The hyperleptinemia state can downregulate cardiorespiratory fitness and energy expenditure in obese women.

INTRODUCTION: In general, in obese people a state of hyperleptinemia may impair both energy balance and the inflammatory process. However, it has not been fully investigated whether there is a relationship between hyperleptinemia and cardiorespiratory fitness (CRF) and resting energy expenditure (REE), in obese women. METHODS: 83 obese women were enrolled in this cross-sectional study. Anthropometric measures, body composition, REE, CRF and serum concentration of leptin were measured. Pearson's correlation coefficient was performed to examine the relationship between circulating leptin level and other clinical variables. Multiple regression analysis was applied to determine predictors of REE and CRF. Effects were considered significant at p≤0.05. RESULTS: The most important finding in the present study is that the hyperleptinemia state was inversely correlated with CRF (r=-0.382, p=0.001) and REE (r=-0.447, p<0.001). Moreover, a positive correlation with fat mass was confirmed (r=0.419, p<0.001). In addition, hyperleptinemia was an independent negative predictor of REE (r2=-2.649, p=0.010) and CRF (r2=-2.335, p=0.023). CONCLUSION: Together our results may suggest a vicious cycle between the state of hyperleptinemia and a decrease in energy expenditure and cardiorespiratory fitness in obese women, which can impair whole body energy homeostasis. This information is important to contribute to clinical practices.

The excessive caloric intake and micronutrient deficiencies related to obesity after a long-term interdisciplinary therapy.

OBJECTIVE: The aim of this study was to assess the effectiveness of a long-term interdisciplinary lifestyle modification therapy on food intake, body composition, and anthropometric measurements of obese women. METHODS: Seventy obese women (age 41 ± 5.9 y) attended the interdisciplinary therapy, with nutrition, physical exercise, physiotherapy, and psychological support during the course of 1 y. Usual food intake was estimated by 3-d dietary record. Dual-energy x-ray absorptiometry was performed to determine body fat and fat-free mass. Waist and hip circumferences also were measured. Student's t test and Wilcoxon test were used for comparisons among categories; P < 0.05 was considered significant. RESULTS: The assessment of dietary intake showed significant changes after interdisciplinary therapy. A reduction in intake of total calories (18.3%), carbohydrates (15.6%), and total fats (13.1%) was observed. Total micronutrient intake did not change positively after therapy, as the intake level of 16 micronutrients was still lower than recommended. The therapy was effective in reducing significantly body weight (5.9%), body mass index (6.1%), body fat (4.7%), and waist (5.2%) and hip (3.8%) circumferences. CONCLUSIONS: Long-term interdisciplinary therapy was effective in decreasing the intake of calories, carbohydrates, and fats. The therapy positively changed the body composition and reduced anthropometric measurements. However, the intake of some micronutrients after therapy was still significantly lower than recommended. These results demonstrated that the proposed interdisciplinary methodology can be effective in treating obesity; however, the present study reinforced the need to address the micronutrient deficiency in the target population.

Long-term interdisciplinary therapy decreases symptoms of binge eating disorder and prevalence of metabolic syndrome in adults with obesity.

Obesity-associated comorbidities greatly impact the quality and expectancy of life. Binge eating disorder (BED) is the most prevalent eating disorder and it is an important risk factor for obesity and metabolic syndrome (MetS). For these reasons, we aimed to assess the effect of an interdisciplinary therapy on the symptoms of BED and the prevalence of MetS in obese adults. It was hypothesized that the interdisciplinary therapy would decrease symptoms of BED and markers of MetS. Twenty-four volunteers (BMI 34.80±3.17 kg/m2; 41.21±6.28 years old) completed a 32-week intervention. Biochemical characteristics, body composition, the degree of symptoms of binge eating, and macronutrients, and sodium consumption pre- and post-treatment were determined. The prevalence of MetS dropped from 75% to 45.8%, post-therapy. Among the markers of MetS, waist circumference and systolic blood pressure decreased significantly, whereas high-density lipoprotein levels increased. Fasting plasma glucose, diastolic blood pressure, and triglycerides did not change. Based on binge-eating scale (BES) scores, before therapy, 33.3% of volunteers were classified as moderate bingers, and after therapy all volunteers were classified as having no BED symptoms. No difference in the prevalence of MetS between individuals classified as normal or moderate bingers was observed, but we found a positive post-therapy correlation between the BES score and body fat, gynoid fat and trunk fat. Sodium, fat, and carbohydrate consumption decreased. Protein intake did not change. In conclusion, the interdisciplinary approach was efficient in reducing symptoms of BED and MetS prevalence in this population.

Terapia Interdisciplinar e a Diminuição da Sobrecarga Cardiovascular em Obesos / Interdisciplinary Therapy and Decrease of Cardiovascular Overload in Obese Patients

Fundamentos: Associação entre obesidade, terapia interdisciplinar e exercício físico intenso foi descrita para obesos. Contudo o estudo das atividades físicas representando as tarefas do dia a dia e o risco cardiovascular nas atividades do cotidiano torna-se necessário para verificar a ocorrência dessa associação. Objetivo: Investigar se um período de 18 semanas de terapia interdisciplinar é capaz de promover benefícios nos parâmetros cardiovasculares no repouso e durante o exercício físico em adultos obesos. Métodos: Amostra de 32 indivíduos de ambos os sexos com índice de massa corporal de 30 a 39,9 kg/m2 e idade entre 30 e 50 anos. Intervenção com terapia interdisciplinar (educação física, psicologia, nutrição e fisioterapia), duração de 18 semanas e mensuração de dados antropométricos de massa corporal, estatura, circunferências de cintura e quadril, avaliação de esforço máximo em ergômetro antes e após o período de terapia. Resultados: A terapia interdisciplinar diminuiu pressão arterial sistólica (PAS): 125,83±9,86 (basal) vs 120,28±16,82(final), frequência cardíaca (FC): 74,75 ± 11,02 (basal) vs 72,77 ± 10,72 (final), e duplo-produto (DP) em repouso. Reduziu também durante o esforço submáximo PAS estágios 1: 143,44 ± 9,28 (basal) vs 131,56 ± 15,26; estágio 2: 152,23 ± 21,91 (basal) vs 141,56 ± 17,43 (final), PAD estágio 2: 89,89 ± 9,58 (basal) vs 83,13 ± 9,65 (final), FC estágio 1: 118,40 ± 12,90 (basal) vs 110,87 ± 7,66 (final); estágio 2: 137,09 ± 16,54 (basal) vs 130,37 ± 11,51 (final) e o DP referentes aos estágios iniciais. Conclusão: A terapia interdisciplinar reduziu a sobrecarga do sistema cardiovascular em repouso e no esforço submáximo em adultos obesos otimizando o repouso e atividades do cotidiano

Background: Association between obesity, interdisciplinary therapy and intense physical exercise was described for obese patients. However, the study of physical activities representing daily tasks and cardiovascular risk in everyday activities becomes necessary to verify the occurrence of this association. Objective: To investigate whether a period of 18 weeks of interdisciplinary therapy is capable of promoting benefits in cardiovascular parameters at rest and during exercise in obese adults. Methods: Sample of 32 individuals of both sexes with body mass index of 30 to 39.9 kg/m2 and age between 30 and 50 years. Intervention with interdisciplinary therapy (physical education, psychology, nutrition and physiotherapy), duration of 18 weeks and measurement of anthropometric data of body mass, height, waist and hip circumferences, maximum exercise ergometer evaluation before and after the therapy period. Results: Interdisciplinary therapy decreased systolic blood pressure (SBP): 125.83 ± 9.86 (baseline) vs 120.28 ± 16.82 (final), heart rate (HR): 74.75 ± 11.02 (baseline) ) Vs 72.77 ± 10.72 (final), and double-product (DP) at rest. Reduced also during the submaximal PAS stress stages 1:143.44 ± 9.28 (baseline) vs 131.56 ± 15.26; Stage 2: 152.23 ± 21.91 (baseline) vs. 141.56 ± 17.43 (final), PAD stage 2: 89.89 ± 9.58 (baseline) vs 83.13 ± 9.65 (final) , FC stage 1: 118.40 ± 12.90 (baseline) vs 110.87 ± 7.66 (final); Stage 2: 137.09 ± 16.54 (baseline) vs 130.37 ± 11.51 (final) and the PD referring to the initial stages. Conclusion: Interdisciplinary therapy reduced the overload of the cardiovascular system at rest and submaximal effort in obese adults, optimizing rest and daily activities

Resting energy expenditure in obese women: comparison between measured and estimated values.

Assessing energy requirements is a fundamental activity in clinical dietetic practice. The aim of this study was to investigate which resting energy expenditure (REE) predictive equations are the best alternatives to indirect calorimetry before and after an interdisciplinary therapy in Brazilian obese women. In all, twelve equations based on weight, height, sex, age, fat-free mass and fat mass were tested. REE was measured by indirect calorimetry. The interdisciplinary therapy consisted of nutritional, physical exercise, psychological and physiotherapy support during the course of 1 year. The average differences between measured and predicted REE, as well as the accuracy at the ±10 % level, were evaluated. Statistical analysis included paired t tests, intraclass correlation coefficients and Bland-Altman plots. Validation was based on forty obese women (BMI 30-39·9 kg/m2). Our major findings demonstrated a wide variation in the accuracy of REE predictive equations before and after weight loss in non-morbid, obese women. The equations reported by Harris-Benedict and FAO/WHO/United Nations University (UNU) were the only ones that did not show significant differences compared with indirect calorimetry and presented a bias <5 %. The Harris-Benedict equation provided 40 and 47·5 % accurate predictions before and after therapy, respectively. The FAO equation provided 35 and 47·5 % accurate predictions. However, the Bland-Altman analysis did not show good agreement between these equations and indirect calorimetry. Therefore, the Harris-Benedict and FAO/WHO/UNU equations should be used with caution for obese women. The need to critically re-assess REE data and generate regional and more homogeneous REE databases for the target population is reinforced.

Composição corporal e aptidão aeróbia de mulheres obesas: efeitos benéficos da terapia interdisciplinar / Body composition and aerobic fitness in obese women: beneficial effects of interdisciplinary therapy

Introdução: A obesidade é uma doença crônica multifatorial de proporções epidêmicas. O sedentarismo e hábitos alimentares pouco saudáveis são considerados seus principais fatores etiológicos. Estudos recentes apontam que o tratamento interdisciplinar pode promover benefícios favorecendo a perda de peso e a melhora da qualidade de vida. Objetivo: Verificar o efeito de 20 semanas de um programa de terapia interdisciplinar de mudança de estilo de vida no consumo máximo de oxigênio, na composição corporal e nos parâmetros antropométricos de mulheres adultas obesas. Metodologia: vinte e nove voluntárias do gênero feminino, com idade entre 30 e 50 anos e índice de massa corporal (IMC) entre 30 e 40 Kg/m², foram submetidas a 20 semanas da terapia interdisciplinar, composta por cinco intervenções semanais, sendo três de exercícios físicos, uma de nutrição e uma de psicologia, com duração de 60 minutos cada intervenção. Foi avaliada a composição corporal e a aptidão aeróbia através de um teste ergoespirométrico máximo. Resultados: Pós-terapia foi encontrado uma redução significativa na massa corporal (- 4,71% p<0,001), IMC (- 4,72% p<0,001) e perímetros analisados, como o perímetro abdominal (- 6,03% p<0,001). Foi verificado também uma melhora significativa na composição corporal, diminuindo a gordura corporal (- 2,2% p<0,001) e no consumo máximo de oxigênio relativo ao peso (+ 15,79% p<0,001) e absoluto (+ 10,91% p<0,001). Conclusão: Após 20 semanas, a terapia interdisciplinar apresentou efeitos benéficos em mulheres obesas o que reforça este modelo como uma estratégia viável para o tratamento da obesidade clínica, melhora da composição corporal e aptidão aeróbia.

Introduction: Obesity is a chronic multifactorial disease and it?s considered a global epidemic. Sedentary lifestyle and unhealthy eating habits are considered its main etiological factors. Recent studies indicate that interdisciplinary therapy can promote benefits favoring weight loss and improve quality of life. Aims: To investigate the effect of an interdisciplinary therapy on maximal oxygen uptake, body composition and anthropometric parameters in obese adult women. Methods: twenty-nine female volunteers, aged between 30 and 50 years and body mass index (BMI) between 30 and 40 kg/m², were enrolled at 20 week interdisciplinary therapy consisting of physical exercise sessions three times a week and nutritional and psychological intervention once a week at the Federal University of São Paulo ? UNIFESP. It was evaluated body composition and aerobic fitness (VO2max) using a maximal cardiopulmonary exercise test. Results: Post-therapy was found a significant reduction on body weight (- 4.71%, p <0.001), BMI (- 4.72%, p <0.001) and perimeters, such as the abdominal circumference (- 6.03 wt% <0.001). We also noticed a significant improvement in body composition, reducing body fat (- 2.2%, p <0.001) and maximal oxygen consumption relative to weight (+ 15.79% p <0.001) and absolute (+ 10.91% p <0.001). Conclusion: In 20 weeks, interdisciplinary therapy showed beneficial effects in obese adult women which reinforces this model as a viable strategy for the treatment of clinical obesity, body composition and aerobic fitness improvement.