The design and rationale of an interdisciplinary, non-prescriptive, and Health at Every Size®-based clinical trial: The "Health and Wellness in Obesity" study.

BACKGROUND: This manuscript describes the design and rationale of a clinical trial that aims to investigate the multiple physiological, attitudinal, nutritional, and behavioral effects of a new interdisciplinary intervention based on the Health at Every Size® (HAES®) approach in obese women. METHODS: This will be a prospective, 7-month, randomized (2:1), mixed-method clinical trial. Obese women will be recruited and randomly allocated into two groups. The intervention group (I-HAES®; proposed n = 40) will undertake a novel HAES®-based intervention. Participants will take part in an exercise program, nutrition counseling sessions, and philosophical workshops, all aligned with the principles of the HAES® approach. The control group (CTRL; proposed n = 20) will participate in a program using a traditional HAES®-based group format, characterized by bimonthly lectures about the same topics offered to the experimental group, encouraging the adoption of a healthy lifestyle. The following multiple quantitative outcomes will be assessed pre and post intervention: health-related quality of life, cardiovascular risk factors, anthropometric assessments, physical activity level, physical capacity and function, and psychological and behavioral assessments. Qualitative analysis will be used to evaluate the experiences of the participants throughout the intervention, as assessed by focus groups and semi-structured interviews. CONCLUSIONS: The interdisciplinary research team leading this study has varied and complementary expertise. The knowledge arising from this study will help to guide new interdisciplinary interventions with the potential to holistically improve the health of obese individuals. This trial is registered at Clinicaltrials.gov (NCT02102061).

Dual effects of a high-protein diet on DSS-treated mice during colitis resolution phase.

The impact of the dietary protein level on the process of colonic mucosal inflammation and subsequent recovery remains largely unknown. In this study, we fed DSS-treated mice with either a normoproteic (NP) or a high-protein (HP) isocaloric diet from the beginning of the 5-day dextran sulfate sodium (DSS) treatment to 14 days later. Measurements of colitis indicators (colon weight:length ratio, myeloperoxidase activity, cytokine expressions) showed a similar level of colonic inflammation in both DSS groups during the colitis induction phase. However, during the colitis resolution phase, inflammation intensity was higher in the DSS-HP group than in the DSS-NP group as evidenced by higher inflammatory score and body weight loss. This coincided with a higher mortality rate. In surviving animals, an increase in colonic crypt height associated with a higher number of colon epithelial cells per crypt, and TGF-ß3 content was observed in the DSS-HP vs. DSS-NP group. Moreover, colonic expression patterns of tight junction proteins and E-cadherin were also different according to the diet. Altogether, our results indicate that the HP diet, when given during both the induction and resolution periods of DSS-induced colitis, showed deleterious effects during the post-induction phase. However, HP diet ingestion was also associated with morphological and biochemical differences compatible with higher colonic epithelium restoration in surviving animals, indicating an effect of the dietary protein level on colonic crypt repair after acute inflammation. These data highlight the potential impact of the dietary protein amount during the colitis course.

Health at Every Size®-Based Interventions May Improve Cardiometabolic Risk and Quality of Life Even in the Absence of Weight Loss: An Ancillary, Exploratory Analysis of the Health and Wellness in Obesity Study.

We examined whether weight loss following HAES®-based interventions associates with changes in cardiometabolic risk factors and quality of life of women with obesity. This was an exploratory, ancillary analysis of a 7-month, mixed-method, randomized controlled trial. Fifty-five women (age: 33.0 ± 7.2; BMI: 30-39.9 kg/m2) were included in this study. Body weight, cardiovascular risk factors, clustered cardiometabolic risk, and quality of life were assessed before (Pre) and after HAES®-based interventions (Post). Delta scores (Post-Pre) were calculated for each outcome and used in linear regression models. After adjusting by potential confounders, weight loss was associated with improvements in waist circumference (ß = 0.83, p <0.001), fasting glycemia (ß = 0.45, p = 0.036), total cholesterol (ß = 1.48, p = 0.024), LDL (ß = 1.33, p = 0.012), clustered cardiometabolic risk (ß = 0.18, p = 0.006), and quality of life (ß = -1.05, p = 0.007). All participants but one who reduced body weight (n = 11) improved clustered cardiometabolic risk and quality of life. Of relevance, 34% and 73% of the participants who maintained or gained weight improved clustered cardiometabolic risk and quality of life, respectively, although the magnitude of improvements was lower than that among those who lose weight. Improvements in cardiovascular risk factors and quality of life following HAES®-based interventions associated with weight loss as expected. However, most of the participants who maintained or even gained weight experienced benefits to some extent. This suggests that weight-neutral, lifestyle-modification interventions may improve wellness and health-related outcomes, even in the absence of weight loss.

Body fat regulation: is it a result of a simple energy balance or a high fat intake?

The search for the causes of obesity has involved genetic abnormalities and endocrine and neural lesions. Although evidence suggests that genetics plays an important role in body weight regulation, rapid increases in obesity rates do not seem to be caused by significant genetic changes within populations. Total energy expenditure and total energy intake are not the only factors that regulate body fat. Nitrogen and carbohydrate balances are eased by the capacity of the organism for adjusting amino acids and glucose oxidation rates, respectively. Regarding fat, this mechanism is considerably less precise; a fat intake increase does not stimulate its oxidation on the same basis. In addition, dietary fat is stored very efficiently as body fat. Elevated carbohydrate ingestion enhances glycogen reserves, which usually are much smaller than the maximum capacity of storage and enlargement of these stores, thus stimulating this nutrient's oxidation. These data point to a very well controlled carbohydrate balance in the body. Various studies show lack of efficiency of the hyperlipidic diet in stimulating satiety. Signals arising from the gastrointestinal tract play a fundamental role in regulation of appetite and energy intake, and evidence indicates that the gastrointestinal and hormonal mechanisms involved in the suppression of appetite and in energy intake are compromised in obesity. A high-fat diet is important in its origin. Additional studies are necessary to explain the mechanisms that lead to adipose tissue retention resulting in a fat-rich diet.

Eating Pleasure in a Sample of Obese Brazilian Women: A Qualitative Report of an Interdisciplinary Intervention Based on the Health at Every Size Approach.

INTRODUCTION: Health at Every Size (HAES) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes and on enhancing pleasure derived from consuming food to achieve sustainable healthy eating outcomes. However, to the best of our knowledge, there are no studies in the literature assessing the effects of the HAES approach on perceptions of eating pleasure. OBJECTIVE: We qualitatively investigated the perceptions of obese women about eating pleasure before and after a new interdisciplinary, nonprescriptive intervention based on the HAES approach. DESIGN: The intervention was a randomized controlled clinical trial, designated as Health and Wellness in Obesity, conducted over 7 months at University of São Paulo (Brazil). We used a qualitative approach to data construction and analysis of perceptions about eating pleasure. Participants were randomized to either the intervention (I-HAES) group or the control (CTRL) group. The I-HAES group featured individual nutritional counseling, group practice of enjoyable physical activity, and philosophical workshops. The CTRL group was a traditional HAES intervention group (lecture-based model). Focus group discussions eliciting perceptions of pleasure around eating were conducted at baseline and post-study. Focus group transcripts were analyzed by exploratory content analysis. PARTICIPANTS: Forty-three women aged 25 to 50 years with body mass index (measured in kilograms per square meter) between 30 and 39. 9 completed the intervention and the focus groups, with 32 in the I-HAES group and 11 in the CTRL group. RESULTS: Lack of guilt about experiencing pleasure while eating and increased reflection on their own desires increased in participants of both groups after the study. The I-HAES group also displayed a greater sense of autonomy related to eating, increased pleasure in commensality, familiarity with the practice of cooking, and decreased automatic eating. CONCLUSION: HAES-based intervention featuring nutritional counseling, appreciation for physical activity, and philosophical engagement was shown to stimulate pleasure around eating without leading to indiscriminate eating.

Effects of a new intervention based on the Health at Every Size approach for the management of obesity: The "Health and Wellness in Obesity" study.

Health at Every Size® (HAES®) is a weight-neutral approach focused on promoting healthy behaviors in people with different body sizes. This study examined multiple physiological, attitudinal, nutritional, and behavioral effects of a newly developed, intensive, interdisciplinary HAES®-based intervention in obese women. This was a prospective, seven-month, randomized (2:1), controlled, mixed-method clinical trial. The intervention group (I-HAES®; n = 39) took part in an intensified HAES®-based intervention comprising a physical activity program, nutrition counseling sessions, and philosophical workshops. The control group (CTRL; n = 19) underwent a traditional HAES®-based intervention. Before and after the interventions, participants were assessed for physiological, psychological, and behavioral parameters (quantitative data) and took part in focus groups (qualitative data). Body weight, body mass index, and waist and hip circumferences did not significantly differ within or between groups (P > 0.05). I-HAES® showed increased peak oxygen uptake and improved performance in the timed-stand test (P = 0.004 and P = 0.004, between-group comparisons). No significant within- or between-group differences were observed for objectively measured physical activity levels, even though the majority of the I-HAES® participants indicated that they were engaged in or had plans to include physical activity in their routines. I-HAES® resulted in improvements in eating attitudes and practices. The I-HAES® group showed significantly improved all Body Attitude Questionnaire subscale and all Figure Rating Scale scores (P ≤ 0.05 for all parameters, within-group comparisons), whereas the CTRL group showed slight or no changes. Both groups had significant improvements in health-related quality of life parameters, although the I-HAES® group had superior gains in the "physical health," "psychological health," and "overall perception of quality of life and health" (P = 0.05, 0.03, and 0.02, respectively, between-group comparisons) domains. Finally, most of the quantitative improvements were explained by qualitative data. Our results show that this new intensified HAES®-based intervention improved participants' eating attitudes and practices, perception of body image, physical capacity, and health-related quality of life despite the lack of changes in body weight and physical activity levels, showing that our novel approach was superior to a traditional HAES®-based program.

Test-retest reliability and discriminant validity of the Restraint Scale translated into Portuguese.

The aim of this study was to evaluate reliability and discriminant validity of the Restraint Scale (RS) translated into Portuguese. The version was obtained through a process of translation and back translation. Women with eating disorders (n = 39: 24 bulimics and 15 anorexics) and students without eating disorders (n = 57) filled the scale. It was hypothesized that if the scale has any discriminant validity, the bulimic scores should differ from those of the students and the anorexics. The questionnaire was applied twice to the controls with 1-month interval to evaluate test-retest stability. Bulimics obtained a score of 28.1 +/- 13 (significantly different from students and anorexics), anorexics obtained 17.3 +/- 9 (significantly different from students), and students 11.3 +/- 5. Body mass index (BMI) was significantly correlated to dietary restraint, especially among controls. Test-retest correlation coefficient was .64 (P = .000001). The RS translated into Portuguese seems to be a valid and reliable instrument, which can be used in many studies of eating behaviors.

Psychometric testing and applications of the Body Attitudes Questionnaire translated into Portuguese.

Although many body attitudes scales have been developed, none have been translated into Portuguese. This study aimed to translate the Ben-Tovim and Walker Body Attitudes Questionnaire and assess validity and reliability for a Brazilian sample. Women with (n = 39) and without (n = 57) eating disorders completed the scale, to assess discriminant validity. Convergent validity was assessed by the correlations between the scores and a measure of body dissatisfaction. The questionnaire was applied twice to controls after 1 mo. to evaluate reliability. Eating-disordered women had significantly higher mean scores on Feeling Fat, Disparagement, Salience and Lower Body Fatness, and lower scores on Attractiveness. No mean difference on Strength and Fitness was found. Most subscales were significantly correlated with the body-dissatisfaction measure. Test-retest coefficients ranged from .57 to .85. The translated version of the Body Attitudes Questionnaire seems to be a valid and reliable measure of body attitudes.

Mucosal healing in inflammatory bowel diseases: is there a place for nutritional supplementation?

Advanced mucosal healing (MH) after intestinal mucosal inflammation coincides with sustained clinical remission and reduced rates of hospitalization and surgical resection, explaining why MH is increasingly considered as a full therapeutic goal and as an endpoint for clinical trials. Intestinal MH is a complex phenomenon viewed as a succession of steps necessary to restore tissue structure and function. These steps include epithelial cell migration and proliferation, cell differentiation, restoration of epithelial barrier functions, and modulation of cell apoptosis. Few clinical studies have evaluated the needs for specific macronutrients and micronutrients and their effects on intestinal MH, most data having been obtained from animal and cell studies. These data suggest that supplementation with specific amino acids including arginine, glutamine, glutamate, threonine, methionine, serine, proline, and the amino acid-derived compounds, polyamines can favorably influence MH. Short-chain fatty acids, which are produced by the microbiota from undigested polysaccharides and protein-derived amino acids, also exert beneficial effects on the process of intestinal MH in experimental models. Regarding supplementation with lipids, although the effects of ω-3 and ω-6 fatty acids remain controversial, endogenous prostaglandin synthesis seems to be necessary for MH. Finally, among micronutrients, several vitamin and mineral deficiencies with different frequencies have been observed in patients with inflammatory bowel diseases and supplementation with some of them (vitamin A, vitamin D3, vitamin C, and zinc) are presumed to favor MH. Future work, including clinical studies, should evaluate the efficiency of supplementation with combination of dietary compounds as adjuvant nutritional intervention for MH of the inflamed intestinal mucosa.

It is over there, next to that fat lady: a qualitative study of fat womens own body perceptions and weight-related discriminations / É lá, perto da moça gorda: estudo qualitativo sobre as percepções de mulheres gordas acerca de seus corpos e discriminações relacionadas ao peso corporal

Abstract We investigated fat women's perceptions of their own bodies and their experiences with weight-related discriminations, and how these situations affected their well-being. Thirty-nine obese women were interviewed, and three axes of analysis were identified: (1) repercussions of being fat, (2) living with a fat body, and (3) am I a person or just a fat body? These axes were composed of eight themes which had similar meaning or complemented each other. The results showed our participants had mechanisms to diminish the magnitude of their stigmatized bodies (e.g., attempting to lose weight and changing their current food choices). Participants also reported being fat had physical and psychological consequences for them. Most notably, their larger bodies influenced their self-evaluation, making them feel devalued, unlovable, incapable, and incomplete. They reported stigmatizing experiences in familiar situations, at the workplace and in public spaces, and reported being stigmatized by both close and unknown individuals, including healthcare professionals. These professionals were reported to treat patients disrespectfully, which urges attention to health care inequalities for obese people. Our results stress stigmatizing attitudes towards fat people and their own considerations about themselves have negative consequences in their physical and mental well-being.

Resumo Investigamos a percepção de mulheres gordas sobre seu próprio corpo e suas experiências com discriminações relacionadas ao peso e como essas situações afetavam seu bem-estar. Trinta e nove mulheres obesas foram entrevistadas, sendo identificados três eixos de análise: (1) repercussões de ser gorda, (2) vivendo com um corpo gordo, e (3) eu sou uma pessoa ou apenas um corpo gordo? Esses eixos eram compostos por oito temas que se complementavam ou tinham significado semelhante. Os resultados mostraram que nossas participantes utilizavam mecanismos para diminuir a magnitude de seus corpos estigmatizados (por exemplo, tentando perder peso e modificando suas escolhas alimentares atuais). As participantes também relataram que ser gorda teve consequências físicas e psicológicas para elas. É importante ressaltar que seus corpos maiores influenciaram sua autoavaliação, fazendo com que se sentissem desvalorizadas, incapazes, incompletas e sem possibilidade de se sentirem amadas. Elas relataram experiências estigmatizadoras em situações familiares, no local de trabalho e em espaços públicos, e relataram serem estigmatizadas por pessoas próximas e desconhecidas, bem como por profissionais de saúde. Foi relatado que esses profissionais tratam os pacientes com desrespeito, o que exige atenção quanto às desigualdades na assistência à saúde de pessoas obesas. Nossos resultados enfatizam que atitudes estigmatizadoras em relação às pessoas gordas e suas próprias considerações sobre si mesmas têm consequências negativas para seu bem-estar físico e mental.

Review of the association between meat consumption and risk of colorectal cancer.

The incidence of colorectal cancer (CRC) is rapidly increasing in developing countries, especially among populations that are adopting Western-style diets. Several, but not all, epidemiological and experimental studies suggest that a high intake of meat, especially red and processed meat, is associated with increased CRC risk. Potential reasons for the association between high red and processed meat intake and CRC risk include the content of the meat (e.g. protein, heme) and compounds generated by the cooking process (e.g. N-nitroso compounds, heterocyclic amines). These factors can affect the large intestine mucosa with genotoxicity and metabolic disturbances. Increased bacterial fermentation (putrefaction) of undigested protein and production of bacterial metabolites derived from amino acids may affect colon epithelial homeostasis and renewal. This correlates with the fact that most colonic cancers are detected in the distal colon and rectum where protein fermentation actively occurs. However, there are still large controversies on the relationship between red meat consumption and CRC risk. Therefore, the purpose of this review is to enhance the current understanding on the association between high red and processed meat intakes with CRC risk. A principal focus of this review will be to discuss the meat-related components, such as proteins in the meat, heme, N-nitroso compounds, and heterocyclic amines, and the effects they have upon the large intestine mucosa and the intestinal gut microbiota.

Does sodium-bicarbonate ingestion improve simulated judo performance?

The aim of the present study was to investigate whether preexercise sodium-bicarbonate ingestion improves judo-related performance. The study used 2 different protocols to evaluate performance: 3 bouts of a specific judo test (n = 9) and 4 bouts of the Wingate test for upper limbs (n = 14). In both protocols athletes ingested 0.3 g/kg of sodium bicarbonate or placebo 2 h before the tests. Blood samples were collected to determine lactate level, and levels of perceived exertion were measured throughout the trials. The study used a double-blind, counterbalanced, crossover design. Ingestion of sodium bicarbonate improved performance in Bouts 2 and 3 of Protocol 1 (P < 0.05), mean power in Bouts 3 and 4 of Protocol 2 (P < 0.05), and peak power in Bout 4 of Protocol 2 (P < 0.05). Ingestion of bicarbonate increased lactate concentration in Protocol 1 (P < 0.05) but not in Protocol 2. Ratings of perceived exertion did not differ between treatments. In conclusion, sodium bicarbonate improves judo-related performance and increases blood lactate concentration but has no effect on perceived exertion.

Concurrent and discriminant validity of the Stunkard's figure rating scale adapted into Portuguese.

This study examined the concurrent and discriminant validity of the Figure Rating Scale adapted into Portuguese. The sample was composed of a control group (98 students without eating disorders) and a clinical group (16 women diagnosed with Bulimia Nervosa). Respondents chose schematic figures representing their current and ideal body sizes. The difference between the two choices was calculated to give an ideal discrepancy score. There were high correlations between body mass index and current body size or ideal discrepancy score. The ideal discrepancy scores were greater among the clinical group, indicating that the scale could discriminate between the two groups. The results of this preliminary work indicate that the scale is a valid measure of body image when used in Brazil.

A ingestão de bicarbonato de sódio pode contribuir para o desempenho em lutas de judô? / Ingerir bicarbonato de sodio puede contribuir en el mejor desempeño de competiciones de judo? / Can sodium bicarbonate intake contribute to judo fights performance?

O objetivo deste estudo foi investigar o efeito da ingestão de NaHCO3 sobre o desempenho no judô. Seis atletas do sexo masculino ingeriram 0,3g x kg¹ de peso corporal de NaHCO3 ou CaCO3 (placebo) 2h antes de três lutas de 5 min, intercaladas por 15 min de recuperação. Imediatamente após e 15 min após cada luta, os atletas relataram a percepção subjetiva de esforço. A concentração sanguínea de lactato foi verificada em repouso, após o aquecimento, 0, 3, 5, 7, 10 e 15 min após cada luta. O mesmo protocolo experimental foi repetido duas vezes por cada atleta, com exceção da substância ingerida. O estudo adotou o modelo duplo-cego contrabalançado. Não houve diferença significativa para as variáveis de desempenho. A percepção subjetiva de esforço não diferiu entre os tratamentos e a concentração sanguínea de lactato foi significativamente maior (p < 0,05) após a ingestão de NaHCO3, especialmente nos primeiros momentos da coleta. Concluindo, os efeitos ergogênicos do NaHCO3 não parecem ser suficientes para contribuir para a melhora da performance em lutas de judô. Contudo, as limitações do modelo utilizado devem ser consideradas quando da generalização dos resultados. Estudos futuros devem utilizar outras ferramentas para avaliar o desempenho no judô.

The objective of this study was to investigate the effect of the NaHCO3 ingestion on the judo performance. Six male athletes ingested 0.3 g x kg¹ body weight of NaHCO3 or CaCO3 (placebo) 2 h before 3 fights of 5 min, with 15 min recovery. Immediately afterwards, and 15 min after each fight, the athletes related their perceived exertion. The blood lactate concentration was verified in rest, after warming up, 0, 3, 5, 7, 10 and 15 min after each fight. The same experimental protocol was repeated twice by each athlete, except for the ingested substance. The study adopted the counterbalanced double-blind model. There was no significant difference for the performance variables. The perceived exertion did not differ among the treatments, and the blood lactate concentration was significantly greater (p < 0.05) after NaHCO3 ingestion in the first moments of the protocol. In conclusion, the ergogenic effects of NaHCO3 are not enough to contribute to the improvement of the performance in judo fights. However, the model limitations must be considered when generalizing these results. Future studies should use other tools to evaluate the performance in judo.

El objetivo de este trabajo ha sido el de investigar el efecto sobre el desempeño en judo al ingerir NaHCO3. Seis deportistas del sexo masculino ingirieron 0,3 g x kg-1 de peso corporal de NaHCO3 o CaCO3 (placebo) 2 h antes de 3 luchas de 5 min, intercaladas por 15 min de recuperación. Inmediatamente después, y 15 min después de cada lucha, los deportistas relataron la percepción subjetiva del esfuerzo. La concentración sanguínea de lactato fue verificada en reposo, después del precalentamiento, 0, 3, 5, 7, 10 y 15 min después de cada lucha. El mismo protocolo experimental fue repetido dos veces en cada deportista, con excepción de la sustancia ingerida. El estudio adoptó el modelo doble-ciego contrabalanceado. No hubo diferencia significativa para las variables de desempeño. La percepción subjetiva del esfuerzo no difirió entre los tratamientos, y la concentración sanguínea de lactato fue significativamente mayor (p < 0.05) después de ingerir NaHCO3, especialmente en los primeros momentos de colecta. En conclusión, los efectos ergogénicos de NaHCO3 no parecen ser suficientes para contribuir en la mejoría del desempeño en las luchas de judo. A pesar de eso, las limitaciones del modelo utilizado deben ser consideradas al intentar generalizar resultados. Estudios futuros deben utilizar otras herramientas para evaluar el desempeño en el judo.

Tradução da escala de desejo de aceitação social de Marlowe & Crowne para a língua portuguesa / Translation into Portuguese of the Marlowe-Crowne social desirability scale

O desejo de aceitação social (social desirability) pode enviesar os parâmetros medidos por auto-relato. Os objetivos do trabalho foram: a) traduzir para a língua portuguesa a Marlowe-Crowne Social Desirability Scale, que quantifica o desejo de aceitação social e; b) analisar sua precisão. A versão da escala foi obtida por meio de tradução e retrotradução. Foi feito o teste-reteste, no qual o instrumento foi aplicado duas vezes, com intervalo de um mês, em estudantes de Nutrição (n = 57). O teste pareado de Wilcoxon verificou se havia diferença entre as duas aplicações. O coeficiente de correlação de Spearman entre as duas aplicações foi calculado. Foi obtida pontuação de 13, 6 ± 4,4 (mediana 13) na primeira aplicação e de 13,4 ± 5,3 (mediana 13) na segunda aplicação. Não houve diferença significativa entre as médias das duas aplicações (z = 1,66; p = 0,10) e a correlação entre elas foi de 0,82 (p = 0,0000001). A pontuação foi semelhante à de estudantes de países desenvolvidos, sugerindo que a tradução não alterou o sentido original da escala. A precisão foi alta e compatível com a obtida na versão original. Estes resultados indicam que a versão final da escala é adequada e precisa.