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)

Results of the ACTION-IO survey in Chilean patients with obesity and health care providers / Resultados de la encuesta ACTION-IO en pacientes con obesidad y profesionales de la salud chilenos

ABSTRACT Background: Most of the Chilean population has overweight or obesity. The ACTION-IO survey identified the perceptions, attitudes, and barriers to effective obesity care in people with obesity (PwO) and healthcare professionals (HCPs). Aim: To report the results of the survey in Chile. Material and Methods: An online survey was conducted in 11 countries. In Chile, eligible PwO were adults with a body mass index ≥ 30 kg/m2. Eligible HCPs were physicians involved in direct patient care. Results: The survey was completed by 1,000 PwO and 200 HCPs in Chile. Seventy four percent of PwO and 95% of HCPs agreed that obesity was a chronic disease. Most PwO (79%) assumed responsibility for their own weight loss, while 47% of HCPs considered weight loss to be the sole responsibility of their patients. Both 82% of PwO and 97% of HCPs believed that lack of exercise was a key barrier to weight loss. Sixty six percent of PwO and 58% HCPs noted that the cost of weight management medications, programs, and services was another barrier. Compared with HCPs, more PwO felt that genetic factors prevented weight loss (26 and 44% respectively). Few HCPs (19%) thought that their patients were motivated to lose weight, while 55% of PwO reported being motivated. Most (70%) PwO had discussed their weight problem with their HCP in the past 5 years, and of those that had not, 89% want their HCP to start a discussion about weight. Conclusions: Chilean data reveal misconceptions among PwO and HCPs about obesity and highlights the need to improve education about its biologic background and clinical management.

Antecedentes: La población chilena tiene una alta prevalencia de sobrepeso u obesidad. La encuesta ACTION-IO, realizada en personas con obesidad (PcO) y profesionales de la salud (PdS), identificó las percepciones, actitudes y barreras para lograr un efectivo manejo de la obesidad. Objetivos: Informar los resultados de la encuesta en Chile. Material y Métodos: Se realizó una encuesta on-line en 11 países. En Chile, las PcO elegibles fueron adultos con un índice de masa corporal ≥ 30 kg/m2 y los PdS eran médicos que realizaban atención directa de pacientes. Resultados: En Chile, la encuesta fue completada por 1000 PcO y 200 PdS. Un 74% de las PcO y 95% de los PdS consideraron que la obesidad es una enfermedad crónica. La mayoría de las PcO (79%) asumieron su total responsabilidad en la pérdida de peso, mientras que el 47% de los PdS consideraron que la pérdida de peso era responsabilidad exclusiva de los pacientes. Un 82% de las PcO y 97% de los PdS estimaron que la falta de ejercicio era una importante barrera para la pérdida de peso. Además, las PcO (66%) y los PdS (58%) refirieron que el costo de los programas, medicamentos y otros servicios constituyen barreras para el control del peso. Un 44% de las PcO y un 26% de los PdS consideraron que factores genéticos dificultaban la baja de peso. Solo el 19% de los PdS pensaban que sus pacientes estaban motivados para perder peso, mientras que el 55% de las PcO afirmaron estar motivados. La mayoría de las PcO (70%), había discutido el problema del peso con algún PdS en los últimos cinco años. De aquellas que no lo habían hecho, el 89% deseaba entablar una conversación sobre el peso con algún PdS. Conclusiones: Los datos chilenos revelan percepciones y creencias discordantes entre PcO y PdS sobre la obesidad, destacando así la necesidad de mejorar la educación sobre su base biológica y manejo clínico.

A cirurgia bariátrica como intervenção segura e eficaz para o controle de comorbidades em idosos / Bariatric surgery as a safe and effective intervention for the control of comorbidities in older adults

INTRODUÇÃO: A obesidade no idoso, além de estar associada à piora de doenças relacionadas à síndrome metabólica e a distúrbios osteoarticulares, aumenta o risco de quedas, síndrome de fragilidade, depressão e demência, com consequente perda de funcionalidade. Entre todos os tratamentos disponíveis, a cirurgia bariátrica é uma alternativa em pacientes elegíveis. OBJETIVOS: Discutir aspectos relacionados à segurança e aos benefícios da cirurgia bariátrica para o controle ou a remissão de comorbidades no idoso. METODOLOGIA: Foi realizada revisão de literatura em bases de dados utilizando os seguintes descritores: bariatric surgery and elderly or aged or older adult and comorbidities or safety. Foram incluídos ensaios clínicos, estudos observacionais, estudos comparativos e revisões que avaliaram o efeito da cirurgia bariátrica no controle ou na remissão de comorbidades em idosos. RESULTADOS: Nos últimos anos, vários estudos têm demonstrado não apenas controle ou remissão de comorbidades como diabetes, hipertensão e síndrome da apneia do sono, mas também reduzida taxa de complicações, semelhante à observada em jovens. CONCLUSÕES: Com base nos resultados desses estudos, há espaço para que procedimentos de cirurgia bariátrica sejam indicados a idosos elegíveis, sem limite de idade, considerando também aspectos funcionais e de expectativa de vida.

INTRODUCTION: In addition to being associated with worsening of diseases related to metabolic syndrome and musculoskeletal disorders, obesity in older adults increases the risk of falls, frailty syndrome, depression, and dementia, with consequent functional loss. Among all treatments available, bariatric surgery is an option for eligible patients. OBJECTIVES: To discuss aspects related to the safety and benefits of bariatric surgery for the control or remission of comorbidities in older adults. METHODS: This literature review was carried out in databases, using the following keywords: bariatric surgery and elderly or aged or older adult and comorbidities or safety. We included clinical trials, observational studies, comparative studies, and reviews that evaluated the effect of bariatric surgery on the control or remission of comorbidities in older adults. RESULTS: In recent years, several studies have evidenced not only control or remission of comorbidities, such as diabetes, hypertension, and sleep apnea syndrome, but also a low rate of complications, similar to those observed in young people. CONCLUSIONS: Based on the results of these studies, bariatric surgical procedures can be indicated for eligible older adults, without age restriction, taking into account functional and life expectancy aspects.

Experiencia de 10 años de la plicatura gástrica laparoscópica / Ten-year Experience in Laparoscopic Gastroplication

RESUMEN Introducción: La obesidad es una enfermedad crónica multifactorial cuyo mejor tratamiento lo constituye en la actualidad la cirugía bariátrica. Objetivo: Describir los resultados a corto y largo plazo de la gastroplicatura vertical laparoscópica como técnica de cirugía bariátrica restrictiva. Métodos: Se realizó un estudio descriptivo, retrospectivo, longitudinal en 436 pacientes obesos intervenidos por gastroplicatura vertical laparoscópica, de enero 2010 a enero 2020, en Hospital Universitario General Calixto García. Se incluyeron pacientes de ambos géneros, mayores de 18 años. Variables analizadas: edad, sexo, peso, talla, índice de masa corporal, grado de obesidad, perímetro de cintura, enfermedades asociadas, valores de glucemia, colesterol y triglicéridos, tiempo quirúrgico, pérdidas sanguíneas intraoperatorias, complicaciones perioperatorias y porcentaje de sobrepeso perdido al año. Resultados: Edad promedio 38,48 años, con predominio del sexo femenino. El índice de masa corporal medio fue de 45,41 Kg/m2. Las enfermedades asociadas fueron: hipertensión arterial, síndrome de apnea obstructiva del sueño y diabetes mellitus. El 8,6 por ciento presentó complicación intraoperatoria, mientras que en el posoperatorio hubo un 5,9 por ciento de complicaciones. Tuvieron mayor relación con índice cintura/cadera incrementado y solo se reportó un fallecido. Conclusiones: Los resultados de las gastroplicatura vertical laparoscópica son prometedores como técnica bariátrica restrictiva según lo descrito en la serie de pacientes tratados durante un periodo de 10 años. La misma permitió una disminución significativa del Índice de Masa Corporal y grado de obesidad con repercusión importante en el porcentaje de peso perdido y escasas complicaciones(AU)

ABSTRACT Introduction: Obesity is a multifactorial chronic disease whose best treatment is currently bariatric surgery. Objective: To describe the short- and long-term outcomes of laparoscopic vertical gastroplication as a restrictive bariatric surgery technique. Methods: A descriptive, retrospective and longitudinal study was carried out in 436 obese patients who received laparoscopic vertical gastroplication, from January 2010 to January 2020, at General Calixto García University Hospital. Patients of both genders, older than 18 years, were included. The variables analyzed were age, sex, weight, height, body mass index, degree of obesity, waist circumference, associated diseases, blood glucose, cholesterol and triglyceride values, surgical time, intraoperative blood loss, perioperative complications, and percentage of overweight lost at one year. Results: The average age 38.48 years, with a predominance of the female sex. The mean body mass index was 45.41 kg/m2. The associated diseases were arterial hypertension, obstructive sleep apnea syndrome, and diabetes mellitus. 8.6 percent presented intraoperative complication, while there were 5.9 percent of complications in the postoperative period. They were more related to the increased waist/hip ratio and only one death was reported. Conclusions: The results of laparoscopic vertical gastroplication are promising based on the usefulness of the restrictive bariatric technique as described in the series of patients treated over a period of ten years. It allowed a significant decrease in body mass index and the degree of obesity, with a significant impact on the percentage of lost weight lost and with few complications(AU)

Fenotipos de comportamiento alimentario: diseño de una nueva escala multidimensional (EFCA) / Eating behavior phenotypes: design of a new multidimensional scale (EFCA)

Introducción: las características conductuales de las personas juegan un papel importante en la heterogeneidad de la res-puesta al tratamiento de la obesidad. Existe evidencia de que ciertos rasgos de la conducta ingestiva humana serían media-dores entre la susceptibilidad genética individual y el exceso de peso corporal. Los fenotipos de comportamiento alimentario pueden utilizarse como predictores de éxito terapéutico. Para mejorar la eficacia de los tratamientos de la obesidad es nece-sario contar con herramientas prácticas que evalúen dichos fe-notipos para realizar abordajes personalizados o de precisión. Objetivos: diseñar y evaluar las propiedades psicométricas de una escala autoadministrada destinada a identificar fenotipos de comportamiento alimentario. Materiales y métodos: 177 sujetos adultos participaron vo-luntariamente en un estudio de validación de una escala au-toadministrada para identificar fenotipos comportamentales en adultos (Escala de Fenotipos de Comportamiento Alimentario, EFCA). La misma consta de 16 ítems que evalúan creencias y actitudes personales de la conducta ingestiva medidos a partir de una escala de Likert de cinco valores (1. nunca a 5. siempre). Se identificaron cinco factores por análisis paralelo y se realizó un análisis factorial exploratorio por máxima verosimilitud con rotación varimax como método de extracción. Resultados: se incluyeron 177 adultos, 75,7% mujeres, 75% con exceso de peso con media de índice de masa corporal (IMC) 30,46 kg/m2 (DE=7,06). La estructura factorial mostró buen ajuste a los datos, con cargas factoriales superiores a .40 en to-dos los casos. El coeficiente Alpha de Cronbach indicó fiabilidad aceptable de .86 para la escala total y entre .73 y .88 para las subescalas obtenidas. Conclusiones: la EFCA es una escala con niveles aceptables de validez y confiabilidad para identificar fenotipos de comporta-miento alimentario en adultos.

Adult Obesity: Management Practices of General Practitioners/Family Physicians in Kingston and St Andrew, Jamaica / Obesidad en Adultos: Prácticas de su Tratamiento por Parte de los Médicos Generales/médicos de Familia en Kingston y Saint Andrew, Jamaica

ABSTRACT Objective: To determine the practices of Family Physicians/General Practitioners in Kingston and St Andrew regarding the management of adult obesity and compare their management to the 2013 American College of Cardiology/American Heart Association/Task Force on Practice Guidelines and The Obesity Society (AHA/ACC/TOS) Guidelines for the Management of Overweight and Obesity in Adults. Methods: A cross-sectional study was done of Family Physicians/General Practitioners in the Kingston and St Andrew area. A Census approach was used with the aid of a self-administered questionnaire and practices compared to the American Guidelines for Obesity Management. Results: There were 117 respondents out of the 155 Family physicians/General practitioners. While most physicians were found to have medium to high level practice scores, 23% had low practice scores. Diagnosis of obesity using body mass index (BMI) was high (99%), but only 64% employed hormonal assays. Almost 36% did not refer patients with BMI > 40 kg/m2 for bariatric surgery. Conclusion: Assessed against existing guidelines, physicians were found generally to have medium to high practice levels regarding management of obesity, however, gaps remain to be closed.

RESUMEN Objetivo: Determinar las prácticas de los médicos de familia/médicos generales en Kingston y Saint Andrew en relación con el tratamiento de la obesidad en adultos y comparar su tratamiento con las Pautas para el Tratamiento del Sobrepeso y la Obesidad en Adultos del Colegio Americano de Cardiología/Sociedad Americana del Corazón/Grupo de Trabajo para las Guías Prácticas y la Sociedad de la Obesidad (AHA/ACC/TOS) de 2013. Métodos: Se realizó un estudio transversal de médicos de familia/ médicos generales en el área de Kingston y Saint Andrew. Se usó un enfoque de censo con la ayuda de un cuestionario autoadministrado y prácticas comparadas a las pautas americanas para el tratamiento de la obesidad. Resultados: Hubo 117 encuestados provenientes de los 155 médicos de familia/médicos generales. Si bien se halló que la mayor parte de los médicos tenían niveles de medio a alto en las puntuaciones de la práctica, el 23% tenía puntuaciones bajas de la práctica. El diagnóstico de la obesidad usando el índice de masa corporal (IMC) fue alto (99%), pero solamente el 64% empleó ensayos hormonales. Casi el 36% no remitió pacientes con IMC > 40 kg/m2 para cirugía bariátrica. Conclusión: Evaluados frente a las pautas existentes, los médicos generalmente mostraron niveles de práctica medios a altos con respecto al tratamiento de la obesidad. Sin embargo, quedan aún vacíos por llenar.

Pilates and aerobic training improve levels of depression, anxiety and quality of life in overweight and obese individuals / O treinamento de Pilates e aeróbio melhoram os níveis de depressão, ansiedade e qualidade de vida em indivíduos com sobrepeso e obesidade

ABSTRACT Objective: To compare the effects of Pilates and walking on quality of life, depression, and anxiety levels. Methods: Sixty-three overweight/obese participants were randomly divided into: control (n = 20), walking (n = 21), and Pilates (n = 22) groups. Pilates and walking groups attended eight weeks of 60-minute exercise sessions three times per week. Quality of life, depression, and state- and trait-anxiety levels were evaluated before and after eight weeks of training. Results: Scores of quality of life, depression, and trait-anxiety improved in the Pilates and walking groups. State-anxiety levels improved only in the walking group. Conclusion: Pilates and walking positively impact quality of life, depression and anxiety. The Pilates method could be used as an alternative to improve mood disorders in overweight/obese individuals.

RESUMO Objetivo: Comparar os efeitos do treinamento com Pilates e caminhada sobre os níveis de qualidade de vida, depressão e ansiedade. Métodos: Sessenta e três participantes com sobrepeso/obesidade foram divididos aleatoriamente em grupos: Controle (n = 20), Caminhada (n = 21) e Pilates (n = 22). Os grupos Pilates e caminhada realizaram oito semanas de sessões de exercício de 60 minutos 3 vezes/semana. Os níveis de qualidade de vida, depressão e ansiedade traço e estado foram avaliados antes e após oito semanas de treinamento. Resultados: Os escores de qualidade de vida, depressão e ansiedade-traço melhoraram nos grupos Pilates e caminhada. Os níveis de ansiedade-estado melhoraram apenas no grupo caminhada. Conclusão: O Pilates e a caminhada impactam positivamente os níveis de qualidade de vida, depressão e ansiedade. O método Pilates pode ser usado como um método alternativo para distúrbios do humor em indivíduos com sobrepeso e obesidade.

Superwellness Program: a cognitive-behavioral therapy-based group intervention to reduce weight gain in patients treated with antipsychotic drugs

Objective: To assess the effectiveness of a cognitive-behavioral therapy-based intervention (Superwellness Program) on weight gain compared with a treatment-as-usual (TAU) approach in patients treated with antipsychotics, and to evaluate the relationship between body mass index (BMI) variation and clinical variables. Method: Eighty-five patients treated with antipsychotics were allocated across two groups, experimental (n=59) and control (n=26). The Superwellness Program (experimental group) consisted of 32 twice-weekly 1-hour sessions, conducted by a psychologist and a nutritionist/nurse, concurrently with moderate food intake and moderate physical activity plans. Sociodemographic, clinical, and biological variables were collected at baseline, at the end of intervention (16 weeks), and after 6 months. Results: BMI change from baseline differed significantly between the experimental and control groups, with a larger decrease in the experimental group (F = 5.5, p = 0.021). Duration of illness moderated the effect of treatment on BMI (p = 0.026). No significant (p = 0.499) effect of intervention during the follow-up period was found. Interestingly, the intervention indirectly induced a significant (p = 0.024) reduction in metabolic risk by reducing BMI. Conclusion: A cognitive-behavioral therapy-based intervention could be useful in reducing weight in a clinical population taking antipsychotics, with consequent benefit to physical and mental health.

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

Obesidad y enfermedad inflamatoria intestinal / Obesity and inflammatory bowel disease

Incidence of obesity is rising worldwide, Chile is no exception with obese patients representing up to one third of general population. This parallels with increasing prevalence of inflammatory bowel disease (IBD). Contrary to conventional belief, comorbidity is high (15-40%), where both diseases present with chronic inflammation and dysbiosis which alters intestinal barrier. Causality between obesity and IBD is difficult to stablish and evidence is scarce to determine association. Obesity would be a risk factor for IBD, particularly in Crohn´s Disease (CD), females and obesity at young age. Other than body mass index (BMI), visceral adipose tissue (VAT) has been recently determined as the best indicator of metabolic and endocrine consequences of obesity. Increasing values of VAT have been related to complicated IBD and worst prognosis. On IBD-related therapy, increasing BMI has been related to suboptimal doses and in biologic therapy, obesity raises the probability of flares, loss of response and therapy optimization. Obese patients require IBD-related surgery before non-obese patients and present more postoperative complications. Similarly, VAT is an independent risk factor for postoperative recurrence in CD. Altogether this evidence suggests that obesity does have an influence on IBD, therefore, multidisciplinary healthcare providers should prevent, educate and intervene actively in obesity in order to improve results in intestinal disease

La obesidad ha ido aumentando progresivamente a nivel mundial. Chile no es la excepción, donde un tercio de la población es obesa. Así mismo, la incidencia y prevalencia de la enfermedad inflamatoria intestinal (EII) también ha ido en aumento. La comorbilidad entre obesidad y EII es alta (15-40%) donde ambas presentan inflamación crónica y dentro de su patogenia tienen en común la disbiosis, que altera la función de barrera intestinal. Establecer una asociación de causalidad es difícil y la evidencia es escasa en relación a su asociación. La obesidad puede ser considerada como factor de riesgo para EII, particularmente en pacientes con Enfermedad de Crohn (EC), mujeres y obesidad temprana. Además, se ha establecido que el tejido adiposo visceral (TAV) es mejor indicador de las consecuencias metabólicas de la obesidad en comparación al índice de masa corporal (IMC) y se ha asociado a EII más complicada y peor evolución natural. Con respecto a la terapia, los pacientes con mayor IMC tienen con mayor frecuencia, dosis subóptima de los fármacos, y en terapia biológica, la obesidad aumenta la probabilidad de crisis, pérdida de respuesta al fármaco u optimización de la terapia. Los pacientes obesos requieren cirugía relacionada a EII antes que los pacientes no obesos, presentan más complicaciones postoperatorias y el TAV es un factor de riesgo independiente para recurrencia postoperatoria en EC. Todos estos resultados sugieren que la obesidad influye en la EII, por lo que una intervención activa y multidisciplinaria pudiese mejorar también los resultados en la enfermedad intestinal.

Consumo de Vitaminas Antioxidantes em Dislipidêmicos com Excesso de Peso / Antioxidant Vitamin Intake in Dyslipidemic Overweight Individuals

Fundamentos: Dislipidemia e obesidade estão associadas com insuficiente consumo de frutas, verduras e legumes, e com desequilíbrio do estado antioxidante. Objetivos: Avaliar o consumo dietético das vitaminas A, E e C e dos macronutrientes, correlacionando-os com biomarcadores em dislipidêmicos com excesso de peso. Métodos: Foram selecionados indivíduos dislipidêmicos de ambos os sexos, com idade ≥ 20 anos e índice de massa corporal (IMC) ≥ 25 kg/m2. Foram excluídos aqueles em uso de medicamentos anorexígenos e/ou realizando dieta hipoenergética. Analisaram-se as variáveis antropométricas [massa corporal, estatura, circunferência da cintura (CC), IMC] e bioquímicas [colesterol total, HDL-C, LDL-C, triglicerídeos (TGs) e F2-isoprostano plasmático]. Avaliou-se o consumo alimentar pelo questionário de frequência alimentar. Testou-se a normalidade das variáveis pelo teste não paramétrico de Kolmogorov-Smirnov e realizou-se a correlação de Spearman, empregando-se o pacote estatístico SPSS18 com nível de significância de 5%.Resultados: Dos 284 participantes, 264 (93,1%) eram mulheres. As médias do IMC e da CC foram 36,0 ± 5,8 kg/m2 e 106,2 ± 12,7cm, respectivamente. O consumo de vitaminas A e C, carboidratos, proteínas, açúcar, ácidos graxos (AG) saturados e AG trans foi superior às recomendações, enquanto os consumos de vitamina E e AG poli- e monoinsaturados não alcançaram 50% das recomendações. Evidenciou-se correlação negativa entre as seguintes variáveis: vitamina E com LDL-C e colesterol total; açúcar e HDL-C; AG poli-insaturados e colesterol total e LDL-C. Observaram-se correlações positivas entre colesterol dietético, CC e IMC, e entre massa gorda e TGs. Conclusão: Observou-se inadequação no consumo dietético de vitamina E, açúcar, AG poli-insaturados e trans, o mesmo não acontecendo com as vitaminas A e C. Não houve correlação de biomarcadores e variáveis dietéticas com F2-isoprostano plasmático

Background: Insufficient consumption of fruits, vegetables and pulses is associated with dyslipidemia and obesity and with antioxidant status imbalance. Objective: To assess the dietary intake of vitamins A, E and C and of macronutrients, correlating them with biomarkers in dyslipidemic overweight individuals. Methods: Dyslipidemic individuals of both sexes, aged ≥ 20 years, with body mass index (BMI) ≥ 25 kg/m2 were selected. Individuals on anorectic drugs and/or hypocaloric diets were excluded. Anthropometric [body mass, height, waist circumference (WC), BMI] and biochemical variables [total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides, and plasma F2-isoprostane) were assessed. Food intake was assessed using the Food Frequency Questionnaire. Statistical analyses were performed with SPSS 18. Results: Of the 284 participants, 264 (93.1%) were women. Mean BMI and WC values were 36.0 ± 5.8kg/m2 and 106.2 ± 12.7cm, respectively. The intakes of vitamins A and C, carbohydrates, proteins, sugar, saturated and trans fatty acids were above the recommended values; the intakes of vitamin E, polyunsaturated fatty acids, and monounsaturated fatty acids were below 50% of the recommended values. There was a negative correlation between the following variables: vitamin E, LDL-C and TC; sugar and HDL-C; and polyunsaturated fatty acids, TC and LDL-C. Positive correlations were observed between dietary cholesterol, WC and BMI; and between fat mass and triglycerides. Conclusion: Inappropriate intakes of vitamin E, sugar, polyunsaturated and trans fatty acids were observed, but not of vitamins A and C. No correlation of biomarkers and dietary variables was observed with plasma F2-isoprostane

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.

Impact of clinical and functional conditions on quality of life in old women with obesity / Impacto de las condiciones clínicas y funcionales en la cualidad de vida de ancianas con obesidad / Impacto das condições clínicas e funcionais na qualidade de vida de idosas com obesidade

Obesity is associated with functional disabilities and impairments of quality of life, and many factors affect this relationship. This study aimed at characterizing and identifying the impact of clinical and functional conditions on health-related quality of life (HRQoL) in obese old women. The HRQoL was assessed by the questionnaires "Outcomes Study Short Form-36 Health Survey" (SF-36) and "Impact of Weight on Quality of Life - Lite" (IWQOL - Lite), which were applied to 63 women with body mass index ≥30 kg/m2. Regression models were developed for general (SF-36) and specific (IWQOL-Lite) HRQoL. The associated factors investigated were: age, number of medicines, number of diseases, depressive symptoms, body mass index, grip strength, level of physical activity, and functional performance. The old women had a low level of strength and physical activity. Their functional performance was good to moderate, but a third of the sample presented deficit of mobility. The level of physical activity and functional performance had a positive impact on the general HRQoL and number of drugs had a negative one (R2=0.44). Depressive symptoms and body mass index negatively affected the specific HRQoL (R2=0.57). The study concluded that obese old women with depressive symptoms, low levels of physical activity, and functional performance, making use of a great number of drugs, are more vulnerable to experiencing poor HRQoL. All the factors associated with the HRQoL in this study are potentially modifiable with interventions of health prevention and promotion.

La obesidad está asociada a incapacidades funcionales y prejuicios a la cualidad de vida, y muchos factores interfieren en esa asociación. Eso estudio tuvo por objetivo caracterizar e identificar el impacto de las condiciones clínicas y funcionales en la cualidad de vida relacionada a la salud (CVRS) en ancianas obesas. La CVRS fue evaluada por los cuestionarios "Outcomes Study Short Form-36 Health Survey" (SF-36) e "Impact of Weight on Quality of Life - Lite" (IWQOL-Lite), aplicados a 63 mujeres con índice de masa corporal ≥30 kg/m2. Fueron desarrollados modelos de regresión para la CVRS general (SF-36) y específica (IWQOL-Lite). Los factores asociados investigados fueron: edad, número de medicamentos, número de enfermedades, síntomas depresivos, índice de masa corporal, fuerza de preensión, nivel de actividad física y desempeño funcional. Las ancianas presentaron un bajo nivel de fuerza y actividad física. El desempeño funcional varió del bueno al moderado, pero un tercio de la muestra presentó déficit de movilidad. Lo nivel de actividad física y desempeño funcional tuvieron un impacto positivo en la CVRS general y el número de medicamentos, negativo (R2=0,44). Síntomas depresivos e índice de masa corporal impactaron negativamente en la CVRS específica (R2=0,57). El estudio concluso que ancianas obesas con síntomas depresivos, bajos niveles de actividad física y desempeño funcional, utilizando una gran cuantía de medicamentos, son más vulnerables a presentaren baja CVRS. Todos los factores asociados a la CVRS son potencialmente modificables con medidas de prevención y promoción a la salud.

A obesidade está associada a incapacidades funcionais e aos prejuízos à qualidade de vida, e muitos fatores interferem nesta associação. Este estudo teve por objetivo caracterizar e identificar o impacto de condições clínicas e funcionais na qualidade de vida relacionada à saúde (QVRS) em idosas obesas. A QVRS foi avaliada pelos questionários "Outcomes Study Short Form-36 Health Survey" (SF-36) e "Impact of Weight on Quality of Life - Lite" (IWQOL-Lite), aplicados a 63 mulheres com índice de massa corporal ≥30 kg/m2. Foram desenvolvidos modelos de regressão para QVRS geral (SF-36) e específica (IWQOL-Lite). Os fatores associados investigados foram: idade, número de medicamentos, número de doenças, sintomas depressivos, índice de massa corporal, força de preensão, nível de atividade física e desempenho funcional. As idosas apresentaram baixo nível de força e atividade física. O desempenho funcional foi de bom a moderado, mas um terço da amostra apresentou déficit de mobilidade. Nível de atividade física e desempenho funcional impactaram de maneira positiva a QVRS geral e número de medicamentos, negativa (R2=0,44). Sintomas depressivos e índice de massa corporal impactaram negativamente a QVRS específica (R2=0,57). O estudo concluiu que idosas obesas com sintomas depressivos, baixos níveis de atividade física e desempenho funcional, fazendo uso de grande número de medicamentos, são mais vulneráveis a apresentarem baixa QVRS. Todos os fatores associados à QVRS são potencialmente modificáveis com medidas de prevenção e promoção de saúde.

Actualización en el tratamiento médico de la obesidad: bases metabólicas / Update on obesity medical treatment: metabolic basis

Obesity is a serious public health problem in Latin America due to the high costs related to the co-morbidities and productive consequences for the patients. Medical treatment of obesity has good results in patients when it is indicated individually according to the medical and social reality of each patient in particular. It is necessary that each one of the measures used as a therapeutic tool is based on recommendations that have a metabolic rationality that allows for greater success and which had been proven to be effective and safe in clinical trials. Treatment success is measured in terms of weight loss, improvement in co-morbidities and improvement of the quality of life. Optimal management incorporates a multi-professional team whose aim is to obtain a change of lifestyle in the patient including aspects of eating behavior, physical activity, and social management, among others. The pharmacological measures available are few and not free from side effects that make their use difficult in the long term. New obesity drugs have been incorporated whose mechanisms of action have not been completely understood yet, but represent a contribution to the support in the management of a chronic disease as devastating as obesity.

La obesidad representa un grave problema de salud pública en Latinoamérica por los altos costos asociados en cuanto a comorbilidades y consecuencias productivas para quienes la padecen. El tratamiento médico de la obesidad tiene resultados positivos en los pacientes cuando es indicado en forma individual según la realidad médica y social de cada paciente en particular. Es necesario que cada una de las medidas empleadas como herramienta terapéutica esté basada en recomendaciones con racionalidad metabólica, que permita un mayor éxito, y que haya probado ser útil en estudios clínicos. El éxito se mide en cuanto a reducción de peso, mejoría de comorbilidades y mejoría de la calidad de vida. El manejo óptimo incorpora a un equipo multi-profesional cuya finalidad es lograr un cambio de estilo de vida en el paciente, que incluya aspectos de alimentación, actividad física, conducta alimentaria y manejo social, entre otras. Las medidas farmacológicas disponibles son pocas y no están exentas de efectos colaterales que dificultan su uso en el largo plazo. Se han incorporado nuevos fármacos con mecanismos de acción no totalmente comprendidos aún, pero que son un aporte para el apoyo en el manejo de una enfermedad crónica tan devastadora como la obesidad.

Respuestas para algunas preguntas sobre obesidad y cirugía bariátrica / Responses to some questions about obesity and bariatric surgery

La cirugía bariátrica en pacientes con obesidad mórbida y la obtención con este proceder de pérdidas de peso mayores y más rápidas que las reportadas por las vías convencionales de tratamiento, constituye, sin duda, una alternativa objetiva para disminuir la morbilidad y la mortalidad observadas en estas personas. Se pretende dar respuesta a las interrogantes que existen sobre algunos aspectos relacionados con la cirugía bariátrica como método más efectivo para tratar la obesidad mórbida. Esta se caracteriza por ser crónica, multifactorial, y asociada a importantes complicaciones físicas y psicológicas, que contribuyen a disminuir la calidad y la esperanza de vida de todo aquel que la padece. La cirugía bariátrica se basa en la reducción de la cámara gástrica, combinada o no con técnicas de mala absorción. Hasta ahora, prácticamente es el único tratamiento que consigue alcanzar las expectativas a largo plazo relacionadas con pérdidas de peso suficientes para controlar adecuadamente las comorbilidades. Este procedimiento se acompaña de importantes cambios, no solo en el peso, sino también en el perfil metabólico de los tratados con este método. Resulta imprescindible realizar un seguimiento médico a largo plazo de los sometidos a este tratamiento, una vez realizada la cirugía, por parte de un grupo multidisciplinario especializado en estos procedimientos, para detectar y tratar los trastornos que posteriormente puedan presentarse. Queda demostrado que existe una alternativa terapéutica para el tratamiento de las comorbilidades de la obesidad grave y mórbida, así como para la obesidad misma(AU)

The bariatric surgery aimed at patients with morbid obesity and the quicker major weight loss through this procedure when compared to the reports of weight loss in the conventional treatments is, beyond any doubt, an objective alternative to reduce morbidity and mortality rates in these persons. This paper was intended to answer the questions about some aspects of the bariatric surgery as a more effective method to treat morbid obesity. This disease is chronic, multifactorial, and related to important physical and psychological complications that contribute to reduced life quality and expectancies of every person who suffer it. The bariatric surgery is based on the reduction of the gastric chamber, either combined or not with malabsorption techniques. As far as it is known, this treatment is practically the only one that reaches the long-term expectations about enough loss of weight to adequately control comorbidities. This procedure brings about important changes not only in bodyweight but also in the metabolic profile of the treated persons. A long-term follow-up of the patients is indispensable after the surgery, which should be in charge of a multidisciplinary specialized team, in order to detect and treat any disorder that might occur. It has been proved that there is a therapeutic alternative for the treatment of comorbidities from severe morbid obesity as well as for the obesity as such(AU)

Evaluación de un programa de intervención nutricional y de actividad física dirigido a mujeres chilenas de bajo nivel socioeconómico

El objetivo del estudio fue evaluar un programa de intervención en educación nutricional y actividad física para disminuir la obesidad, cambiar hábitos alimentarios y aumentar la actividad física en mujeres de nivel socioeconómico bajo. Para ello se seleccionaron cuatro grupos seguidos por seis meses: uno intervenido en educación nutricional y actividad física (grupo A); otro con educación nutricional (grupo B); un tercero con actividad física (grupo C), y un grupo control. Se realizaron tres talleres de alimentación por líderes de la comunidad y nutricionistas, y tres sesiones semanales de actividad física. Se efectuaron evaluaciones antropométricas y encuestas de compra, consumo de alimentos y actividad física, antes y después de la intervención. En el grupo A se incrementó la obesidad, pero en los otros dos grupos intervenidos (B y C), bajó en un 10% y en el grupo B disminuyó la grasa corporal total. En el grupo control se mantuvo el porcentaje de obesidad y aumentó la grasa corporal total. La adherencia a sesiones de actividad física fue baja, lo que repercutió en los resultados de evaluación nutricional en los dos grupos intervenidos con actividad física (B y C). Los tres grupos intervenidos tuvieron cambios saludables en sus hábitos de compra y consumo de alimentos. Se concluye que la obesidad bajó en un 10% en los grupos intervenidos B y C, y en el B disminuyó la grasa corporal total. En los tres grupos intervenidos mejoraron los hábitos alimentarios y de actividad física. Los resultados permiten contar con un programa de intervención comunitaria en educación nutricional y actividad física para mujeres de nivel socioeconómico bajo.

Evaluation of a nutrition education and physical activity intervention in Chilean low socioeconomic women The objective of the study was to assess a nutrition education and physical activity intervention to decrease obesity changing food habits and increasing physical activity in low socioeconomic women. Four groups were selected and followed-up during six months: one was intervened with food education and physical activity (group A); another with food education (group B); a third with physical activity (group C), and a control group. Three nutrition education workshops were carried out with community leaders and nutritionists, and three times per week physical activity sessions were performed. Anthropometric measurements and food and physical activity surveys were carried out before and after the intervention. Obesity increased in group A, but decreased 10% in the other two intervened groups (B and C), and total fatty mass decreased in group B. In the control group, obesity did not change but total fatty mass increased. Attendance to physical activity sessions was poor, with negative results in the nutritional impact in the physical activity intervened groups (B and C). We conclude that obesity was reduced in 10% in groups B and C; total fatty mass was reduced in group B and increased in the control group. Healthy diet and physical activity habits improved in the three intervened groups. With these results, an intervention program in nutrition education and physical activity can be available for future community interventions in low socioeconomic women.

The effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders: results from a national multicentric study / Efetividade de uma intervenção não farmacológica para manejo do ganho de peso em pacientes com transtornos mentais graves: resultados de um estudo multicêntrico

OBJECTIVE: To evaluate the effectiveness of a non-pharmacological intervention for weight gain management in severe mental disorders. METHOD: An open, multicentre interventional study was conducted in 93 mental health services. Patients concerned with weight gain were included in this study and received a 12-week 1-hour group intervention focused on nutrition counseling, lifestyle, physical activity and self-esteem. Weight, waist circumference and blood pressure were measured before and after the intervention. RESULTS: 1,071 patients were enrolled in the study, and 73.9 percent completed the 12-week intervention. Significant weight loss (Mean difference: 0.41, CI 95 percent: 0.18 to 0.64, p = 0.001) and a significant BMI reduction (Mean difference: 0.13, CI 95 percent: 0.04 to 0.22, p = 0.006) were observed. During the intervention 37 (4.4 percent) patients lost > 7 percent of their initial weight, 780 (92.5 percent) maintained their weight, and 26 (3.1 percent) of the patients had a meaningful weight gain (> 7 percent). There was a significant increase in the proportion of patients undertaking physical activity after the intervention (70.8 percent, p < 0.001). CONCLUSION: In this 3-month open study we found a small weight and waist reduction, and increased physical activity practice, suggesting a trend towards anthropometric profile improvement. However, further randomized-controlled trials are necessary to evaluate the efficacy and clinical relevance of this psychosocial intervention for weight gain.

OBJETIVO: Avaliar a efetividade de uma intervenção não farmacológica no manejo do ganho de peso para pacientes com transtornos mentais graves. MÉTODO: Foi realizado um estudo aberto multicêntrico longitudinal em 93 serviços de saúde. Pacientes preocupados com o peso foram incluídos e participaram de uma intervenção em grupo de uma hora de duração durante 12 semanas com foco em educação alimentar, atividade física e autoestima. Peso, circunferência da cintura e pressão arterial foram avaliados antes e após a intervenção. RESULTADOS: 1071 pacientes foram incluídos no estudo, 73,9 por cento completaram a intervenção. Foram observados diminuição de peso e índice de massa corporal significativos (peso: diferença da média: 0,41, IC 95 por cento: 0,18-0,64, p = 0,001; índice de massa corporal: diferença da média: 0,13, IC 95 por cento: 0,04-0,22, p = 0,006). Após a intervenção, 37 (4,4 por cento) pacientes perderam mais que 7 por cento do peso inicial, 780 (92,5 por cento) mantiveram o peso e 26 (3,1 por cento) dos pacientes apresentaram ganho de peso acima de 7 por cento. Houve aumento da proporção de pacientes que praticavam atividade física (70,8 por cento, p < 0,001). CONCLUSÃO: Encontramos uma pequena redução de peso e cinturae aumento de atividade física, sugerindo uma tendência à melhora no perfil antropométrico. Ensaios clínicos controlados e randomizados são necessários para avaliar a eficácia e a relevância clínica dessa intervenção.

Prevalência de insuficiência venosa superficial dos membros inferiores em pacientes obesos e não obesos / Prevalence of lower limbs superficial venous insufficiency in obese and non-obese patients

CONTEXTO: A insuficiência venosa crônica dos membros inferiores é a mais prevalente das doenças venosas. Muito se discute sobre sua etiologia e fisiopatologia. Vários fatores de risco têm sido associados ao seu desenvolvimento, como idade, sexo, dieta, entre outros. A obesidade é um problema de saúde pública e sua incidência tem aumentado. O ecocolor Doppler é um método útil para avaliar a presença de refluxo e/ou obstrução no sistema venoso. OBJETIVO: Comparar a prevalência de insuficiência venosa superficial e sintomas associados em pacientes obesos e não obesos. MÉTODOS: Após pesagem, medição da estatura e exame físico, os pacientes com índice de massa corpórea (IMC) <30 kg/m² e >35 kg/m² e queixas compatíveis com insuficiência venosa foram distribuídos nos grupos I e II, respectivamente. Foram submetidos à realização do ecocolor Doppler dos membros inferiores para avaliação da presença ou não de refluxo. RESULTADOS: Foram examinados 311 membros de 168 pacientes com 25-72 anos. Para análise estatística, foram consideradas queixas de varizes, dor, edema, dermatite, eczema e úlcera, associados ou não. Foi obtido um total de 109 e 104 membros com varizes nos grupos I e II, respectivamente. Queixas de varizes visíveis (p<0,001) e varizes visíveis com dor (p = 0,0118) foram mais prevalentes no grupo I. Queixas de varizes com edema (p<0,001), somente edema (p<0,001) e edema associado a dor (p<0,001) foram mais prevalentes no grupo II. Os dados não mostraram diferença estatisticamente significante na prevalência de varizes entre os grupos I e II. CONCLUSÃO: A prevalência de varizes é semelhante entre os obesos e não obesos; as queixas clínicas diferem entre os grupos e são compatíveis e dependentes da presença de insuficiência venosa.

BACKGROUND: Chronic venous insufficiency of the lower limbs is the most prevalent venous disease. There is an ongoing debate about its etiology and pathophysiology. Several risk factors have been associated with its development, such as age, sex and diet. Obesity is a public health problem and its prevalence has been increasing. Color Doppler ultrasonography is a useful method to evaluate the presence of reflux and/or obstruction of the venous system. OBJECTIVE: To compare the prevalence of superficial venous insufficiency and associated symptoms in obese and non-obese patients. METHODS: After weighing, height measurement and physical examination, patients with body mass index (BMI) <30 kg/m² and >35 kg/m² and complaints compatible with venous insufficiency were divided into groups I and II, respectively. They underwent color Doppler ultrasonography of the lower limbs, in order to assess the presence or absence of reflux. RESULTS: A total of 311 limbs of 168 patients 25 to 72 years old were examined. For statistical analysis, complaints of varicose veins, pain, swelling, dermatitis, eczema and ulcers, associated or not, were considered. A total of 109 and 104 limbs with varicose veins were obtained in groups I and II, respectively. The prevalence of visible varicose veins (p<0.001) and visible varicose veins with pain (p=0.0118) was higher in group I. Complaints of varicose veins with edema (p<0.001), only edema (p<0.001) and edema with pain (p<0.001) were more prevalent in group II. Data did not present significant statistical difference in the prevalence of varicose veins between groups I and II. CONCLUSION: The prevalence of varicose veins in obese and non-obese individuals is similar ; clinical complaints differ between groups and are consistent and dependent on the presence of venous insufficiency.

Programa de intervenção nutricional associado à atividade física: discurso de idosas obesas / Nutritional intervention program associated with physical activity: discourse of obese elderly women

A obesidade é um problema nutricional complexo, com dimensões sociais e psicológicas, que afeta indivíduos de todas as idades. Além de apresentar fatores de risco para algumas doenças, pode interferir na qualidade de vida do idoso. Este estudo exploratório de natureza qualitativa investigou o discurso de idosas obesas quanto à participação em um programa de intervenção nutricional associado à atividade física. Participaram da pesquisa dezoito idosas obesas, inseridas em Centros de Referência e Cidadania do município de João Pessoa (PB). Para a coleta de dados, foi utilizada a técnica da entrevista a partir de um roteiro que contemplou a questão norteadora pertinente ao objetivo da investigação. Os dados obtidos foram analisados mediante a técnica de discurso do sujeito coletivo (DSC). Do DSC emergiram as seguintes ideias centrais: mudanças no estilo de vida, no hábito alimentar, na saúde e na autoestima. As ideias centrais refletem a valorização do referido programa para a promoção da saúde do grupo de idosas participantes do estudo. Espera-se que esta proposta possa subsidiar novas investigações na área da saúde do idoso.

Obesity is a complex nutritional problem with social and psychological dimensions, which affects individuals of all ages. In addition to presenting risk factors for some diseases, obesity may interfere with the quality of life of the elderly. This qualitative study of an exploratory nature investigated the discourse of obese elderly women regarding their participation in a nutritional intervention program associated with physical activity. Eighteen obese elderly women attending Centers of Reference and Citizenship in the city of João Pessoa, state of Paraiba, Brazil were enlisted in the study. Interviews using a series of questions that addressed the core issue pertaining to the scope of the study was the technique used for data collection. The data obtained were analyzed by the collective subject discourse (CSD) technique. The following central ideas emerged from CSD: changes in lifestyle, in eating habits, in health and in self-esteem. The core ideas reflected the value attributed to the aforesaid program for promotion of health of the group of elderly women who participated in the study. It is hoped that this research might elicit further investigation in the area of health of the elderly.