Homeostatic and neurocognitive control of energy intake in response to exercise in pediatric obesity: a psychobiological framework

The effectiveness of multidisciplinary weight loss interventions is associated with initial cardiorespiratory fitness in adolescents with obesity

BACKGROUND

The identification of predictive parameters of the success of multidisciplinary weight loss interventions (MWLI) appears essential to optimize obesity management. The association between baseline cardiorespiratory fitness (CRF) and changes in anthropometric parameters and body composition during MWLI remains underexplored in adolescents with obesity.

OBJECTIVES

To assess whether baseline CRF was associated with the effectiveness of a 16-week MWLI measured through improved body mass, body mass index (BMI) and body composition (percentage of total fat mass (FM) as the main criterion).

METHODS

Cardiorespiratory fitness and body composition were respectively measured by peak oxygen consumption (VO2peak) during maximal exercise tests and dual-photon x-ray absorptiometry (DXA), before (T0) and after (T1) a 16-week MWLI in 165 adolescents (aged 13.3 ± 1.38 years, 61.2% female, BMI 35.11 ± 5.16 kg/m2).

RESULTS

Reductions in BMI and total FM percentage between T0 and T1 were greater in subjects with a baseline VO2peak ≥ 3rd quartile compared to the first quartile (p < 0.001) and the interquartile range (p < 0.05 and p < 0.001, respectively). Baseline VO2peak and VO2 at the first ventilator threshold were positively correlated with the reductions in body mass, BMI and total and visceral FM percentages and with the increase in lean mass (LM) percentage between T0 and T1 after adjustment for age and gender (p < 0.001).

CONCLUSION

Initial CRF is associated with the success of MWLI in adolescents with obesity. Improving their aerobic fitness before starting a MWLI might be a promising strategy to optimize its benefits.

A brief bout of moderate intensity physical activity improves preadolescent children's behavioral inhibition but does not change their energy intake

Children in rural communities consume more energy-dense foods relative to their urban peers. Identifying effective interventions for improving energy intake patterns are needed to address these geographic disparities. The primary aim of this study was to harness the benefits of physical activity on children's executive functioning to see if these improvements lead to acute changes in eating behaviors. In a randomized crossover design, 91 preadolescent (8-10y; M age = 9.48 ± 0.85; 50.5% female; 85.7% White, 9.9% Multiracial, 9.9% Hispanic) children (86% rural) completed a 20-minute physical activity condition (moderate intensity walking) and time-matched sedentary condition (reading and/or coloring) ~ 14 days apart. Immediately following each condition, participants completed a behavioral inhibition task and then eating behaviors (total energy intake, relative energy intake, snack intake) were measured during a multi-array buffet test meal. After adjusting for period and order effects, body fat (measured via DXA), and depressive symptoms, participants experienced significant small improvements in their behavioral inhibition following the physical activity versus sedentary condition (p = 0.04, Hedge's g = 0.198). Eating behaviors did not vary by condition, nor did improvements in behavioral inhibition function as a mediator (ps > 0.09). Thus, in preadolescent children, small improvements in behavioral inhibition from physical activity do not produce acute improvements in energy intake. Additional research is needed to clarify whether the duration and/or intensity of physical activity sessions would produce different results in this age group, and whether intervention approaches and corresponding mechanisms of change vary by individual factors, like age and degree of food cue responsivity.

Diazoxide and moderate-intensity exercise improve skeletal muscle function by decreasing oxidants and enhancing antioxidant defenses in hypertensive male rats

High sodium intake is decisive in the incidence increase and prevalence of hypertension, which has an impact on skeletal muscle functionality. Diazoxide is an antihypertensive agent that inhibits insulin secretion and is an opener of KATP channels (adosine triphosphate sensitive potasium channels). For this reason, it is hypothesized that moderate-intensity exercise and diazoxide improve skeletal muscle function by reducing the oxidants in hypertensive rats. Male Wistar rats were assigned into eight groups: control (CTRL), diazoxide (DZX), exercise (EX), exercise + diazoxide (EX + DZX), hypertension (HTN), hypertension + diazoxide (HTN + DZX), hypertension + exercise (HTN + EX), and hypertension + exercise + diazoxide (HTN + EX + DZX). To induce hypertension, the rats received 8% NaCl dissolved in water orally for 30 days; in the following 8 weeks, 4% NaCl was supplied to maintain the pathology. The treatment with physical exercise of moderate intensity lasted 8 weeks. The administration dose of diazoxide was 35 mg/kg intraperitoneally for 14 days. Tension recording was performed on the extensor digitorum longus and the soleus muscle. Muscle homogenates were used to measure oxidants using fluorescent probe and the activity of antioxidant systems. Diazoxide and moderate-intensity exercise reduced oxidants and increased antioxidant defenses.

Higher energy flux may improve short-term appetite control in adolescents with obesity: the NEXT study

Recent evidence suggests better appetite control in states of high-energy flux (HEF) in adults and lean children. Nevertheless, it is unknown whether this extends to youth with obesity. This study compares the effects of low, moderate or HEF on short-term appetitive control in adolescents with obesity. Sixteen adolescents with obesity (12-16 years, Tanner stages 3-5, 11 females) randomly completed three conditions: (i) low-energy flux (LEF); (ii) moderate energy flux (MEF; + 250 kcal) and (iii) HEF (HEF; + 500 kcal). Energy flux was achieved in MEF and HEF through elevated energy intake (EI) and concomitant increase in energy expenditure using cycling exercise (65 % VO2peak). Ad libitum EI, macronutrient intake and relative EI were assessed at dinner, subjective appetite sensations taken at regular intervals and food reward measured before dinner. Ad libitum EI at dinner was greater in LEF compared with HEF (P = 0·008), and relative EI (REI) was higher in LEF compared with MEF (P = 0·003) and HEF (P < 0·001). The absolute consumption of carbohydrates was lower in LEF compared with MEF (P = 0·047) and HEF (P < 0·001). Total AUC for hunger and desire to eat was lower in HEF compared with LEF (P < 0·001) and MEF (P = 0·038). Total AUC for prospective food consumption was lower on HEF compared with LEF (P = 0·004). Food choice sweet bias was higher in HEF (P = 0·005) compared with LEF. To conclude, increasing energy flux may improve short-term appetite control in adolescents with obesity.

Effect of virtual reality-based exercise and physical exercise on adolescents with overweight and obesity: study protocol for a randomised controlled trial

INTRODUCTION

Obesity is a complex and multifactorial disease that has affected many adolescents in recent decades. Clinical practice guidelines recommend exercise as the key treatment option for adolescents with overweight and obesity. However, the effects of virtual reality (VR) exercise on the physical and brain health of adolescents with overweight and obese remain unclear. This study aims to evaluate the effects of physical and VR exercises on physical and brain outcomes and explore the differences in benefits between them. Moreover, we will apply a multiomics analysis to investigate the mechanism underlying the effects of physical and VR exercises on adolescents with overweight and obesity.

METHODS AND ANALYSIS

This randomised controlled clinical trial will include 220 adolescents with overweight and obesity aged between 11 and 17 years. The participants will be randomised into five groups after screening. Participants in the exercise groups will perform an exercise programme by adding physical or VR table tennis or soccer classes to routine physical education classes in schools three times a week for 8 weeks. Participants in the control group will maintain their usual physical activity. The primary outcome will be the change in body fat mass measured using bioelectrical impedance analysis. The secondary outcomes will include changes in other physical health-related parameters, brain health-related parameters and multiomics variables.

ETHICS AND DISSEMINATION

This study was approved by the Ethics Committee of Shanghai Sixth People's Hospital and registered in the Chinese Clinical Trial Registry. Dissemination of the findings will include peer-reviewed publications, conference presentations and media releases.

TRIAL REGISTRATION NUMBER

ChiCTR2300068786.

Toward an Integrated Consideration of 24 h Movement Guidelines and Nutritional Recommendations

While physical activity, sleep and sedentary behaviors are almost always considered independently, they should be considered as integrated human behaviors. The 24 h Movement approach proposes a concomitant consideration of these behaviors to promote overall health. Not only do these behaviors impact energy expenditure, but they have also been shown to separately impact energy intake, which should be further explored when considering the entire integration of these movement behaviors under the 24 h movement approach. After an evaluation of the prevalence of meeting the 24 h Movement and dietary recommendations, this review summarizes the available evidence (using English publications indexed in PubMed/MEDLINE) regarding the association between the 24 h Movement Guidelines and eating habits. Altogether, the results clearly show the beneficial impact of promoting the 24 h guidelines simultaneously, highlighting that the higher the number of respected movement recommendations, the better eating behaviors in both children and adults. Importantly, our results point out the importance of emphasizing the need to reach sedentary guidelines for better eating habits. Movement and dietary behaviors appear closely related, and giving recommendations on one might impact the other. Combining the 24 h Movement with dietary Guidelines might be more efficient than promoting them separately in public health strategies.

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.

Effect of acute dietary- versus combined dietary and exercise-induced energy deficits on subsequent energy intake, appetite and food reward in adolescents with obesity

BACKGROUND

Acute dietary-induced energy deficits have been shown to favor compensatory appetitive responses. The aim of this study was to compare energy intake (EI), appetite sensations and the hedonic responses to equivalent energy deficits induced by dietary restriction alone and combined with exercise in adolescents with obesity.

METHODS

In a within-subjects design, seventeen adolescents with obesity (12-16 years, Tanner stage 3-5, 6 males) randomly completed three 14 h conditions: (i) control (CON); (ii) deficit induced by diet only (Def-EI) and; (iii) deficit induced by combined diet and physical exercise (Def-mixed). Breakfast and lunch were calibrated to generate a 500 kcal deficit in Def-EI and 250 kcal deficit in Def-mixed. A 250 kcal deficit was created through a cycling exercise set at 65% VO_2peak in Def-mixed. Ad libitum EI, macronutrients and relative EI (REI) were assessed at dinner, subjective appetite sensations taken at regular intervals, and food reward measured before dinner.

RESULTS

EI at dinner was significantly lower in Def-EI compared to CON (p = 0.014; Effect size (ES): -0.59 [-1.07; -0.12]), with no difference between Def-mixed and both CON and Def-EI. Total REI was lower in both deficit conditions compared with CON (Def-mixed: p < 0.001; ES: -3.80 [-4.27; -3.32], Def-EI: p < 0.001; ES: -4.90 [-5.37; -4.42] respectively), indicating incomplete compensation for the energy deficits. Absolute protein ingestion at dinner was lower in Def-EI than Def-mixed (p = 0.037; ES: -0.50 [-0.98; -0.03]) and absolute lipid ingestion was lower in Def-EI than in CON (p = 0.033; ES: -0.51 [-0.99; -0.04]). A higher proportion of protein and a lower proportion of carbohydrates was observed in Def-mixed than in Def-EI (p = 0.078; ES: -0.42 [-0.90; 0.04] and p = 0.067; ES: 0.44 [-0.03; 0.92] respectively). Total area under the curve for appetite sensations were similar between conditions. Explicit liking for sweet relative to savoury food was lower in Def-mixed compared to CON (p = 0.027; ES: -0.53 [-1.01; -0.06]) with no difference in food reward between Def-EI and CON.

CONCLUSION

Neither of the two acute isoenergetic deficits led to subsequent appetitive compensation, with the dietary deficit even inducing a lower ad libitum EI at the subsequent dinner. Further studies are needed to better understand the appetitive response to dietary and exercise energy balance manipulations in this population.

Diet- but not exercise-induced iso-energetic deficit induces compensatory appetitive responses

Although physical exercise and dietary restriction can be both used to induce energy deficits, they have been suggested to favor different compensatory appetitive responses. While dietary restriction might favor increased subsequent energy intake and appetite sensations, such compensatory responses have not been observed after a similar deficit by exercise. The present work provides a first overview of the actual evidences discussing the effects of iso-energetic deficits induced by exercise versus dietary restriction on subsequent energy intake, appetite sensations, and on the potentially involved hedonic and physiological mechanisms.

Delayed meal timing after exercise is associated with reduced appetite and energy intake in adolescents with obesity

BACKGROUND

While the beneficial effects of exercise on appetite might depend on its timing during the day or relative to a meal, this remains poorly explored in youth.

OBJECTIVES

To examine the importance of meal timing (+30 vs +90 minutes) after performing exercise on energy intake, appetite and food reward in adolescents with obesity.

METHODS

Eighteen adolescents with obesity randomly completed three conditions: (a) lunch (12:00 pm) set 30 minutes after a rest session (11:00 am); (b) lunch (12:00 pm) set 30 minutes after an exercise session (11:00 am)(MEAL-30); (c) lunch (01:00 pm) set 90 minutes after an exercise session (11:00 am)(MEAL-90). Lunch and dinner ad libitum energy intake was assessed, food reward (LFPQ) assessed before and after lunch, and before dinner, appetite sensations were assessed at regular intervals.

RESULTS

Energy intake was lower at MEAL-90 than MEAL-30 and CON at lunch (P < .05 and P < .01, respectively) and lunch + dinner combined (P < .001). A decrease in intake (g) of protein, fat and carbohydrate was observed. Post-exercise hunger was lower on MEAL-90 compared with CON. No condition effects were found at lunch for food reward.

CONCLUSIONS

Delaying the timing of the meal after exercise might help affect energy balance by decreasing ad libitum energy intake without increasing hunger and by improving satiety in adolescents with obesity.

Effect of a 10-month residential multidisciplinary weight loss intervention on food reward in adolescents with obesity

BACKGROUND

While multidisciplinary weight loss (WL) programs have been suggested to improve the sensitivity of appetite control system, this study examined for the first time the effect of a specific multidisciplinary intervention on the hedonic aspects of food intake in adolescents with obesity.

STUDY DESIGN

Twenty-four adolescents (11-15 years) with obesity (mean BMI: 35.7 ± 4.5 kg/m²; BMI percentile: 98.7 ± 0.5) took part in a 10-month inpatient WL program, which included physical activity, nutritional education and psychological support. Height, weight, body composition, food reward (pre- and post-meal), ad libitum energy intake, appetite sensations and eating behavior traits were assessed at baseline, 5 months and at the end of the 10-month intervention. Analyses were conducted with linear mixed models and paired t-tests.

RESULTS

The mean WL was 8.9 ± 6.9 kg. Appetite sensations and pre-meal hedonic ratings of liking for all food categories (HF: high-fat; LF: low-fat; SA: savory; SW: sweet) increased after 5 months (fasting hunger, p = 0.02; fasting desire to eat, p = 0.01; daily hunger, p = 0.001; pre-meal liking for HFSA, p = 0.03; LFSA, p = 0.04; HFSW, p = 0.009; LFSW, p = 0.005). In contrast, appetite sensations (fasting and daily), emotional eating (p < 0.001), uncontrolled eating (p = 0.009), and pre-meal explicit liking (for all food categories) decreased between months 5 and 10. Post-meal liking for HFSA (p < 0.001), LFSA (p = 0.002), HFSW (p = 0.02) and LFSW (p < 0.001) decreased between baseline and month 5 and remained unchanged between months 5 and 10.

CONCLUSION

These findings suggest that adaptive mechanisms to WL occurring in the short-to-medium term are attenuated in the longer term with the persistence of WL. These results indicate improvements in the reward response to food in adolescents with obesity and may contribute to the beneficial effect of multicomponent WL interventions in this population. Future studies are required to confirm these findings and elucidate underlying mechanisms.

Does exercising before or after a meal affect energy balance in adolescents with obesity?

BACKGROUND AND AIM

Exercise timing has been suggested to affect appetite and energy intake (EI). The aim of this study was to examine the impact of exercising immediately before or after a meal on EI, appetite sensations and food reward (FR) in adolescents with obesity.

METHODS AND RESULTS

Seventeen adolescents with obesity completed 3 experimental sessions (randomized controlled trial): rest + lunch (CON); exercise + lunch (EX-MEAL); lunch + exercise (MEAL-EX). The exercise consisted of cycling 30 min at 65%V̇O_2peak. Outcomes included ad libitum EI (weighed lunch and dinner), FR (Leeds Food Preference Questionnaire at pre- and post-combination of exercise/rest and lunch, and pre-dinner) and appetite sensations (visual analogue scales). EI was not different between conditions. Compared with CON, relative EI at lunch was lower in EX-MEAL and MEAL-EX (p ≤ 0.05) and daily only in MEAL-EX (p < 0.01). Postprandial fullness was higher in EX-MEAL compared to CON. Compared with CON, both EX-MEAL and MEAL-EX attenuated the increase in wanting for sweet food and reduced explicit liking for fat.

CONCLUSIONS

These preliminary results suggest that exercising immediately before or after a meal produce few differences in appetite and have small beneficial effects on overall energy balance in adolescents with obesity, as well as on FR.

CLINICAL TRIALS

NCT03967782.

The Impact of Physical Activity on Food Reward: Review and Conceptual Synthesis of Evidence from Observational, Acute, and Chronic Exercise Training Studies

PURPOSE OF REVIEW

This review brings together current evidence from observational, acute, and chronic exercise training studies to inform public debate on the impact of physical activity and exercise on food reward.

RECENT FINDINGS

Low levels of physical activity are associated with higher liking and wanting for high-energy food. Acute bouts of exercise tend to reduce behavioral indices of reward for high-energy food in inactive individuals. A dissociation in liking (increase) and wanting (decrease) may occur during chronic exercise training associated with loss of body fat. Habitual moderate-to-vigorous physical activity is associated with lower liking and wanting for high-fat food, and higher liking for low-fat food. Food reward does not counteract the benefit of increasing physical activity levels for obesity management. Exercise training appears to be accompanied by positive changes in food preferences in line with an overall improvement in appetite control.

High-intensity Interval Training Promotes the Shift to a Health-Supporting Dietary Pattern in Young Adults

A healthy lifestyle is based on a correct diet and regular exercise. Little is known about the effect of different types of exercise on dietary preferences. To address the question of whether high-intensity interval training (HIIT) could modulate spontaneous food choices, an experimental study was carried out on 32 young, healthy normal-weight subjects. The spontaneous diet of each subject has been monitored over nine weeks of indoor-cycling training, divided into three mesocycles with an incremental pattern: total energy intake, macronutrients and micronutrients have been analysed. A two-way mixed model has been used to assess differences in dietary variables; a principal factor analysis has been performed to identify sample subgroups. An increased energy intake (+17.8% at T3; p < 0.01) has been observed, although macronutrients' proportions did not vary over time, without differences between sexes. An increase of free fat mass was found in the last mesocycle (+3.8%), without an augmentation of body weight, when, despite the increased training load, a stabilization of energy intake occurred. Three different subgroups characterized by different dietary modifications could be identified among participants that showed a common trend towards a healthier diet. Nine weeks of HIIT promoted a spontaneous modulation of food choices and regulation of dietary intake in young normal-weight subjects aged 21-24. Importantly, this life-period is critical to lay the foundation of correct lifestyles to prevent metabolic diseases and secure a healthy future with advancing age.

Exceptional Reported Effects and Data Anomalies Merit Explanation from "A randomized controlled trial of coordination exercise on cognitive function in obese adolescents" by

We read the recent article in Psychology of Sport and Exercise by Liu et al. ("A randomized controlled trial of coordination exercise on cognitive function in obese adolescents") with great interest. Our interest in the article stemmed from the extraordinary differences in obesity-related outcomes reported in response to a rope-jumping intervention. We requested the raw data from the authors to confirm the results and, after the journal editors reinforced our request, the authors graciously provided us with their data. We share our evaluation of the original data herein, which includes concerns that weight and BMI loss by the intervention appears extraordinary in both magnitude and aspects of the distributions. We request that the authors address our findings by providing explanations of the extraordinary data or correcting any errors that may have occurred in the original report, as appropriate.

Post-moderate-intensity exercise energy replacement does not reduce subsequent appetite and energy intake in adolescents with obesity

Exercise modifies energy intake (EI) in adolescents with obesity, but whether this is mediated by the exercise-induced energy deficit remains unknown. The present study examined the effect of exercise with and without dietary replacement of the exercise energy expenditure on appetite, EI and food reward in adolescents with obesity. Fourteen 12–15-year-old adolescents with obesity (eight girls; Tanner 3–4; BMI 34·8 (sd 5·7) kg/m2; BMI z score 2·3 (sd 0·4)) randomly completed three experimental conditions: (i) rest control (CON); (ii) 30-min cycling (EX) and (iii) 30-min cycling with dietary energy replacement (EX + R). Ad libitum EI was assessed at lunch and dinner, and food reward (Leeds Food Preference Questionnaire) before and after lunch. Appetite was assessed at regular intervals. Lunch, evening and total EI (excluding the post-exercise snack in EX − R) were similar across conditions. Lunch and total EI including the post-exercise snack in EX + R were higher in EX − R than CON and EX; EX and CON were similar. Total relative EI was lower in EX (6284 (sd 2042) kJ) compared with CON (7167 (sd 2218) kJ; P < 0·05) and higher in EX + R (7736 (sd 2033) kJ) compared with CON (P < 0·001). Appetite and satiety quotients did not differ across conditions (P ≥ 0·10). Pre-meal explicit liking for fat was lower in EX compared with CON and EX + R (P = 0·05). There was time by condition interaction between EX and CON for explicit wanting and liking for fat (P = 0·01). Despite similar appetite and EI, adolescents with obesity do not adapt their post-exercise food intake to account for immediate dietary replacement of the exercise-induced energy deficit, favouring a short-term positive energy balance.

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.