The effect of a physical activity consultation on body mass index z-score of overweight adolescents: results from a pediatric outpatient obesity clinic

Utility of a high-intensity interval training app as a remote exercise support strategy in children with obesity: An exploratory study of adherence, effect, and perceptions of its use

Objective

This study aimed to explore the utility of a high-intensity interval training (HIIT) app as a remote exercise support strategy in children with obesity through assessing adherence, possible effects on obesity-related outcomes, and perceptions of its use to support counseling and improve the treatment of children with obesity.

Methods

Thirty-seven children (94.6% with obesity; 45.9% girls), with a mean age of 10.4 (±1.8) years and a mean body mass index (BMI) z-score of 3.31 (±1.09) were recruited to use the app during 6 weeks. Assessments were performed at baseline, 6 (end of intervention), and 12 weeks (follow up).

Results

Thirty-two (86.3%) participants completed both intervention and follow-up assessments and were analyzed. On average, children used the HIIT app 2.5 times per week (95% confidence interval (CI): 1.9 to 3.0), with the highest perceived exertion of 4.1 (95% CI: 3.6 to 4.5). No over-time differences were found in body composition, physical activity, screen time, sleep duration, or water intake after the intervention; however, an over-time decrease in sugary beverages intake (Δ-0.9, 95% CI: -1.6 to -0.1, p = .019). No differences in body composition were found at follow up. Although none of the children or parents perceived impairments in nutritional behavior, general wellbeing, or fitness as a consequence of intervention, most children (64.5%), but not parents, perceived improvements in nutritional behavior and general wellbeing.

Conclusion

Although feasible, the 6-week effect of HIIT app use is modest or absent regarding body composition, movement, and nutritional behavior change, probably due to its low volume. More studies are needed to explore the utility of HIIT apps as a remote exercise support strategy for children with obesity further.

Appraisal of Clinical Care Practices for Child Obesity Treatment. Part I: Interventions

The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.

Atherosclerosis Prevention in Adolescents with Obesity: The Role of Moderate-Vigorous Physical Activity

Carotid intima-media thickness (cIMT) is a subclinical marker of atherosclerotic development, which is impaired in adolescents with obesity. This study aimed to analyze the impact of physical activity (PA), cardiorespiratory fitness (CRF), body mass index (BMI), and body composition changes on the cIMT of adolescents with obesity. Longitudinal data (6 months) from adolescents aged 12-18 years, with a BMI ≥97th percentile, previously recruited for the non-randomized controlled trial PAC-MAnO (Clinicaltrials.gov-NCT02941770) were analyzed using partial correlations controlling for sex and pubertal status and multiple regressions. A total of 105 adolescents (51.4% girls, 86.7% Caucasian), 14.8 ± 1.8 years old, with a BMI z-score of 3.09 ± 0.74 were included. Total body fat mass (TBFM) (F(1,91) = 23.11, p < 0.001), moderate-vigorous PA (MVPA) (F(1,91) = 7.93, p = 0.0006), and CRF (mL/kg/min) (F(1,90) = 19.18, p < 0.001) predicted cIMT variance with an R2 of 0.24, 0.09, and 0.23, respectively. MVPA changes showed a high correlation with CRF variation (r(91) = 0.0661, p < 0.001). This study suggests that although cIMT is impaired in overweight adolescents, improvements in TBFM, MVPA, and CRF are associated with cIMT improvement. Although both energy intake and MVPA may influence TBFM, MVPA plays the most relevant role in cIMT development due to its direct association with CRF.

Thyroid Function and Metabolic Syndrome in Children and Adolescents with Neuromotor Disability

Thyroid function plays a crucial role in nervous system integrity and metabolic homeostasis. We evaluated the pattern of TSH, FT4 and FT3 release in children with neuromotor impairment (NI) in relationship with metabolic syndrome (MS). We enrolled 55 patients with NI and 30 controls. Clinical parameters, thyroid function and MS presence were recorded. Principal component analysis (PCA), cluster analysis, and logistic regression models were performed. MS was detected in 54.5% of patients. Four clusters were identified: the first one included only controls and, contrasting with cluster 4, was exclusively characterized by children with disability and MS. This latter showed increased FT4 and FT3 and decreased TSH levels. Cluster 2, characterized by disability without MS showed high FT4 and FT3, whereas cluster 3 with low FT4 and FT3 mainly included disability (90%) and showed prevalent MS (57%). The association between TSH and NI is represented by a U-shape structure. The TSH, FT3 and FT4 release patterns may reflect thyrotropic adaptation, allostatic response and compensatory mechanisms. These mechanisms, found in both MS and disability, show that the odds of having a condition of NI with or without MS increase as the TSH values deviate, in both directions, from a value of 2.5 mLU/mL.

The Effectiveness of Wearable Devices as Physical Activity Interventions for Preventing and Treating Obesity in Children and Adolescents: Systematic Review and Meta-analysis

Background

The prevalence of obesity in children and adolescents remains a global public health issue. Wearable devices may offer new opportunities for prevention and intervention in obesity. Previous systematic reviews have only examined the effect of the wearable device interventions on preventing and treating obesity in adults. However, no systematic review has provided an evaluation of wearable devices as physical activity interventions for preventing and treating obesity in children and adolescents.

Objective

The purpose of this review and meta-analysis was to evaluate the effectiveness of wearable devices as physical activity interventions on obesity-related anthropometric outcomes in children and adolescents.

Methods

Research articles retrieved from PubMed, EMBASE, Cochrane Library, Scopus, and EBSCO from inception to February 1, 2021, were reviewed. The search was designed to identify studies utilizing wearable devices for preventing and treating obesity in children and adolescents. The included studies were evaluated for risk of bias following the Cochrane recommendation. Meta-analyses were conducted to evaluate the effectiveness of wearable devices as physical activity interventions on body weight, body fat, BMI z-score (BMI-Z), BMI, and waist circumference. Subgroup analyses were performed to determine whether the characteristics of the interventions had an impact on the effect size.

Results

A total of 12 randomized controlled trials (3227 participants) were selected for meta-analysis. Compared with the control group, wearable device interventions had statistically significant beneficial effects on BMI (mean difference [MD] –0.23; 95% CI –0.43 to –0.03; P=.03; I²=2%), BMI-Z (MD –0.07; 95% CI –0.13 to –0.01; P=.01; I²=81%), body weight (MD –1.08; 95% CI –2.16 to –0.00; P=.05; I²=58%), and body fat (MD –0.72; 95% CI –1.19 to –0.25; P=.003; I²=5%). However, no statistically significant effect was found on waist circumference (MD 0.55; 95% CI –0.21 to 1.32; P=.16; I²=0%). The subgroup analysis showed that for participants with overweight or obesity (MD –0.75; 95% CI –1.18 to –0.31; P<.01; I²=0%), in the short-term (MD –0.62; 95% CI –1.03 to –0.21; P<.01; I²=0%), wearable-based interventions (MD –0.56; 95% CI –0.95 to –0.18; P<.01; I²=0%) generally resulted in greater intervention effect size on BMI.

Conclusions

Evidence from this meta-analysis shows that wearable devices as physical activity interventions may be useful for preventing and treating obesity in children and adolescents. Future research is needed to identify the most effective physical activity indicators of wearable devices to prevent and treat obesity in children and adolescents.

A Multivariate Analysis of “Metabolic Phenotype” Patterns in Children and Adolescents with Obesity for the Early Stratification of Patients at Risk of Metabolic Syndrome

Background: Metabolic syndrome (MS) is closely linked to obesity; however, not all individuals with obesity will develop obesity-related complications and a metabolically healthy obesity (MHO) group is also described. Objective: To perform a multivariate analysis (MVA) of the anthropometric and biochemical data in pediatric patients with obesity to reveal a “phenotype” predictive for MS. Methods: We analyzed 528 children with obesity (OB) and 119 normal-weight pediatric patients (NW). Adiposity indices were recorded, and MS was detected. MVA was performed. Results: Analysis of the structure of correlation of the variables showed that the variables of waist circumference (WC), body mass index (BMI), and estimated fat mass (eFM) were positively correlated with each other as a whole. In addition, the variables of the triglycerides (TG), triglyceride–glucose (TyG) index, and visceral adiposity index were positively correlated with each other as a whole, although none were correlated with the variables of BMI z-score, waist-to-height ratio, WC, eFM, or weight. The variables that related to insulin resistance (IR) and dyslipidemia were crucial for the early stratification of patients at risk of MS. Conclusions: Independently of body weight, IR, dyslipidemia, hypertriglyceridemia, and fat distribution seem to be the strongest MS risk factors. The early detection of and intervention in these modifiable risk factors are useful to protect children’s health.

The effect of a physical activity consultation in the management of adolescent excess weight: Results from a non-randomized controlled trial

The value of physical activity (PA) counselling and its impact on PA behaviour and weight management have been in question. The main aim of this study was to analyse 6 and 12-month effects of a PA consultation (PAC-a structured form of PA counselling) with and without the inclusion of structured exercise, on body mass index (BMI) z-score, body composition and PA levels of adolescents with excess weight (BMI ≥p85), as part of a clinical multicomponent weight management program. Participants were allocated at baseline into a control (CG-standard care, including paediatric and nutrition consultations) and two experimental groups (EGI and EGII). Both EG's were exposed to standard care plus PAC for 12 months. During the first 6 months, EGII additionally participated in two weekly exercise sessions. From 165 participants recruited, 102 completed the intervention (CG n = 28, EGI n = 36 and EGII n = 38). According to generalized estimating equations, at 6 months both EG's improved (p < 0.05) their BMI z-score, waist-height ratio (WHtR), body fat mass, skeletal muscle mass, sedentary time and moderate-vigorous PA (MVPA) compared to CG. Further improvements were observed in BMI z-score between 6 and 12 months in EG's compared to CG. At 6 months, EGII showed a higher (p < 0.05) increase in MVPA compared to EGI, and EGI a higher decrease in WHtR. No other differences were found between EG's. This study suggests that PAC is a time-effective approach to improve BMI z-score, body composition and PA levels in adolescents with excess weight, even without the inclusion of structured exercise.

Qualitative study on the key elements of obesity counseling in Korean Medicine

INTRODUCTION

The increasing prevalence of obesity worldwide necessitates the provision of support for many patients. Patients with obesity appreciate receiving advice from doctors. Previous studies have qualitatively explored clinicians' counseling for weight loss; however, this is limited to primary physicians or general practitioners working in community health centers. In contrast, Korean Medicine Doctors (KMDs) have treated patients with obesity using a holistic approach with a multicomponent approach on counseling. However, there is currently no data regarding KMDs' consulting practices for weight loss. Therefore, the present study will explore KMDs' experience in counseling for weight loss and describe the constituents of counseling for weight loss in Korean medicine practice.

METHODS

This qualitative study utilizes a phenomenological framework. The KMDs who have worked >1 year as practitioners in treating patients with obesity will be invited to describe their lived experiences of counseling patients for weight loss. Purposive and snowball sampling will be undertaken to ensure that the sample provides information-rich cases that are representative of KMDs' experiences of counseling for weight loss. Face-to-face, individual, and semi-structured interviews will be conducted with the participants, which will be analyzed using a phenomenological method.

ETHICS AND DISSEMINATION

Ethical approval was granted by the Human Research Ethics Committee of the Korea Institute of Oriental Medicine (I-1908/006-001). The results will be disseminated via journal articles and conference presentations.

TRIAL REGISTRATION NUMBER

Korean Clinical Trial Registry, KCT0004985.

CORRELATES OF PHYSICAL ACTIVITY IN ADOLESCENTS OF PUBLIC SCHOOLS IN CURITIBA, PARANÁ, BRAZIL

Objective:

To verify the association of nutritional status, biological maturation, social support and self-efficacy with the physical activity level of 2,347 students of both sexes, aged between 11 and 15 years old, enrolled in state schools in the city of Curitiba, Paraná, Brazil.

Methods:

Anthropometric measurements of body mass, height and sitting height were collected. The assessment of biological maturation was based on the analysis of the age at peak height and sexual maturity. The physical activity level, social support from parents and friends and self-efficacy were evaluated by self-reported questionnaires. Sex/age-specific body mass index (BMI) cutoff points identified the nutritional status. Gross and adjusted binary logistic regression were used to obtain odds (OR) ratios with 95% confidence intervals (95%CI), adopting p≤0.05 as significant.

Results:

More than half (52.3%; n=1,227) of students were active, with boys in a higher proportion (64.1%; p≤0.01). The correlates of physical activity were: nutritional status (OR 1.25; 95%CI 1.01-1.56), early somatic maturation (OR 0.71; 95%CI 0.54-0.93), moderate (OR 1.85; 95%CI 1.50-2.30) and high social support from parents (OR 2.70; 95%CI 2.11-3.42) and high social support from friends (OR 1.78; 95%CI 1.42-2.24).

Conclusions:

Nutritional status, early somatic maturation, social support of parents and friends were correlates of physical activity. Overweight girls with moderate and high parental support and boys with greater social support from parents and friends were more active. Girls with early somatic maturation were less active.

Organised sports participation and adiposity among a cohort of adolescents over a two year period

Background

Overweight and obesity among young people is alarmingly high. While hundreds of millions of children participate in organised sports worldwide, it is currently unknown whether time spent in organised sports is associated with levels of adiposity among young people. This study aimed to investigate bidirectional associations between participation in organised sports and adiposity over a two year period.

Method

Data were drawn from the Longitudinal Study of Australian Children. In total, 4033 participants (51% male) reported time spent in organised sports and had their body mass index, body fat percentage, and waist circumference measured at age 12, and again two years later. A cross-lagged panel model was used to examine bidirectional relationships over time, as well as interaction effects.

Results

Total sport participation at age 12 was not associated with subsequent BMI-z scores (β = 0.01 [95% CI, -0.02, 0.04]), body fat (β = 0.01 [95% CI, -0.02, 0.03]), or waist circumference (β = -0.01 [95% CI, -0.05, 0.02]). Similarly, measure of adiposity at age 12 were not associated with subsequent sports participation (BMI-z score: β = -0.01 [95% CI, -0.02, 0.04]; body fat percentage: β = -0.02 [95% CI, -0.05, 0.02]; waist circumference: β = -0.01 [95% CI, -0.01, 0.03]). There were no differences in the strength or direction of the relationships by type of sport or by sex (p < .05).

Conclusion

Policy and programmatic changes may be needed before organised youth sports are considered a preventative strategy for overweight and obesity. However, a more nuanced understanding of why organised youth sports are not associated with adiposity is needed before evidence-based changes can be made.

Anthropometric outcomes of a motivational interviewing school-based randomized trial involving adolescents with overweight

Motivational interviewing (MI) is an effective method to promote weight loss that can be delivered by non-mental health providers. The aim of this study was to evaluate whether MI was superior to conventional counseling to improve the anthropometric outcomes of adolescents with obesity/overweight. It was a controlled cluster randomized trial with parallel design in a school setting. The study included two groups: Motivational Interviewing Group (MIG) and control group (Conventional Intervention Group, CIG). Students participated in three face-to-face 30-min interviews, 3 months apart. Outcomes were BMI z-score, abdominal circumference, percentages of fat mass and muscle mass, and blood pressure. Sessions were coded with the Motivational Interviewing Treatment Integrity (MITI) manual. Mixed repeated-measures ANOVAs were used to assess the group versus time interaction. Effect sizes were calculated for each ANOVA with eta-squared measures (η²). Eighty-three adolescents finished the protocol. While MIG participants showed a significant improvement in all anthropometric scores at 6 months, CIG participants showed an unfavorable change in those variables.Conclusion: Our results provide additional evidence of the short-term usefulness of a school-based MI intervention on anthropometric outcomes of adolescents with obesity/overweight, demonstrating that pediatricians can play an important role in the prevention and management of pediatric obesity.Trial registration: The study is called IMAGINE and is registered in Clinicaltrials.gov with the number NCT02745795. What is Known: • Although MI has been recognized as an effective counseling style for behavioral change in weight loss, there are few reports about the anthropometric outcomes of interventions with adolescents being treated for obesity/overweight. • Our study showed significant positive changes in anthropometric variables (BMI z-score, abdominal circumference, percentage of fat mass, percentage of muscular mass, systolic and diastolic blood pressure) after only three face-to-face sessions over 6 months. What is New: • MI delivered by non-mental health providers in a school setting seems to have short-term usefulness in a program aiming the treatment of obese/overweight adolescents.

Effect of a Physical Activity Consultation in the Management of Adolescent Overweight (the PAC-MAnO project): study rationale, design and methods

BACKGROUND

Adolescent overweight is a major public health concern, as it is associated with several short-run and long-run adverse health outcomes. Inappropriate health behaviours may be at the front of this epidemic. There is widespread need for new strategies that may positively influence dietary and physical activity behaviours. This trial (NCT02941770) was designed to investigate the impact of a physical activity consultation, based on motivational interview technique, on physical activity behaviour and weight status among overweight adolescents followed at a tertiary paediatric care centre.

METHODS/DESIGN

This is an ongoing non-randomised controlled clinical trial with a 6-month duration and follow-up at month 12. It is expected to be concluded in December 2018. Adolescents (n=129) aged 12-18 with a body mass index ≥p85 are recruited and allocated into three groups: (1) control group: standard care (paediatric and nutrition consultations, n=43); (2) experimental group I: standard care plus physical activity consultation (n=43); and (3) experimental group II: exposure to two sessions/week of structured physical exercise, in addition to the standard care plus physical activity consultations (n=43). Sample size was calculated according to power analysis. Participants undergo a set of socioeconomic, anthropometric, body composition, clinical and behavioural (dietary and physical activity) assessments.

DISCUSSION

Adolescence is a critical period for the acquisition of a healthy lifestyle. The promotion of an active lifestyle may influence adolescents' weight status and further prevent multiple comorbidities. The findings of our study will provide further understanding on the impact of a physical activity consultation on physical activity behaviour and weight reduction/maintenance among overweight adolescents.

TRIAL REGISTRATION NUMBER

NCT02941770.