Weight loss interventions for overweight and obese adolescents: a systematic review

Does body mass index distinguish motor proficiency, social and emotional maturity among adolescent girls?

BACKGROUND

The objective of this study was to investigate whether different body mass index (BMI) groups could serve as a distinguishing factor for assessing motor proficiency and social and emotional maturity in adolescent girls.

METHODS

140 girls ranging from 12 to 14.5 years old were selected from the schools of Tabriz city, Iran. After their height and weight were measured to calculate body mass index, they completed the following questionnaires: Bruininks-Oseretsky Test of motor proficiency, Second Edition,Vineland Social Maturity Scale, and Emotional Maturity scale.

RESULTS

normal-weight girls had a meaningful advantage against overweight and underweight participants in the gross motor factor of motor proficiency (p = 0.004), but there wasn't a meaningful difference in the fine motor p = 0.196) and coordination factors (p = 0.417). Also, social maturity showed an advantage of normal and underweight adolescent girls in the self-help dressing factor (p = 0.018), while the locomotion skills (p = 0.010) factor revealed a better performance of normal weight and overweight groups over underweight adolescents. No significant differences were observed in the emotional maturity subscales (p = 0.63) between the groups.

CONCLUSIONS

The present study demonstrates that BMI has a direct influence on adolescents' gross motor proficiency and social maturity.

Adolescent and Caregiver Perspectives on Family Navigation to Improve Healthcare Access and Use for Managing Pediatric Obesity

We interviewed families to explore their views on the role of family navigation (FN) to improve access to and use of health services for managing pediatric obesity. From March to December, 2020, we conducted individual, structured telephone interviews with adolescents with obesity (13-17 years old) and their caregivers from Edmonton and Calgary, Canada. Among our 37 participants (14 adolescents, 23 caregivers), most (n = 27; 73.0%) reported FN could improve their access to obesity management. Participants recommended several activities to support healthcare access and use, including appointment reminders, evening/weekend appointments, parking/transportation support, and in-clinic childcare, all of which help families to attend appointments over an extended period to support obesity management. Most participants preferred FN be offered by healthcare professional 'navigators' who were approachable, empathic, and compassionate since issues regarding health and obesity can be sensitive, emotional topics to discuss. Overall, families supported integrating FN into multidisciplinary pediatric obesity management to improve healthcare access and use by navigators who apply a range of practical strategies and relational skills to enhance long-term access and adherence to care.

Effectiveness of lifestyle medicine on cognitive functions in mild cognitive impairments and dementia: A systematic review on randomized controlled trials

Mild cognitive impairment (MCI) and dementia are associated with lifestyle risk factors, making lifestyle medicine a potentially viable intervention for people with MCI and dementia. The present study aims to examine the effectiveness of lifestyle medicine on cognitive functions among people with MCI and dementia, by performing a systematic review and meta-analysis on randomized controlled trials (RCT). A systematic literature search was conducted to extract RCTs adopting lifestyle interventions of diet, exercise, and stress management or emotional well-being. Results showed that 65 studies were eligible. Exercise was the most promising lifestyle intervention that improved various cognitive functions among people with MCI and dementia, and was more effective in MCI than in dementia. Interventions on stress management or emotional well-being did not show a significant effect on people with MCI, and the evidence for people with dementia was insufficient to conclude. Similarly, due to the lack of RCTs on a healthy dietary pattern, the effectiveness of diet interventions was not examined. In conclusion, the exercise component of lifestyle medicine can be an effective and clinically significant intervention for protecting people with MCI and dementia against cognitive declines, especially when served as an early intervention at the stage of MCI.

A multi-center, randomized, 12-month, parallel-group, feasibility study to assess the acceptability and preliminary impact of family navigation plus usual care versus usual care on attrition in managing pediatric obesity: a study protocol

BACKGROUND

Pediatric obesity management can be successful, but some families discontinue care prematurely (i.e., attrition), limiting treatment impact. Attrition is often a consequence of barriers and constraints that limit families' access to obesity management. Family Navigation (FN) can improve access, satisfaction with care, and treatment outcomes in diverse areas of healthcare. To help our team prepare for a future effectiveness trial, the objectives of our randomized feasibility study are to (i) explore children's and caregivers' acceptability of FN and (ii) examine attrition, measures of study rigor and conduct, and responses to FN + Usual Care vs Usual Care by collecting clinical, health services, and health economic data.

METHODS

In our 2.5-year study, 108 6-17-year-olds with obesity and their caregivers will be randomized (1:1) to FN + Usual Care or Usual Care after they enroll in obesity management clinics in Calgary and Mississauga, Canada. Our Stakeholder Steering Committee and research team will use Experience-Based Co-Design to design and refine our FN intervention to reduce families' barriers to care, maximizing the intervention dose families receive. FN will be delivered by a navigator at each site who will use logistical and relational strategies to enhance access to care, supplementing obesity management. Usual Care will be offered similarly at both clinics, adhering to expert guidelines. At enrollment, families will complete a multidisciplinary assessment, then meet regularly with a multidisciplinary team of clinicians for obesity management. Over 12 months, both FN and Usual Care will be delivered virtually and/or in-person, pandemic permitting. Data will be collected at 0, 3, 6, and 12 months post-baseline. We will explore child and caregiver perceptions of FN acceptability as well as evaluate attrition, recruitment, enrolment, randomization, and protocol integrity against pre-set success thresholds. Data on clinical, health services, and health economic outcomes will be collected using established protocols. Qualitative data analysis will apply thematic analysis; quantitative data analysis will be descriptive.

DISCUSSION

Our trial will assess the feasibility of FN to address attrition in managing pediatric obesity. Study data will inform a future effectiveness trial, which will be designed to test whether FN reduces attrition.

TRIAL REGISTRATION

This trial was registered prospectively at ClinicalTrials.gov (# NCT05403658 ; first posted: June 3, 2022).

intervenção cognitivo-comportamental em grupo com indivíduos com obesidade

A obesidade tem causas multifatoriais e a Terapia Cognitivo-Comportamental apresenta resultados positivos sobre os aspetos cognitivos, emocionais e comportamentais relativos à perda de peso. Este estudo apresenta uma avaliação preliminar do Programa Cognitivo Comportamental de Educação Alimentar em Grupo (PROMETA). Foi realizado um estudo quantitativo, pré-experimental com avaliação pré e pós-teste. Sessenta e sete participantes adultos com sobrepeso ou obesidade realizaram as 12 sessões da intervenção em grupos. Foram utilizados os inventários Beck de depressão, de ansiedade, e de desesperança, a escala de compulsão alimentar periódica, e a escala de figuras de silhuetas. Os resultados indicaram que o PROMETA contribuiu para redução de sintomas de depressão, ansiedade, desesperança, e compulsão alimentar. Portanto, o programa apresenta resultados satisfatórios para esta amostra.

A visualized and scientometric analysis of research trends of weight loss in overweight/obese children and adolescents (1958-2021)

Background

Weight loss is an appropriate approach to reduce the health risks associated with overweight/obese children and adolescents, and the optimal method of weight loss requires further research. This study systematically explores scientific co-operation, disciplinary interaction, hotspots and trends in the field of weight loss in overweight/obese children and adolescents (WLOCA), and provides references for further research.

Methods

Citespace 5.8.R1 (64-bit) was adopted to conduct a comprehensive visualization analysis of the literature on WLOCA from Web of Science Core Collection, including publication, institution, country/region, author, journal, keywords and reference.

Results

2,513 papers were found in the Web of Science Core Collection, and the annual number of papers published has increased significantly since 2003. Cincinnati Children's Hospital is the institution with the largest number of publications, while Washington University plays a pivotal role in the collaboration network. In terms of nations, USA has made greater contributions than the rest in terms of the number of publications and global co-operation research. The most influential authors in this field are Thomas H. Inge, Thomas Reinehr, Todd M. Jenkins, Epstein LH, Ogden CL, etc. The most active journals are "Obesity," "International Journal of Obesity," "Obesity Surgery," "Pediatrics," etc. which are characterized by interdisciplinary interactions. Research hot topics mainly include "assessment of obesity and pathophysiological mechanism," "comprehensive intervention," and "bariatric surgery," and there's a gradual shift from "lifestyle intervention" and "pathophysiological mechanism" to "clinical surgical application." In addition, disciplinary integration and comprehensive research, targeted intervention and treatment, and prospective research are the future research trends.

Conclusion

The overall trend in WLOCA study is positive. The main contribution of this study is to reveal the overall picture of the research in this field with visual maps and detailed data by combining quantitative with qualitative approaches, which can provide valuable references for relevant researchers to quickly understand the status of studies on WLOCA, to seek co-operation, and grasp research hotspots and frontier trends.

Association between alanine aminotransferase as surrogate of fatty liver disease and physical activity and sedentary time in adolescents with obesity

To compare patterns of sedentary (SED) time (more sedentary, SED + vs less sedentary, SED-), moderate to vigorous physical activity (MVPA) time (more active, MVPA + vs less active, MVPA-), and combinations of behaviors (SED-/MVPA + , SED-/MVPA-, SED + /MVPA + , SED + /MVPA-) regarding nonalcoholic fatty liver diseases (NAFLD) markers. This cross-sectional study included 134 subjects (13.4 ± 2.2 years, body mass index (BMI) 98.9 ± 0.7 percentile, 48.5% females) who underwent 24-h/7-day accelerometry, anthropometric, and biochemical markers (alanine aminotransferase (ALT) as first criterion, and aspartate aminotransferase (AST), gamma-glutamyl transpeptidase (GGT), AST/ALT ratio as secondary criteria). A subgroup of 39 patients underwent magnetic resonance imaging-liver fat content (MRI-LFC). Hepatic health was better in SED- (lower ALT, GGT, and MRI-LFC (p < 0.05), higher AST/ALT (p < 0.01)) vs SED + and in MVPA + (lower ALT (p < 0.05), higher AST/ALT (p < 0.01)) vs MVPA- groups after adjustment for age, gender, and Tanner stages. SED-/MVPA + group had the best hepatic health. SED-/MVPA- group had lower ALT and GGT and higher AST/ALT (p < 0.05) in comparison with SED + /MVPA + group independently of BMI. SED time was positively associated with biochemical (high ALT, low AST/ALT ratio) and imaging (high MRI-LFC) markers independently of MVPA. MVPA time was associated with biochemical markers (low ALT, high AST/ALT) but these associations were no longer significant after adjustment for SED time.

CONCLUSION

Lower SED time is associated with better hepatic health independently of MVPA. Reducing SED time might be a first step in the management of pediatric obesity NAFLD when increasing MVPA is not possible.

WHAT IS KNOWN

• MVPA and SED times are associated with cardiometabolic risks in youths with obesity. • The relationships between NAFLD markers and concomitant MVPA and SED times have not been studied in this population.

WHAT IS NEW

• Low SED time is associated with healthier liver enzyme profiles and LFC independent of MVPA. • While low SED/high MVPA is the more desirable pattern, low SED/low MVPA pattern would have healthier liver enzyme profile compared with high MVPA/high SED, independent of BMI, suggesting that reducing SED time irrespective of MVPA is needed to optimize liver health.

Karate Training Improves Metabolic Health in Overweight and Obese Adolescents: A Randomized Clinical Trial

PURPOSE

This study evaluated the effects of 12 weeks of karate training on cardiometabolic parameters, oxidative stress, and inflammation in adolescents with overweight and obesity.

METHOD

Seventy adolescents were randomized into 2 groups: control received nutritional and psychological interventions once a week for 12 weeks, and treatment received nutritional and psychological interventions once a week, plus 3 karate sessions per week, for 12 weeks. The main outcome measure was improvement in cardiometabolic parameters, oxidative stress, and inflammation.

RESULTS

After the intervention period, the treatment group showed a reduction in resting heart rate (77.86 [10.89]), high-density lipoprotein cholesterol (40.86 [8.31]), and triglycerides (75.18 [32.29]) and an increase in low-density lipoprotein cholesterol (95.64 [42.53]) in relation to pretraining. Regarding oxidative stress markers, there was a reduction in protein carbonylation (0.07 [0.06]) and nitric oxide (1.39 [1.11]) and an increase in superoxide dismutase (0.68 [0.31]) and glutathione (0.11 [0.08]) compared with pretraining. With respect to inflammation, adiponectin increased (14.54 [5.36]) after the intervention when compared with preintervention.

CONCLUSION

The study concluded that the intervention may improve cardiometabolic parameters, oxidative stress, and inflammation in adolescents with overweight and obesity. Long-term effects need to be evaluated.

Effects of Movement Behaviors on Overall Health and Appetite Control: Current Evidence and Perspectives in Children and Adolescents

PURPOSE OF REVIEW

To present the definitions and recommendations for movement behaviors in children and adolescents, including physical activity (PA), sedentary behaviors (SB), and sleep, and to provide an overview regarding their impact on health and obesity outcomes from childhood to adulthood, as well as interactions with appetite control.

RECENT FINDINGS

PA represents a variable proportion of daily energy expenditure and one can be active with high SB or vice versa. Studies have described movements across the whole day on a continuum from sleep to SB to varying intensities of PA. More PA, less SB (e.g., less screen time) and longer sleep are positively associated with indicators of physical health (e.g., lower BMI, adiposity, cardiometabolic risk) and cognitive development (e.g., motor skills, academic achievement). However, less than 10% of children currently meet recommendations for all three movement behaviors. Movement behaviors, adiposity, and related cardiometabolic diseases in childhood track into adolescence and adulthood. Furthermore, low PA/high SB profiles are associated with increased energy intake. Recent studies investigating energy balance regulation showed that desirable movement behavior profiles are associated with better appetite control and improved eating habits. Early identification of behavioral phenotypes and a comprehensive approach addressing all key behaviors that directly affect energy balance will allow for individual strategies to prevent or treat obesity and its comorbidities. Investigating exercise as a potential "corrector" of impaired appetite control offers a promising weight management approach.

Bone Response to High-Intensity Interval Training versus Moderate-Intensity Continuous Training in Adolescents with Obesity

INTRODUCTION

Since adolescents with obesity are prone to bone fragility during weight loss, the aim was to compare the impact of high-intensity interval training (HIIT) versus moderate-intensity continuous training (MICT) on bone density, geometry, and strength.

METHODS

Sixty-one adolescents were randomly assigned to 2 cycling trainings (HIIT and MICT) and a control (CTR, without training) group. Anthropometry, dual-energy X-ray absorptiometry with hip structural analysis and the trabecular bone score (TBS) were assessed before and after the 16-week intervention.

RESULTS

Body mass index (BMI) and fat mass (FM) percentage decreased at T1 versus T0 in both training groups (p < 0.001 for HIIT, p = 0.01 for MICT), though to a larger extent in HIIT (p < 0.05). Total body bone mineral density (BMD) and bone mineral content (BMC) increased in both training groups (p < 0.001), but to a greater extent in HIIT for BMC (p < 0.05). Lumbar spine BMD and BMC increased in both training groups (p < 0.001 for HIIT, p < 0.01 for MICT), with a time × group interaction between HIIT and CTR (p < 0.05) only. TBS increased in both training groups (p < 0.01 for HIIT, p < 0.05 for MICT). Hip BMD and BMC increased in both HIIT (p < 0.001 and p < 0.01) and MICT (p < 0.01 and p < 0.05). At the narrow neck (NN), endocortical diameter, width (p < 0.01), cross-sectional moment of inertia, and section modulus (Z) (p < 0.05) increased only in the HIIT group, such as BMD and Z (p < 0.05) at the intertrochanteric region (IT) and average cortical thickness (p < 0.001) and width (p < 0.05) at the femoral shaft. At the NN and IT, the buckling ratio decreased only in the HIIT group (p < 0.05), predicting higher resistance to fracture.

CONCLUSIONS

In addition to inducing greater BMI and FM percentage decreases in comparison to MICT, HIIT improves multisite bone density, geometry, and strength, which heighten the justification for HIIT as part of weight loss interventions in adolescents with obesity.

Association between Metabolic Syndrome Diagnosis and the Physical Activity-Sedentary Profile of Adolescents with Obesity: A Complementary Analysis of the Beta-JUDO Study

Metabolic syndrome (MetS) is highly prevalent in children and adolescents with obesity and places them at an increased risk of cardiovascular-related diseases. However, the associations between objectively measured movement-related behaviors and MetS diagnosis remain unexplored in youths with obesity. The aim was to compare profiles of sedentary (SED) time (more sedentary, SED+ vs. less sedentary, SED−), moderate to vigorous physical activity (MVPA) time (more active, MVPA+ vs. less active, MVPA−) and combinations of behaviors (SED−/MVPA+, SED−/MVPA−, SED+/MVPA+, SED+/MVPA−) regarding the MetS diagnosis. One hundred and thirty-four adolescents with obesity (13.4 ± 2.2 years) underwent 24 h/7 day accelerometry, waist circumference (WC), blood pressure (BP), high-density lipoprotein-cholesterol (HDL-c), triglycerides (TG) and insulin-resistance (IR) assessments. Cumulative cardiometabolic risk was assessed by using (i) MetS status (usual dichotomic definition) and (ii) cardiometabolic risk z-score (MetScore, mean of standardized WC, BP, IR, TG and inverted HDL-c). SED− vs. SED+ and MVPA+ vs. MVPA− had lower MetS (p < 0.01 and p < 0.001) and MetScore (p < 0.001). SED−/MVPA+ had the lowest risk. While SED and MVPA times were lower in SED−/MVPA− vs. SED+/MVPA+ (p < 0.001), MetScore was lower in SED−/MVPA− independently of body mass index (BMI) (p < 0.05). MVPA, but not SED, time was independently associated with MetS diagnosis (p < 0.05). Both MVPA (p < 0.01) and SED times (p < 0.05) were associated with MetScore independently of each other. A higher MVPA and lower SED time are associated with lower cumulative cardiometabolic risk.

Is there a difference in body size dissatisfaction between the patients with obesity seeking and not seeking treatment for obesity?

BACKGROUND

Various factors motivate people to undertake treatment for obesity. Among others they include health benefits, willingness to please others, and dissatisfaction with one's appearance. The present study aimed to assess body size dissatisfaction in patients with obesity seeking and not seeking treatment for obesity.

METHODS

Two-hundred-sixteen adult subjects (154 women, 62 men) including 80 people with BMI ≥ 30 kg/m2 starting treatment for obesity (BMI 35.7 ± 5.3 kg/m2) and 136 volunteers with obesity (BMI 34.7 ± 4.3 kg/m2) not seeking treatment for obesity, were enrolled. Body size satisfaction was assessed using the Figure Rating Scale adapted by Stunkard.

RESULTS

Patients with obesity starting obesity treatment had more often a high level of body size dissatisfaction than volunteers with obesity not seeking the treatment (p <  0.001). There was a significant difference in the distribution of body size dissatisfaction in women (p <  0.05), but not in men (p = 0.47).

CONCLUSION

Patients with obesity, especially women, seeking obesity treatment more often represent a high level of body size dissatisfaction than volunteers with obesity not seeking treatment for obesity. This implies the need for public health campaigns to address negative attitudes or misconceptions about obesity and its treatment. Placing more attention and emphasis on body size dissatisfaction in more vulnerable women with obesity may help to define personal motivations and goals, strengthen the doctor-patient relationship and better adapt therapeutic strategies.

A Review of the Increasing Prevalence of Metabolic-Associated Fatty Liver Disease (MAFLD) in Children and Adolescents Worldwide and in Mexico and the Implications for Public Health

Non-alcoholic fatty liver disease (NAFLD) affects almost a quarter of the world’s population and is the most common cause of chronic liver disease in children and adolescents. The recent proposal to replace the terminology of NAFLD with metabolic-associated fatty liver disease (MAFLD) aims to reflect the pathophysiology and risk factors for this disease. Importantly, the risk factors for MAFLD may be prenatal, such as genetic factors, or postnatal, such as obesity and insulin resistance. MAFLD is increasingly recognized in children and adolescents. Early diagnosis and identification of high-risk individuals with type 2 diabetes mellitus and metabolic syndrome is important. The diagnosis and management of MAFLD in children and adolescents should follow international clinical guidelines, such as those from the American Diabetes Association (ADA) and the International Society for Pediatric and Adolescent Diabetes (ISPAD). Current guidelines recommend lifestyle and dietary modifications, exercise, screening, individualized patient assessment, and multidisciplinary patient management. This review assesses the revised terminology and discusses the epidemiology, risk factors, pathophysiology, diagnosis, and prevention of MAFLD in children and adolescents worldwide and in Mexico, and also considers the implications for public health.

Effectiveness of a Weight Loss Program Using Digital Health in Adolescents and Preadolescents

Objective: To identify an efficacious intervention on treating adolescents with overweight and obesity, this might result in health benefits. Methods: Adolescents with overweight or obesity aged 10-17 years with BMI percentile ≥85th were included in this historical observational analysis. Subjects used an entirely remote weight loss program combining mobile applications, frequent self-weighing, and calorie restriction with meal replacement. Body weight changes were evaluated at 42, 60, 90, and 120 days using different metrics including absolute body weight, BMI, and BMI z-score. Chi-square or Fisher exact tests (categorical variables) and Student's t-test (continuous variables) were used to compare subjects. Results: In total, 2,825 participants, mean age 14.4 ± 2.2 years, (54.8% girls), were included from October 27, 2016, to December 31, 2017, in mainland China; 1355 (48.0%) had a baseline BMI percentile ≥97th. Mean BMI and BMI z-score were 29.20 ± 4.44 kg/m2 and 1.89 ± 0.42, respectively. At day 120, mean reduction in body weight, BMI, and BMI z-score was 8.6 ± 0.63 kg, 3.13 ± 0.21 kg/m2, and 0.42 ± 0.03; 71.4% had lost ≥5% body weight, 69.4% of boys and 73.2% of girls, respectively. Compared with boys, girls achieved greater reduction on BMI z-score at all intervals (p < 0.004 for all comparisons). Higher BMI percentile at baseline and increased frequency of use of the mobile application were directly associated with more significant weight loss. Conclusions: An entirely remote digital weight loss program is effective in facilitating weight loss in adolescents with overweight or obesity in the short term and mid term.

Current Systems-Level Evidence on Nutrition Interventions to Prevent and Treat Cardiometabolic Risk in the Pediatric Population: An Evidence Analysis Center Scoping Review

Improving and maintaining cardiometabolic health remains a major focus of health efforts for the pediatric population. Recent research contributes understanding of the systems-level nutrition factors influencing cardiometabolic health in pediatric individuals. This scoping review examines current evidence on interventions and exposures influencing pediatric cardiometabolic health to inform registered dietitian nutritionists working at each systems level, ranging from individual counseling to public policy. A literature search of MEDLINE, CINAHL, Cochrane Databases of Systematic Reviews, and other databases was conducted to identify evidence-based practice guidelines, systematic reviews, and position statements published in English from January 2017 until April 2020. Included studies addressed nutrition interventions or longitudinal exposures for participants 2 to 17 years of age who were healthy or had cardiometabolic risk factors. Studies were categorized according level of the social-ecological framework addressed. The databases and hand searches identified 2614 individual articles, and 169 articles were included in this scoping review, including 6 evidence-based practice guidelines, 141 systematic reviews, and 22 organization position statements. The highest density of systematic reviews focused on the effects of dietary intake (n = 58) and interventions with an individual child or family through counseling or education (n = 54). The least frequently examined levels of interventions or exposures were at the policy level (n = 12). Registered dietitian nutritionists can leverage this considerable body of recent systematic reviews to inform a systems-level, collaborative approach to prevention and treatment of pediatric cardiometabolic risk factors.

Appetite Control Might not Be Improved after Weight Loss in Adolescents with Obesity, Despite Non-Persistent Metabolic Syndrome

The aim of this study was to evaluate the effect of a multidisciplinary weight loss intervention on energy intake and appetite sensations in adolescents with obesity, depending on the initial diagnosis or persistence of the metabolic syndrome. Ninety-two adolescents with obesity (12-15 years) followed a 16-week multidisciplinary weight loss intervention. Anthropometric and body composition characteristics, metabolic profile, ad libitum daily energy intake, and appetite sensations were assessed before and after the intervention. The presence of metabolic syndrome (MS) was determined at baseline (MS vs. non-MS) and after the program (persistent vs. non-persistent). While the intervention was effective in inducing weight loss (body weight T0: 87.1 ± 14.9 vs. T1: 81.2 ± 13.0 kg; p < 0.001) and body composition improvements in both adolescents with and without MS, energy intake (p = 0.07), hunger (p = 0.008), and prospective food consumption (p = 0.03) increased, while fullness decreased (p = 0.04) in both groups. Energy intake and appetite were not improved in non-persistent MS after the program and remained significantly higher among non-persistent adolescents compared with initially non-MS adolescents. To conclude, appetite control seems impaired in obese adolescents, irrespective of being affected by MS or not, whereas the treatment of MS in this population might fail to effectively preclude the adolescents from potential post-intervention compensatory food intake and subsequent weight regain.

Bone response to eccentric versus concentric cycling in adolescents with obesity

OBJECTIVES

Because adolescents with obesity are susceptible to bone fragility during weight loss (WL), we evaluated the impact of eccentric (ECC) versus classical concentric (CON) training at the same oxygen consumption (V˙O₂) on bone density, geometry and strength.

METHODS

Thirty five adolescents were included into 2 training (CON and ECC cycling) and a control (CTR, without training) groups. Anthropometry, dual-energy X-ray absorptiometry, hip structural analysis and quantitative bone ultrasound were assessed before and after the 12-week intervention.

RESULTS

The trainings promoted significant improvements in body mass index, total fat (FM) and lean mass (LM), with better improvements for FM and LM in the ECC group (p < 0.05). Leg LM percentage increased only in the ECC group (p < 0.05). Total body bone mineral content and density increased in both training groups (p < 0.001) with significant time x group interactions only between ECC and CTR (p < 0.05). Buckling ratio at the intertrochanteric region and femoral shaft increased only in CTR and CON groups (p < 0.05). Speeds of sounds at the calcaneum increased only in ECC group (p < 0.01).

CONCLUSIONS

Bone fragility, from a compromised relationship between density, geometry and strength, might be prevented with the ECC modality.

Effectiveness of martial arts exercise on anthropometric and body composition parameters of overweight and obese subjects: a systematic review and meta-analysis

BACKGROUND

Obesity is considered a top public health concern, and its prevalence is growing every day. Thus, interventions to address this problem should be encouraged and further studied. In this regard, the aim of this review was to summarize the evidence of martial arts interventions to evaluate their effectiveness on the anthropometric and body composition parameters of overweight and obese subjects.

METHODS

A systematic literature search was conducted on January 26, 2020 using the PubMed, Medline, Lilacs, Cochrane, and Scielo databases. Reference lists of eligible articles and relevant reviews have also been examined. All randomized clinical trials on martial arts that evaluated the anthropometric and body composition parameters of overweight and obese subjects were included, and a narrative synthesis of eligible studies was conducted in accordance with PRISMA guidelines. The Downs & Black checklist was used to assess the quality of the studies. This review was registered in the International Prospective Register of Systematic Reviews (PROSPERO) (identifier CRD42018086116).

RESULTS

A total of 82 articles were identified from the initial search strategy. A further 2 articles were identified from the review of relevant bibliographies. Six studies encompassing 258 participants who were overweight or obese were included. Four studies reported Tai Chi practice, one study reported Kung Fu exercise, and another study reported martial arts exercise. The examined meta-analyses did not reveal significant benefits from martial arts practice over control groups after the experiment period for body mass index (- 1.34 kg/m2; 95% CI: - 2.72, 0.05), waist circumference (1.41 cm; 95% CI: - 0.72, 3.54) and percentage of body fat (- 0.75%; 95% CI: - 5.58, 4.08).

CONCLUSION

The scarcity, heterogeneity, short intervention time, small sample size, and significant methodological limitations of the available studies do not allow to conclude whether martial arts are effective in the anthropometric and body composition parameters of overweight and obese individuals. This study highlights the need for more research to assess the benefits of martial arts for overweight and obese individuals.

Effectiveness of Family-Based Behavior Change Interventions on Obesity-Related Behavior Change in Children: A Realist Synthesis

Effective treatment interventions for childhood obesity involve parents, are multicomponent and use behavior change strategies, but more information is needed on the mechanisms influencing behavioral outcomes and the type of parental involvement that is efficacious in behavioral treatment interventions with school-age children. This review aimed to understand key characteristics of programs that contribute to dietary and physical activity behavioral outcomes, and through which key mechanisms. This was a systematic review with narrative synthesis following PRISMA guidelines and realist analysis using RAMESES guidelines to explain outcome patterns and influence of parental involvement. Overall, the findings contribute to understanding the complex relationship between family barriers to behavior change, strategies employed in treatment interventions and behavioral outcomes. Implications for enhancing future policy and practice include involving parents in goal setting, motivational counselling, role modeling, and restructuring the physical environment to promote mutual empowerment of both parents and children, shared value and whole-family ownership in which intrinsic motivation and self-efficacy are implicit. These characteristics were associated with positive dietary and physical activity behavior change in children and may be useful considerations for the design and implementation of future theory-based treatment interventions to encourage habitual healthy diet and physical activity to reduce childhood obesity.

Thirty-two weeks of randomized interdisciplinary therapy or combined physical training promote similar improvements in anthropometric and biochemical parameters of obese women

BACKGROUND

Obesity is a multicausal illness that generates large expenses to health systems and also for the families of obese individuals. It is important to note that obesity disrupts all systems, generating metabolic consequences that may be irreversible. Interdisciplinary therapy is recommended as the primary method for treating obesity. However, the cost of interdisciplinary treatment can be high due to the need for various professionals, from different areas of expertise. This study compares the effects of 32 weeks of physical training combined with interdisciplinary therapy on anthropometric and biochemical parameters in obese women.

METHODS

Seventy-six subjects were randomized into two groups: Group Physical Exercise (EXE) and Group Interdisciplinary Treatment (INTER), being evaluated in the initial moment and after 32 weeks. 30 subjects completed the intervention and were evaluated (EXE: N.=13; INTER: N.=17).

RESULTS

Psychobiological and biochemical variables were measured. EXE and INTER were similar before treatment and both showed significantly improvements in anthropometric and biochemical parameters after interventions, without difference between groups.

CONCLUSIONS

The results confirmed the relevant role of physical training or the interdisciplinary therapy on metabolic profile of obese women. We realized that physical training can be incorporated into public or private health systems as an alternative strategy for obesity control, especially in locations that do not have the possibility of offering a complete interdisciplinary therapy.

The occurrence of depressive symptoms in obese subjects starting treatment and not seeking treatment for obesity

INTRODUCTION

The psychological profile of obese people deciding to start obesity treatment may be different from those not choosing to seek the therapy. Previous studies have shown a higher incidence of depression in obese than in normal weight people. However, data are lacking concerning the occurrence of depressive symptoms and their severity in obese subjects who do or do not decide to start treatment for obesity. Therefore, the aim of this study was to evaluate the prevalence and severity of depressive symptoms among obese people starting treatment and not seeking treatment for obesity.

MATERIALS AND METHODS

Enrolled subjects were 331 adults (241 women, 90 men), including 193 obese subjects starting treatment for obesity (46.8 ± 13.2 years, BMI 37.6 ± 5.5 kg/m2) and 138 obese volunteers never seeking treatment for obesity (44.3 ± 12.5 years, BMI 34.7 ± 4.3 kg/m2). Depression levels were determined using the Beck Depression Inventory (BDI).

RESULTS

The level of depression was significantly higher among those starting treatment for obesity than those never seeking treatment for obesity (13.2 ± 9.2 vs. 9.5 ± 7.9 points; p < 0.001). This difference was statistically significant in women (14.4 ± 9.2 and 11.0 ± 8.2 points, respectively; p < 0.01), but not in men (7.2 ± 6.4 and 7.3 ± 7.1 points, respectively; p = 0.95). There were more women with moderate/severe depressive symptoms in the group starting treatment than in the group not seeking treatment for obesity (44.7 and 24.4%, respectively). No such difference was observed in men.

CONCLUSIONS

Obese subjects, especially women, with depressive symptoms are more likely to start treatment for obesity.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Introducing eccentric cycling during a multidisciplinary weight loss intervention might prevent adolescents with obesity from increasing their food intake: The TEXTOO study

PURPOSE

The present study compared the appetite responses to an inpatient eccentric vs. concentric cycling training programs in adolescents with obesity.

METHODS

24 adolescents with obesity (12-16yrs; Tanner 3-4) followed a 12-week multidisciplinary intervention (Phase1), after which they were randomized to concentric (CON) or eccentric (ECC) training for 12 weeks (Phase2). Assessment of anthropometrics, body composition (DXA), aerobic power (VO_2max), energy (EI) and macronutrient intake, food reward, and subjective appetite were performed at baseline, and after Phase1 (T1) and Phase2 (T2).

RESULTS

Body mass, BMI, and fat mass (FM%) decreased in both groups (p < 0.001). FM% reduction was greater in ECC at T2 (-9.9%). EI did not change in either group at T1, but was greater at T2 relative to T1 in CON only (p < 0.001,+22%). There was no correlation between the change in body mass, FM%, fat-free mass and EI. Hunger (p = 0.002) and desire to eat (p = 0.001) were higher in CON vs. ECC with no time effects nor interactions. Prospective food consumption increased in both groups with no group effect nor interaction. Satiety was not different between groups or over time. In ECC, preference for high-fat foods increased (p = 0.03), and preference (p = 0.004) and implicit wanting (p = 0.016) for sweet foods decreased.

CONCLUSION

Eccentric cycling as part of an inpatient multidisciplinary weight-loss intervention might help prevent increased ad libitum energy intake compared to concentric exercise training in adolescents with obesity, potentially through distinct effects of the food reward system.

Effect of HIIT versus MICT on body composition and energy intake in dietary restrained and unrestrained adolescents with obesity

High-intensity interval training (HIIT) has been suggested as an effective alternative to traditional moderate-intensity continuous training (MICT) that can yield improvements in a variety of health outcomes. Yet, despite the urgent need to find effective strategies for the treatment of pediatric obesity, only a few studies have addressed the impact of HIIT on eating behaviors and body composition in this population. This study aimed to compare the effect of HIIT versus MICT on eating behaviors in adolescents with obesity and to assess if the participants' baseline dietary status is associated with the success of the intervention. Forty-three adolescents with obesity were randomly assigned to a 16-week MICT or HIIT intervention. Body composition and 24-h ad libitum energy intake were assessed at baseline and at the end of the program. Restrained eating, emotional eating, and external eating were assessed using the Dutch Eating Behavior Questionnaire at baseline. Both interventions led to significant weight, body mass index (BMI), and fat mass percentage (FM%) reductions, with better improvements in FM% in the HIIT group; whereas 24-h ad libitum energy intake increased to a similar extent in both groups. HIIT provides better body composition improvements over MICT, despite a similar increase in energy intake. Restrained eaters experienced less weight loss and smaller BMI reduction compared with unrestrained eaters; higher baseline cognitively restrained adolescents showed a greater increase of their ad libitum energy intake. Novelty HIIT favors better body composition improvements compared with MICT. Both MICT and HIIT increased ad libitum energy intake in adolescents with obesity. Weight loss achievement is better among unrestrained eaters.

Does an Age-Specific Treatment Program Augment the Efficacy of a Cognitive-Behavioral Weight Loss Program in Adolescence and Young Adulthood? Results from a Controlled Study

Research on weight-loss interventions in emerging adulthood is warranted. Therefore, a cognitive-behavioral group treatment (CBT), including development-specific topics for adolescents and young adults with obesity (YOUTH), was developed. In a controlled study, we compared the efficacy of this age-specific CBT group intervention to an age-unspecific CBT group delivered across ages in an inpatient setting. The primary outcome was body mass index standard deviation score (BMI-SDS) over the course of one year; secondary outcomes were health-related and disease-specific quality of life (QoL). 266 participants aged 16 to 21 years (65% females) were randomized. Intention-to-treat (ITT) and per-protocol analyses (PPA) were performed. For both group interventions, we observed significant and clinically relevant improvements in BMI-SDS and QoL over the course of time with small to large effect sizes. Contrary to our hypothesis, the age-specific intervention was not superior to the age-unspecific CBT-approach.

Health-related quality-of-life model in adolescents with different body composition

The purpose of the present study was to develop and evaluate a causal model of health-related quality of life (HRQoL) in adolescents with different body composition. The participants were 209 adolescents (107 women and 102 men) ranging from 10 to 15 years of age. A model based on that proposed by Wilson and Cleary (JAMA 273(1):59-65, 1995) was elaborated. The body composition of the participants was analyzed. They were asked to complete a battery of questionnaires composed of the following factors: biological status (BS; included body mass index and weight), symptomatic psychological status (SPS; included the variables of drive for thinness and food concerns), functional status (FS; composed of physical activity, food consumption estimation, and socioeconomic status), and HRQoL, which included the dimensions of psychological well-being, autonomy and relationship with parents, social support and peers, and the academic environment. Structural equation modeling produced a model, which obtained an adequate fit for the prediction of HRQoL (χ²(38) = 51.88, p = .07; NNFI = 0.97, CFI = 0.98, GFI = 0.95, and RMSEA = 0.04). The main outcome demonstrated the indirect effect of BS (0.44) and SPS (- 0.45) as well as a direct effect of FS (0.21) on HRQoL. In addition, a second path was observed, BS has an indirect effect on FS (0.34) and FS on HRQoL (0.21). These results provide empirical support for the evaluated model.Level of evidence: Level V, Descriptive study.

Link between Physical Activity Type in Adolescence and Body Composition in Adulthood

PURPOSE

We investigated whether type of physical activity (PA) (sports, running, and fitness/dance) engaged in during adolescence is associated with body composition in late adolescence or early adulthood.

METHODS

Data were drawn from 631 participants in the Nicotine Dependence in Teens study, a prospective investigation of students ages 12-13 yr at inception. Self-report PA data were collected at baseline, in grade 7, and every 3-4 months thereafter during the 5 yr of high school (1999-2005). Anthropometric indicators (height, weight, waist circumference, triceps, and subscapular skinfold thickness) were measured at ages 12, 16, and 24 yr. On the basis of prior exploratory factor analysis, PA was categorized into one of three types (sports, running, and fitness/dance). Regression models estimated the association between number of years participating in each PA type (0-5 yr) during high school and body composition measures in later adolescence or early adulthood.

RESULTS

In multivariable models accounting for age, sex, and parent education, more number of years participating in running during adolescence was associated with lower body mass index, waist circumference, and skinfold thickness in later adolescence and early adulthood (all P < 0.01). This association was no longer apparent in models that accounted for body composition at age 12 yr. The number of years participating in sports was positively associated with body mass index in early adulthood (P = 0.02), but fitness/dance was not statistically significantly associated with any outcome.

CONCLUSION

Sustaining participation in running, but not in other PA types, during adolescence was related to lower body composition in later adolescence and adulthood. However, more research is needed to determine whether this association is attributable to a relationship between PA and body composition in early adolescence.

Cognitive restriction accentuates the increased energy intake response to a 10-month multidisciplinary weight loss program in adolescents with obesity

BACKGROUND

Multidisciplinary interventions have shown some merits in weight reduction strategies in youth, however, their impact on subsequent daily energy intake remains largely unknown. The aim of the present study was to evaluate the nutritional responses to a 10-month multidisciplinary intervention among adolescents with obesity, in relation to their eating behavior characteristics.

METHODS

Thirty-five adolescents (mean age: 13.4 ± 1.2 years) with obesity took part in a 10-month residential multidisciplinary weight loss program. Anthropometric measurements, body composition (dual-energy X-ray absorptiometry), 24-h ad libitum energy intake (weighted), eating behaviors (Dutch Eating Behavior Questionnaire) and appetite sensations (Visual Analogue Scales) were assessed on three occasions: at their arrival in the institution (T0), after 5 months (T1), and at the end of the 10-month program (T2).

RESULTS

The mean weight loss reached 11% of the adolescents' initial body weight, with an important inter-individual variability (-25% to +3% of their initial body weight). Results revealed sex differences change, with boys showing a higher decrease in fat mass percent and increase in fat-free mass compared with girls. Weight loss was accompanied by a significant decrease in emotional (-8.3%, p < 0.05) and external (-14.8%, p < 0.001) eating scores and a significant increase in 24-h ad libitum energy intake (+246 kcal, p < 0.001). The observed subsequent increased 24-h ad libitum energy intake at T2 compared to T0 was significantly higher in cognitively restrained eaters (+492 kcal) compared to unrestrained eaters (+115 kcal, p = 0,015). Dietary restraint score at baseline was inversely correlated with the percentage of weight loss (r = -0.44, p = 0.010).

CONCLUSION

A 10-month multidisciplinary weight loss intervention induced an increase in 24-h ad libitum energy intake compared to baseline, especially in cognitively restrained eaters. Moreover, initially cognitively restrained eaters tended to lose less body weight compared to unrestrained ones. These findings suggest that cognitive restriction may be a useful eating behavior characteristic to consider as a screening tool for identifying adverse responders to weight loss interventions in youth.

A Review of Systematic Reviews Targeting the Prevention and Treatment of Overweight and Obesity in Adolescent Populations

PURPOSE

Adolescent obesity is a powerful predictor of morbidity and mortality, yet amenable to modifiable behaviors. To accurately summarize the effects of behavioral interventions on changes in adolescent body mass index and/or weight status, we assessed existing systematic reviews for reporting transparency and methodological quality.

METHODS

Five databases were searched through September 2017 to identify relevant systematic reviews. Reviews were evaluated for reporting transparency and methodological quality using PRISMA Reporting Checklist and Assessment of Multiple Systematic Reviews Instrument. Evidence was synthesized across high-quality reviews.

RESULTS

Four of twelve systematic reviews were of high methodological quality. All four focused on the treatment of overweight/obesity in adolescent populations, representing 97 international studies. Findings indicate intervention compared with no intervention/wait list showed larger effects for improving BMI/BMI z-scores. Small improvements (averaging a 3.7-kg decrease) in weight/weight percentile were observed following a supervised exercise plus dietary and/or behavior support intervention. Health-related quality of life may improve following interventions, but overall attention to associated psychological variables (depression, self-esteem/perception) is limited.

CONCLUSIONS

Adherence to objective checklists and protocols for rigorous conduct and reporting of systematic reviews is warranted. Consensus evidence is urgently needed to define and report behavior change interventions related to obesity prevention and treatment.

Motivational Interviewing to Treat Adolescents With Obesity: A Meta-analysis

CONTEXT

Successful treatment approaches are needed for obesity in adolescents. Motivational interviewing (MI), a counseling approach designed to enhance behavior change, shows promise in promoting healthy lifestyle changes.

OBJECTIVE

Conduct a systematic review of MI for treating overweight and obesity in adolescents and meta-analysis of its effects on anthropometric and cardiometabolic outcomes.

DATA SOURCES

We searched Medline, Embase, Cumulative Index to Nursing and Allied Health Literature, PsychINFO, Web of Science, Cochrane Library, and Google Scholar from January 1997 to April 2018.

STUDY SELECTION

Four authors reviewed titles, abstracts, and full-text articles.

DATA EXTRACTION

Two authors abstracted data and assessed risk of bias and quality of evidence.

RESULTS

Seventeen studies met inclusion criteria; 11 were included in the meta-analysis. There were nonsignificant effects on reducing BMI (mean difference [MD] -0.27; 95% confidence interval -0.98 to 0.44) and BMI percentile (MD -1.07; confidence interval -3.63 to 1.48) and no discernable effects on BMI z score, waist circumference, glucose, triglycerides, cholesterol, or fasting insulin. Optimal information size necessary for detecting statistically significant MDs was not met for any outcome. Qualitative synthesis suggests MI may improve health-related behaviors, especially when added to complementary interventions.

LIMITATIONS

Small sample sizes, overall moderate risk of bias, and short follow-up periods.

CONCLUSIONS

MI alone does not seem effective for treating overweight and obesity in adolescents, but sample size and study dose, delivery, and duration issues complicate interpretation of the results. Larger, longer duration studies may be needed to properly assess MI for weight management in adolescents.

Transtheoretical model for change in obese adolescents: MERC randomized clinical trial

The randomized controlled trial evaluated the effectiveness of an intervention based on the Transtheoretical Model of Change on anthropometric, metabolic and motivational outcomes in obese adolescents. A total of 135 male and female adolescents were randomized to two groups: intervention group (n = 65) and control group (n = 70). The adolescents were evaluated 1 week before the interventions began and at the end of 12 weeks. There was no statistically significant difference between groups in the outcome variables. Intervention group reported magnitude of effect more expressive on body mass index percentile, waist circumference, waist-to-hip ratio, readiness to change diet and readiness to start exercise.

Individuals with lumbar spinal stenosis seek education and care focused on self-management-results of focus groups among participants enrolled in a randomized controlled trial

BACKGROUND CONTEXT

The effectiveness of treatments for chronic, degenerative conditions of the lumbar spine can be influenced by patient perceptions and expectations regarding treatment.

PURPOSE

The primary purpose of this study was to understand the factors that are important to individuals with lumbar spinal stenosis (LSS) regarding different nonsurgical treatments. These factors were considered within the context of each treatment received as a part of the parent randomized controlled trial (RCT).

STUDY DESIGN

Focus group study of RCT participants.

PATIENT SAMPLE

Convenience sample of 50 individuals with LSS (28 female, average age 73±7.7 years) from an RCT participated in one of six focus groups. Focus groups consisted of patients previously randomized to one of three nonsurgical treatments: (1) medical care; (2) community-based group exercise; and (3) clinic-based manual therapy and individualized exercise.

OUTCOME MEASURES

Experiences, opinions, and preferences of individuals with LSS who participated in an RCT. Inter-coder agreement for qualitative analysis was conducted with kappa statistics.

METHODS

Participants discussed their experiences and perceptions regarding study treatment and their general experience with LSS using open-ended questions provided by a facilitator. Transcripts were coded according to modified grounded theory in an open approach, using codes that addressed the primary focus group discussion topics (primary coding) and codes for emerging topics (secondary coding). Secondary coding sought to identify themes concerning living with LSS and seeking treatment that were emergent from the focus groups. This study was funded by the Patient-Centered Research Outcomes Institute. The authors report no conflicts of interest.

RESULTS

Three themes related to medical treatment and symptom management arose from analyses: (1) an emotional response to LSS; (2) a desire for education about LSS and motivation to pursue education from any available source; and (3) a desire for individualized care based on self-management techniques and lifestyle changes. Emotional responses were more evident in individuals receiving medical care, whereas the other two themes were consistent across all three treatment groups.

CONCLUSIONS

The chronic pain associated with LSS may result in negative emotional responses. Individuals with LSS may believe misinformation and information from nonmedical sources, especially when medical providers do not spend sufficient time explaining the disease process and the reasoning behind treatment strategies. Receiving individualized care focused on self-management led to fewer negative emotions toward care and the disease process. Clinicians should be prepared to address all three of these aspects when providing care to individuals with LSS.

Sustained impact of the "Healthy Habits, Healthy Girls - Brazil" school-based randomized controlled trial for adolescents living in low-income communities

Pediatric obesity is a major public health concern in low- and middle-income countries, such as Brazil. There is an urgent need for preventive programs for adolescents and, the assessment of their sustained impact. This paper reports the longer-term (6-month post intervention) effects of the "H3G-Brazil" obesity prevention program on weight status and weight-related behaviors. A cluster randomized controlled trial starting with 10 public schools in the city of São Paulo, Brazil involved 253 adolescent girls [mean (se) age = 15.6 (0.87) years]. Body mass index (BMI), waist circumference (WC), dietary intake, physical activity (PA) and sedentary behaviors (SB) were assessed at baseline, immediate post-intervention and 6-month post-intervention (follow-up). ANCOVA was performed using intention to treat principles. There was no effect on BMI, the primary outcome. Although, meaningful increases occurred in waist circumference for both groups, the intervention group presented a lower increase (F = 3.31, p = 0.04). This effect size, however, was lower than the criterion for small (d = 0.102). Unfortunately, significant results favored the control group for time spent on TV/weekdays (F = 5.13, p = 0.01), TV/weekends (F = 5.46, p = 0.01) and sedentary behaviors/weekdays (F = 5.32, p = 0.04). No other significant results were found. This obesity prevention intervention among Brazilian adolescent girls did not have the desire effect on BMI. The significantly lower increase in waist circumference in the intervention groups is inconsistent with the adverse changes detected in sedentary time.

Obesity and eating disorders in integrative prevention programmes for adolescents: protocol for a systematic review and meta-analysis

INTRODUCTION

Obesity and eating disorders are public health problems that have lifelong financial and personal costs and common risk factors, for example, body dissatisfaction, weight teasing and disordered eating. Obesity prevention interventions might lead to the development of an eating disorder since focusing on weight may contribute to excessive concern with diet and weight. Therefore, the proposed research will assess whether integrating obesity and eating disorder prevention procedures ('integrated approach') do better than single approach interventions in preventing obesity among adolescents, and if integrated approaches influence weight-related outcomes.

METHODS AND ANALYSIS

Integrated obesity and eating disorder prevention interventions will be identified. Randomised controlled trials and quasi-experimental trials reporting data on adolescents ranging from 10 to 19 years of age from both sexes will be included. Outcomes of interest include body composition, unhealthy weight control behaviours and body satisfaction measurements. MEDLINE/PubMed, PsycINFO, Web of Science and SciELO will be searched. Data will be extracted independently by two reviewers using a standardised data extraction form. Trial quality will be assessed using the Cochrane Collaboration criteria. The effects of integrated versus single approach intervention studies will be compared using systematic review procedures. If an adequate number of studies report data on integrated interventions among similar populations (k>5), a meta-analysis with random effects will be conducted. Sensitivity analyses and meta-regression will be performed only if between-study heterogeneity is high (I² ≥75%).

ETHICS AND DISSEMINATION

Ethics approval will not be required as this is a systematic review of published studies. The findings will be disseminated through conference presentations and peer-reviewed journals.

The effectiveness of contingency management in the treatment of patients with anorexia nervosa: A systematic review

Contingency management in stipulating weight gain is routinely used in the treatment of anorexia nervosa, however, empirical investigations concerning its effectiveness have been scarce. This systematic review was conducted according to the PRISMA statement. Of N = 973 hits, 42 full-texts were included in the qualitative synthesis (11 theoretical texts, 19 case reports, 12 descriptive, cohort, and controlled trials). A central topic in the included publications concerns the enhancement of patients' autonomy through participation in the contingency management process. This heightened autonomy is achieved by using contingency contracts. Positive short-term effects on weight gain were shown, whereas follow-up results were heterogeneous. Although contingency contracts are widely used in clinical practice, our systematic review shows that empirical evidence on underlying mechanisms and efficacy is still scarce. Using an explicit treatment contract can enhance patients' motivation, compliance, and autonomy. Clinical practice should see further development including innovative motivation enhancing and conflict dissolving techniques in addressing the pronounced ambivalence often shown by patients with anorexia nervosa.

A scoping review protocol to map the evidence on interventions to prevent overweight and obesity in children

INTRODUCTION

Obesity has become one of the biggest public health problems of the 21st century. Prevalence of obesity in children and adolescents has increased dramatically worldwide over the last 20 years, and this trend is expected to continue. Obesity in childhood is concerning as it predicts obesity in adulthood, a common risk factor for a wide array of chronic diseases and poor health outcomes. Obesity is preventable and a vast but fragmented body of evidence on preventative interventions is now available. This article outlines the protocol for a scoping review of published literature reviews on interventions to prevent obesity in children. The scoping review addresses the broad research question 'What is the evidence on interventions to prevent childhood obesity?'. It aims to give an overview of the various interventions available, understand those which are effective and identify barriers and facilitators to their effectiveness.

METHODS AND ANALYSIS

The six-staged Arksey and O'Malley methodology framework is used to guide the scoping review process: following the definition of the research questions (stage 1); the eligibility criteria and search strategy are defined (stage 2); the study selection process based on the eligibility criteria identified will follow (stage 3); a framework developed for this review will then inform the extraction and charting of data from the included reviews (stage 4); results will be aggregated and summarised with criteria relevant for health professionals and policy-makers (stage 5); and the optional consultation (stage 6) exercise is not planned.

ETHICS AND DISSEMINATION

Since the scoping review methodology aims at synthetising information from available publications, this study does not require ethical approval. An article reporting the results of the scoping review will be submitted for publication to a scientific journal, presented at relevant conferences and disseminated as part of future workshops with professionals involved in obesity prevention.

Are emotionally driven and addictive-like eating behaviors the missing links between psychological distress and greater body weight?

There is now a large body of evidence suggesting a significant association between emotional discomfort management, disordered eating behaviors and weight status. In the field of overweight and obesity, emotionally driven eating habits that resemble addictive behaviors are considered as a risk factor. This study aimed to investigate in a large sample of French university students 1) the associations between self-reported levels of psychological distress (PD), emotional eating (EE), food addiction (FA) and Body Mass Index (BMI); and 2) the potential mediation effect of eating behaviors (EE and FA) between PD and BMI. The responses of 1051 students (76.3% females) to self-reports assessing PD (Perceived Stress Scale, Hospital Anxiety and Depression Scale), EE (Intuitive Eating Scale-2) and FA (modified Yale Food Addiction Scale) were analysed. Associations between variables (Spearman correlation) and group comparisons by sex and BMI categories (Student's t tests/ANOVA) were tested, followed by Structural Equation Modeling (SEM) by sex. Among females and males, EE and FA scores were positively inter-related and correlated with PD scores and BMI. Moreover, among females and males, SEM showed that both EE and FA acts as mediators between PD and BMI. Hence, among educated young adults, using food consumption for down-regulating negative mood places the individual at risk for overweight and obesity. This study further emphasizes the necessity to take into account emotionally driven and addictive-like eating behaviors in interventions for promoting healthy eating and weight management.