Healthy Lifestyle Deck of cards as a tool for cognitive-behavioral therapy in adults with obesity / Baralho do Estilo de Vida como ferramenta da terapia cognitivo-comportamental de adultos com obesidade

This is a mixed-methodology controlled clinical study that assessed the effect of the Health Lifestyle Deck of cards as a Cognitive-Behavioral Group Therapy tool for obese adults. Method The sample was divided into two groups: Intervention group and Intervention+Deck. The therapy was interdisciplinary handled by psychology, nutrition and physical education professionals, along 12 sessions. The following measures were performed: anthropometric assessment, indicators of binge eating, depression, anxiety and stress, quality of life, self-efficacy for eating habits, and physical activity at the beginning and the end of the intervention. Participants' written and verbal reports' content was analyzed. Results The results were: a reduction in body mass, binge eating, and improvement of self-efficacy to regulate eating habits in both groups. There was an improvement in the psychological domain of quality of life only in the Intervention+Deck group. Conclusion The study concluded that the intervention favored participants' cognitive and behavioral changes.

Este estudo clínico controlado de metodologia mista avaliou o efeito do Baralho do Estilo de Vida como ferramenta da Terapia Cognitivo-comportamental em grupo de adultos com obesidade. Método A amostra foi dividida em dois grupos: grupo Intervenção e grupo Intervenção+Baralho. A terapia foi interdisciplinar com profissionais da psicologia, nutrição e educação física e foram realizadas 12 sessões. As avaliações realizadas foram: avaliação antropométrica, indicadores de compulsão alimentar, depressão, ansiedade e estresse, qualidade de vida, autoeficácia para hábito alimentar e atividade física no início e no fim da intervenção. Foi realizada análise de conteúdo dos relatos verbais e por escrito dos participantes. Resultados Neste sentido, verificou-se redução da massa corporal, da compulsão alimentar e melhora da autoeficácia para regular o hábito alimentar nos dois grupos. Houve melhora no domínio psicológico da qualidade de vida apenas no grupo Intervenção+Baralho. Conclusão O estudo concluiu que a intervenção favoreceu mudanças cognitivas e comportamentais dos participantes.

Cognitive Behavioral Approach to Treat Obesity: A Randomized Clinical Trial.

Our aim was to analyze and compare the effects of three different long-term treatments on anthropometric profiles, eating behaviors, anxiety and depression levels, and quality of life of groups of adults with obesity. Methods: The 43 participants in the study were randomly assigned to one of three groups: the education and health group (EH, n = 12), which received lectures on health topics; the physical exercise group (PE, n = 13), which underwent physical training; and the interdisciplinary therapy plus cognitive behavioral therapy (IT + CBT) (n = 18) group, which received physical training, nutritional advice, and physical and psychological therapy. Results: Total quality of life increased significantly in the EH group (△ = 2.00); in the PE group, body weight significantly decreased (△ = -1.42) and the physical domain of quality of life improved (△ = 1.05). However, the most significant changes were seen in the IT + CBT group, in which the anthropometric profile improved; there were an increase in quality of life in all domains (physical, psychological, social, and environmental), an improvement in eating behaviors [Dutch Eating Behavior Questionnaire (DEBQ), total △ = -8.39], and a reduction in depression [Beck Depression Inventory (BDI), △ = -10.13). Conclusion: The IT + CBT program was more effective than the PE and EH programs. Clinical Trial Registration Number: NCT02573688.

Effects of functional training and 2 interdisciplinary interventions on maximal oxygen uptake and weight loss of women with obesity: a randomized clinical trial.

Our aim was to analyze and compare functional training, interdisciplinary therapy, and interdisciplinary education on cardiorespiratory fitness (CF) and anthropometric characteristics of women with obesity. Forty-four women (age = 39.7 ± 5.9 years, body mass index (BMI) = 35.5 ± 2.8 kg/m2) completed 30 weeks of intervention randomly assigned to 3 groups: functional training (FT) (n = 14), interdisciplinary therapy (IT) (n = 19), and interdisciplinary education (IE) (n = 11). The FT group participated in the training program (3/week), the IT group received the same training intervention plus nutrition (1/week) and psychology advice (1/week) and physical therapy (1/week). The IE group participated in interdisciplinary lectures on topics related to health promotion (1/month). CF (ergospirometry), anthropometry, and body composition (electrical bioimpedance) were measured pre-intervention (Pre) and post-intervention (Post). CF increased (p ≤ 0.05) significantly (Pre vs. Post) in the FT (7.5%) and IT (10.8%) groups, but not in the IE group (1.8%). Body mass (BM), BMI, relative fat mass, and waist circumference significantly (p ≤ 0.05) decreased (Pre vs. Post) in IT (-4.4%, -4.4%, -2.3%, and -5.1%, respectively). The IE group showed a significant decrease in BM (-3.7%), BMI (-3.7%), and waist circumference (-3.5%), whereas the FT group promoted significant decrease in waist circumference (-3.4%). In conclusion, functional training increased CF but only interdisciplinary interventions improved the anthropometric profile of women with obesity. Novelty Interdisciplinary therapy provided more comprehensive adaptations in women with obesity, including morphological variables and CF. Functional training increased CF but reduced only abdominal obesity. Interdisciplinary education provided benefits on morphological variables, but it does not increase CF.

Neuroendocrine Control, Inflammation, and Psychological Aspects After Interdisciplinary Therapy in Obese Women.

Obesity is a chronic and multifactorial disease promoted by positive energy balance. The objective was to evaluate the effects of interdisciplinary therapy in the neuroendocrine control of food intake, inflammatory markers, and psychological aspects in obese women. Forty-seven obese women (43.32±5.82 years, 34.86±3.08 kg/m2), aged 30-50 years, participated in an interdisciplinary lifestyle change therapy, consisting of nutritional counseling, physical exercises, and psychological therapy for 36 weeks. After the long-term therapy, there was a decrease in body weight (Δ -5.36 kg), BMI (Δ -2.01 kg/m2), abdominal (Δ -9.09 cm), hip (Δ -5.03 cm), and thigh (Δ -5.07 cm) perimeters. There was also a significant improvement in body composition, with an increase in fat-free mass (Δ 1.60%) and reduction of body fat (Δ -3.74 kg). The therapy proposed also provided an improvement in depression scores (Δ -6.63), anxiety (Δ -4.07), body image (Δ -25.25), and binge eating (Δ -5.25). There was a significant reduction in serum levels of leptin (Δ -15.62 ng/ml). The interdisciplinary therapy was able to provide both, physical and psychological benefits in energy balance, which enables the use of this model as a feasible clinical strategy for the treatment of obesity.

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.

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.