthermore, our study shows statistically significant differences in nutrition and physical activity behavior between disabled and nondisabled children. CONCLUSIONS: There is a need to promote a healthy lifestyle and to reduce the prevalence of overweight and obesity in disabled children.

Do diagnostico a acao: Programa de Atividades para o Paciente obeso (PAPo) - uma abordagem interdisciplinar com adolescentes / From diagnosis to action: Program of Activities for the obese Patient (PAPo) - an interdisciplinary approach with adolescents

O Programa de Atividades para o Paciente Obeso aplica uma abordagem interdisciplinar de intervencao para tratamento do excesso de peso em mocas adolescentes, focado na mudanca de comportamentos e habitos de vida. As atividades, realizadas em 32 semanas de intervencao, sao fundamentalmente educacionais e de suporte as mudancas, buscando utilizar estrategias motivadoras e interessantes para as jovens. Atualmente, o programa oferece as adolescentes atividades nas areas de Educacao Fisica, Modalidades Esportivas, Educacao Nutricional, Psicologia e Percepcao Corporal, todas realizadas em grupo. Mensalmente, ha reunioes de aconselhamento comportamental com os familiares, para que possam interferir positivamente nos habitos das mocas. Alem disso, ocorrem alguns eventos pontuais como caminhada no parque, gincana no mercado municipal e oficina de maquiagem. Tambem fazem parte do programa avaliacoes pre e pos-intervencao. Desta forma, espera-se contribuir para que as mudancas de comportamentos e habitos de vida sejam alcancaveis, assim como sua manutencao.

The Program of Activities for the Obese Patient applies an interdisciplinary intervention approach for treatment of overweight adolescent girls, focusing behaviors and lifestyle changes. The activities, carried out at 32 weeks of intervention, are primarily educational and supportive, seeking to use motivational and interesting strategies for young people. Currently, the program offers activities of Physical Education, Sports, Nutritional Education, Psychology, and Body Perception, all performed in group. Monthly, there are meetings of behavioral counseling with family members, so they can positively affect the habits of hers girls. In addition, there are events such as walking in parks, contests in municipal markets and make-up workshops. It is also part of the program pre and post intervention evaluations. Thus, to contribute to enable attainable behavior and lifestyle changes, as well as its maintenance, are expectations of the program.