The effect of a physical activity consultation in the management of adolescent overweight, including anthropometry, physical activity levels, cardiorespiratory fitness, and endothelial health

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Vigorous physical activity: a potential ally in adolescent obesity management

Publication . Videira-Silva, Antonio; Manco, Licínio; Sardinha, Luís B.; Fonseca, Helena

Individual variability may contribute to the modest and inconsistent results reported in obesity-management interventions. This study aimed to investigate the impact of non-modifiable as well as modifiable factors on body mass index (BMI) and body fat variance in adolescents with obesity followed in a clinical obesity-management programme, in order to better understand individual variability. Non-modifiable factors (i.e. socio-economic status, pregnancy BMI, weight progression across pregnancy, BMI at time of delivery, way of delivery, birth weight, breastfeeding duration, age at overweight onset, overweight duration, and FTO rs9939609 polymorphism) and modifiable factors data (i.e. self-determination level, self-efficacy and perception of importance to lose weight, energy intake, physical activity, and sedentary behaviours) from 63 adolescents (93.7% Caucasian, 55.6% girls), with a median age of 15.0 (2.5) years, and a median BMI z-score of 2.88 (0.70), followed for 6 months were analyzed. BMI z-score variance was predicted by vigorous physical activity (VPA) (F(1,57) = 4.55, p = .039), overweight duration (F(1,59) = 5.61, p = .022), way of delivery (F(2,58) = 6.55, p = .003) and self-determination level (F(1,59) = 4.75, p = .034). VPA further predicted body fat mass (%) (F(1,57) = 9.99, p = .003) as well as trunk fat mass variance (F(1,57) = 8.94, p = .006). This study suggests that although both non-modifiable and modifiable factors influence BMI and body fat variance to some extent, in adolescents with obesity, VPA (modifiable factor) stands out as the factor with the best association with both outcomes. VPA may be a potential ally in the success of clinical obesity management in adolescents, and so should be emphasised in this population.Highlights There is a huge individual variability within studies in response to adolescent obesity-management interventions.Both non-modifiable and modifiable factors may influence body mass index (BMI) and body fat variance, influencing interventions' outcomes.The predictive value of both non-modifiable and modifiable factors largely overlaps, making lighter the burden of the former and highlighting the value of lifestyle changes.Among modifiable factors, vigorous physical activity standouts as the factor with the best (negative) association with BMI and body fat variance.

2022Journal article

Restricted access

Metabolically healthy overweight adolescents : definition and components

Publication . Videira-Silva, Antonio; Freira, Silvia; Fonseca, Helena

Purpose: In adolescents, the definition and clinical implications of metabolically healthy overweight (MHO) status have not been established. This study aimed to investigate the prevalence of MHO according to its most widespread definition, which is based on metabolic syndrome (MS), and to explore further metabolic indicators such as Homeostatic Model Assessment of Insulin Resistance, total cholesterol, low-density lipoprotein cholesterol, alanine aminotransferase, and C-reactive protein levels, together with metabolic health predictors in a sample of adolescents attending a pediatric obesity clinic. Methods: Data from 487 adolescents categorized as overweight (52.6% females, 88.1% white), with a mean body mass index (BMI) z-score of 2.74 (±1.07 standard deviation [SD]), and a mean age of 14.4 years (±2.2 SD) were cross-sectionally analyzed. From this original sample, a subsample of 176 adolescents underwent a second assessment at 12 (±6 SD) months for longitudinal analysis. Results: From the 487 adolescents originally analyzed, 200 (41.1%) were categorized as MHO, but only 93 (19.1%) had none of the metabolic indicators considered in this study. According to longitudinal analysis, 30 of the 68 adolescents (44%) categorized as MHO at baseline became non-MHO over time. BMI z-score was the best predictor of metabolic health both in cross-sectional and longitudinal analyses. Increased BMI z-score reduced the odds of being categorized as MHO (odds ratio [OR], 0.6; 95% confidence interval [CI], 0.4–0.9; P=.008) and increased the odds of having hypertension (OR 2.1, 95% CI: 1.4–3.3, P=0.001), insulin resistance (OR, 2.4; 95% CI, 1.4–4.1, P=0.001), or a proinflammatory state (OR, 1.2; 95% CI, 1.1–1.3, P=0.002). Conclusion: Diagnosis of MHO should not be exclusively based on MS parameters, and other metabolic indicators should be considered. Adolescents categorized as overweight should participate in weight-management lifestyle interventions regardless of their metabolic health phenotype.

2020Journal article

Open access

The effect of a physical activity consultation in the management of adolescent overweight : (The PAC-MAnO project)

Publication . Silva, António José Videira da; Fonseca, Maria Helena Regalo da; Sardinha, Luís Bettencourt

O excesso de peso (incluindo pré-obesidade e obesidade) na adolescência é uma preocupação de saúde pública, uma vez que está associado a condições de saúde adversas, a curto e longo prazos. Comportamentos de saúde inapropriados, como um aporte energético excessivo e níveis insuficientes de atividade física (AF), podem conduzir ao excesso de peso. Existe uma necessidade urgente em encontrar estratégias que possam influenciar positivamente os comportamentos alimentares e de AF. O projeto PAC-MAnO (The effect of a Physical Activity Consultation in the management of adolescent overweight) foi desenhado com o objetivo de investigar o impacto de uma Consulta de Atividade Física, com recurso a técnicas de entrevista motivacional, no comportamento de AF e z-score do índice de massa corporal (IMC) em adolescentes com excesso de peso seguidos em consulta de Obesidade Pediátrica. De acordo com o nosso conhecimento, este é o primeiro estudo realizado em Portugal a analisar, de forma vasta, o impacto de uma Consulta de Atividade Física na gestão do peso em adolescentes com excesso de peso. Entre setembro de 2016 e dezembro 2018, os adolescentes com excesso de peso (IMC ≥ p85), em consulta de primeira vez (n=165), que consentiram em participar no projeto PAC-MAnO, foram alocados por amostragem consecutiva em três grupos: Grupo de controlo (GC), Grupo experimental I (GEI), e Grupo experimental II (GEII). O GC seguiu o plano assistêncial base (consultas de Pediatria e Nutrição) durante 12 meses. Os GEs foram expostos à Consulta de AF adicionalmente ao plano assistêncial base durante os mesmos 12 meses. Os participantes incluídos no GEII foram adicionalmente convidados/encorajados a participar em duas sessões semanais de exercício físico, durante os primeiros 6 meses do projeto (fase I). No momento inicial, aos 6 (final da fase I) e aos 12 meses (final da fase II), foi realizado um conjunto de avaliações antropométricas, clínicas, nutricionais e de AF. Dos participantes recrutados, 132 completaram a fase I (GC n=41, GI n=45, GEII n=46) e 102, a fase II (GC n=28, GEI n=36, GEII n=38). Apenas 43,5% (n=20) dos participantes do GEII cumpriram pelo menos 80% das sessões de exercício agendadas (fase I). Aos 6 meses, quer o GEI, quer o GEII mostraram melhorias significativas no z-score do IMC (d=0.75, p=.002; d=0.60, p=.045), composição corporal, aptidão cardiorespiratória (ApCR) (d=1.48, p=.012; d=1.32, p=.022), e AF moderada (d=0.81, p=.005; d=1.39, p<.001), vigorosa (d=0.83, p=.001; d=1.04, p<.001) e moderada-vigorosa (d=0.90, p=.001; d=1.43, p<.001). O GEI mostrou ainda melhorias no espessamento do complexo íntima-média da artéria carótida primitiva (d=1.09, p=.044), bem como no tempo em comportamento sedentário (d=0.70, p=.019) aos 6 meses, comparativamente ao GC. Aos 12 meses foram observadas melhorias adicionais no z-score do IMC (d=0.95, p<.001; d=0.86, p=.015), composição corporal e ApCR (ml/kg/min) (d=1.58, p=.033; d=1.17, p=.043) em ambos os GEs, comparativamente ao GC. O custo líquido atribuído ao GEI foi de 12,41 e 7,78 € por participante (representando um acréscimo de 19.5 e 24.1% comparativamente ao GC) para a fase I e II, respetivamente. Estimou-se uma redução de 0,002 e 0,009 no z-score do IMC aos 6 e 12 meses, para cada Euro (1€) gasto no GEI. O custo líquido do GEII foi de 252,37 e 7,78 € por participante, para a fase I e II, respetivamente. De acordo com os resultados observados, a inclusão de uma Consulta de AF num programa clínico multidisciplinar de gestão do peso em adolescentes (com recurso a técnicas de entrevista motivacional) pode melhorar de forma eficaz os níveis de AF, z-score do IMC, composição corporal e ApCR dos adolescentes, comparativamente àqueles expostos ao plano assistêncial base (consultas de Pediatria e Nutrição), com um bom custoeficácia. Estes resultados são observáveis a 6 meses, com melhorias adicionais a 12 meses. A inclusão de sessões de exercício físico poderá representar uma mais-valia, desde que se assegure a presença dos participantes nas referidas sessões.

2020-07Doctoral thesis

Open access

Acanthosis nigricans as a clinical marker of insulin resistance among overweight adolescents

Publication . Videira-Silva, Antonio; Albuquerque, Carolina; Fonseca, Helena

Purpose: Acanthosis nigricans (AN) is a hyperpigmented dermatosis associated with obesity and insulin resistance (IR). There is no consensus whether AN extension scoring offers added value to the clinical estimation of IR. In this study we aimed to assess and score AN using both a short and an extended version of the scale proposed by Burke et al. and analyze the relationships of both versions with hyperinsulinemia and IR. Methods: We analyzed data from 139 overweight adolescents (body mass index ≥85th percentile) aged 12–18 with (n=67) or without (n=72) AN who were followed at a pediatric obesity clinic. Results: Adolescents with AN had higher levels of insulin (d=0.56, P=0.003) and HOMA-IR (d=0.55, P=0.003) compared to those without. Neither the short nor the extended versions of AN scores explained either hyperinsulinemia (β=1.10, P=0.316; β=1.15, P=0.251) or IR (β=1.07, P=0.422; β=1.10, P=0.374). The presence of AN alone predicted hyperinsulinemia and the presence of IR in 7.3% (β=2.68, P=0.008) and 7.1% (β=2.59, P=0.009) of adolescents, respectively. Conclusion: Screening for AN at the neck and axilla is a noninvasive and cost-effective way to identify asymptomatic overweight adolescents with or at risk of developing IR.

2019Journal article

Open access

Combined high-intensity interval training as an obesity-management strategy for adolescents

Publication . Videira-Silva, Antonio; Hetherington-Rauth, Megan; Sardinha, Luís B.; Fonseca, Helena

Effective and safe exercise protocols for obesity management in adolescents are imperative. This study aimed to analyse compliance, efficacy, and safety of combined high-intensity interval training circuit (HIIT) in the management of obesity (including overweight) in adolescents, compared to traditional training (TT). Data from 55 adolescents (47.3% girls) (TT n = 31; HIIT n = 24), aged 12-18 (mean age of 14.3 ± 1.7), with overweight and obesity (median BMI z-score of 2.95), were assessed at baseline and month 6 (Clinicaltrials.gov/NCT02941770). During the 6-month intervention, participants in both exercise groups attended two exercise sessions/week (60 min/session) along with a set of appointments with a paediatrician, nutritionist, and exercise physiologist. Forty-six participants completed the intervention (TT n = 23; HIIT n = 23). Exercise session attendance (≥80%) was significantly higher among HIIT participants (73.9 vs. 13.0%, p < .001). HIIT, but not TT, showed a significant decrease in BMI z-score (d = 0.40, p < .001), body fat mass (BFM, %) (d = 0.41, p = .001), and trunk fat mass (d = 0.56, p < .001), as well as a significant increase in muscle mass (MM, %) (d = 0.28, p = .001) between baseline and 6 months. According to generalized estimating equations, time-by-attendance interactions (instead of time-by group) were found in BMI z-score (β = 0.25, 95%CI: 0.17, 0.33), BFM (β = 2.29, 95%CI: 1.02, 3.56), trunk fat mass (β = 2.94, 95%CI: 1.70, 4.18), and MM (β = -1.16, 95%CI: -1.87, -0.45). No adverse events were reported during HIIT sessions. Although compliance may mediate the impact of an exercise protocol on health-related outcomes, HIIT showed to be safe, with higher compliance compared to TT, which may result in improved outcomes overtime.

2021Journal article

Restricted access