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      Efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes internados com obesidade severa Translated title: Effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents

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          Abstract

          OBJETIVO: Descrever os efeitos da terapia multidisciplinar de longo prazo sobre a composição corporal de adolescentes obesos severos internados. MÉTODOS: Um total de 728 adolescentes obesos extremos, incluindo 249 meninos (15,25±1,56 anos) e 479 meninas (15,34±1,59 anos), recebeu terapia multidisciplinar durante um período de 3 a 9 meses. A terapia consistiu de redução da ingestão energética, orientação dietética, exercícios físicos e terapia psicológica. A composição corporal foi analisada pela bioimpedância elétrica, e a aptidão física foi avaliada pelo teste em ciclo ergômetro multiestágios. O tipo e duração de cada atividade foram avaliados através de recordatório diário de atividade física. RESULTADOS: Foi verificada redução significante (p < 0,05) na massa corporal (27,84±12,49 kg para meninos e 21,60±9,87 kg para meninas), índice de massa corporal (9,19±3,88 kg/m² para meninos e 7,72±3,98 kg/m² para meninas) e da gordura corporal. Além disso, a porcentagem de massa magra aumentou significantemente (p < 0,05) nos meninos (de 58,8±6,41 para 69,98±7,43%) e nas meninas (de 51,86±4,96 para 60,04±5,65%). CONCLUSÃO: A terapia multidisciplinar de longo prazo permite reduzir acentuadamente a obesidade severa, preservando o crescimento e a porcentagem de massa magra.

          Translated abstract

          OBJECTIVE: To describe the effects of long-term multidisciplinary inpatient therapy on body composition of severely obese adolescents. METHODS: A total of 728 extremely obese adolescents, including 249 boys (aged 15.25±1.56 years) and 479 girls (aged 15.34±1.59 years) received multidisciplinary therapy during a period of 3 to 9 months. The therapy consisted of reduced energy intake, dietetic education, physical exercises and psychological therapy. Body composition was assessed by bioelectrical impedance analysis, and physical capacity was assessed by the multistage cycle ergometer test. Type and duration of each activity were recorded using a daily controlled activity diary. RESULTS: There was a significant decrease (p < 0.05) in body mass (27.84±12.49 kg for boys and 21.60±9.87 kg for girls), body mass index (9.19±3.88 kg/m² for boys and 7.72±3.98 kg/m² for girls) and fat mass. In addition, the percentage of fat free mass increased significantly (p < 0.05) in boys (from 58.8±6.41 to 69.98±7.43%) and in girls (from 51.86±4.96 to 60.04±5.65%). CONCLUSION: Long-term multidisciplinary approach allows significant reduction in severe obesity, preserving growth and percentage of fat free mass.

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          Childhood obesity and self-esteem.

          Although childhood obesity may have detrimental consequences for childhood self-esteem, the prevalence and magnitude of this problem is controversial. In addition, the social and emotional effects of decreased self-esteem in obese children are unknown. A total of 1520 children, 9 to 10 years of age, born to mothers in the National Longitudinal Survey of Youth were studied. Comprehensive demographic data including race and family income were available in 97% of the cohort. Self-esteem was measured using Self-Perception Profile for Children. The 4-year follow-up Self-Perception Profile for Children scores were available in 79% of the children. Obesity was defined as a body mass index greater than the 95th percentile for age and gender. Additional data include a self-administered questionnaire at 13 to 14 years of age concerning emotional well being, smoking, and alcohol consumption. Data were stratified by race and gender. The data were weighted to reflect a nationally representative sample of children born to mothers 17 to 28 years of age. Scholastic and global self-esteem scores were not significantly different among 9- to 10-year-old obese and nonobese children. However, over the 4-year period, obese Hispanic females and obese white females showed significantly decreased levels of global self-esteem compared with nonobese Hispanic females and nonobese white females, respectively. Mild decreases in self-esteem also were observed in obese boys compared with nonobese boys. As a result, by 13 to 14 years of age, significantly lower levels of self-esteem were observed in obese boys, obese Hispanic girls, and obese white girls compared with their nonobese counterparts. Decreasing levels of self-esteem in obese children were associated with significantly increased rates of sadness, loneliness, and nervousness compared with obese children whose self-esteem increased or remained unchanged. In addition, obese children with decreasing levels of self-esteem over the 4-year period were more likely to smoke and drink alcohol compared with obese children whose self-esteem increased or remained unchanged. Obese Hispanic and white females demonstrate significantly lower levels of self-esteem by early adolescence. In addition, obese children with decreasing levels of self-esteem demonstrate significantly higher rates of sadness, loneliness, and nervousness and are more likely to engage in high-risk behaviors such as smoking or consuming alcohol.
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            Effects of exercise intensity on cardiovascular fitness, total body composition, and visceral adiposity of obese adolescents.

            Little is known about how the intensity of exercise influences cardiovascular fitness and body composition, especially in obese adolescents. Our goal was to determine the effects of physical training intensity on the cardiovascular fitness, percentage of body fat (%BF), and visceral adipose tissue (VAT) of obese adolescents. Obese 13-16-y-olds (n = 80) were assigned to 1) biweekly lifestyle education (LSE), 2) LSE + moderate-intensity physical training, or 3) LSE + high-intensity physical training. The intervention lasted 8 mo. Physical training was offered 5 d/wk, and the target energy expenditure for all subjects in physical training groups was 1047 kJ (250 kcal)/session. Cardiovascular fitness was measured with a multistage treadmill test, %BF with dual-energy X-ray absorptiometry, and VAT with magnetic resonance imaging. The increase in cardiovascular fitness in the high-intensity physical training group, but not in the moderate-intensity group, was significantly greater than that in the LSE alone group (P = 0.009); no other comparisons of the 3 groups were significant. Compared with the LSE alone group, a group composed of subjects in both physical training groups combined who attended training sessions >or=2 d/wk showed favorable changes in cardiovascular fitness (P < 0.001), %BF (P = 0.001), and VAT (P = 0.029). We found no evidence that the high-intensity physical training was more effective than the moderate-intensity physical training in enhancing body composition. The cardiovascular fitness of obese adolescents was significantly improved by physical training, especially high-intensity physical training. The physical training also reduced both visceral and total-body adiposity, but there was no clear effect of the intensity of physical training.
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              Reliability and variability of bioimpedance measures in normal adults: effects of age, gender, and body mass.

              This study aimed to analyze the reliability and evaluate the causes of variability of bioimpedance parameters. Direct measures were analyzed because they are not affected by inappropriate prediction models. Resistance (R), reactance (Xc), and phase angle (PA) were determined at three fixed frequencies (5, 50, and 100 kHz) in 653 normal Germans (244 males and 409 females), aged 20-90 years, using a phase-sensitive whole-body tetrapolar bioimpedance analyzer (BIA 2000-M, Data Input, Germany). From these values, six bioimpedance ratios were calculated (R(5)/R(50), R(5)/R(100), Xc(5)/Xc(50), Xc(5)/Xc(100), PA(5)/PA(50), and PA(5)/PA(100)). Reliability of duplicate measurements, as determined by technical error, is high. ANOVA for repeated measurements yields a significant frequency main effect (within-subjects factor) and significant effects of age and gender (between-subject factors) on variation of resistance, reactance, and phase angle. Multiple regression analyses indicate independent effects of age, gender, and body mass index on variability of resistance, reactance, and phase angle at the three frequencies. Gender primarily influences variation in resistance (smaller values in males), whereas age mainly affects variations in reactance and phase angle (smaller values in older adults). Obesity is associated with smaller resistance (at all frequencies) and smaller reactance (high frequencies), but larger phase-angle values (low frequency). The study shows that variability of direct bioimpedance measures depends on age, gender, and body mass characteristics of the study population. The potential benefit for using both low and high frequencies in R measures is to differentiate between extra- and intracellular fluid spaces, which may be altered during human growth and aging. Copyright 2003 Wiley-Liss, Inc.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                jped
                Jornal de Pediatria
                J. Pediatr. (Rio J.)
                Sociedade Brasileira de Pediatria (Porto Alegre )
                1678-4782
                June 2009
                : 85
                : 3
                : 243-248
                Affiliations
                [1 ] Universidade Federal de São Paulo Brazil
                [2 ] Obesity Rehabilitation Centre INSULA Alemanha
                [3 ] Universidade Federal de São Paulo Brazil
                Article
                S0021-75572009000300010
                10.1590/S0021-75572009000300010
                c1384ed2-cff3-4594-8a13-075b5e262c65

                http://creativecommons.org/licenses/by/4.0/

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                SciELO Brazil

                Self URI (journal page): http://www.scielo.br/scielo.php?script=sci_serial&pid=0021-7557&lng=en
                Categories
                PEDIATRICS

                Pediatrics
                Adolescent,body composition,body weight loss,exercise,nutrition,obesity,Adolescente,composição corporal,redução de massa corporal,exercício físico,nutrição,obesidade

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