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

Optimisation des stratégies interdisciplinaires de prise en charge de l'obésité pédiatrique : de l'évaluation clinique aux effets du Timing exercice-repas sur le comportement alimentaire de l'adolescent en situation d'obésité

The rise of pediatric overweight, obesity and of their metabolic complications calls for the development of innovative, effective and integrative weight management strategies. Physical exercise is an essential component of multidisciplinary weight loss interventions that is no longer considered as a simple source of additional energy expenditure but is now recognized for its potential effects on energy intake (EI) and appetite control. The aim of the present work was to assess the effect of the exercise-meal timing (TIMEX program, for Timing Meal - Exercise) on energy intake, appetite sensations and food reward in adolescents with obesity. Based on our results, it would seem beneficial to encourage exercise close to the meal, which will also depend on the time between the exercise and the preceeding meal. Furthermore, our results suggest that these nutritional adaptations to exercise can be further optimized through a timing - intensity interaction, with a potentiated effect through high intensity exercise. As our experimental studies are the first in adolescents with obesity, they call for further works to confirm the present results. However, it seems essential today to consider the timing of exercise as an essential element of our physical activity prescriptions in order to empower our interventions among adolescents with obesity.L'augmentation de la surcharge pondérale, de l'obésité et de leurs complications métaboliques chez les enfants nécessite le développement de stratégies de gestion du poids innovantes, efficaces et intégratives. L'exercice physique est une composante essentielle des interventions multidisciplinaires de perte de poids, et il n'est plus considéré comme une simple source de dépense énergétique supplémentaire mais reconnu pour ses effets potentiels sur le contrôle alimentaire. Le but du présent travail a été d'évaluer l'effet du Timing Exercise-Repas (programme TIMEX, pour TIming Meal - EXercice) sur l'apport énergétique, les sensations d'appétit et la récompense alimentaire chez des adolescents en situation d'obésité. Si d’après nos résultats, il semblerait bénéfique de favoriser des exercices plutôt à proximité du repas, il apparaît nécessaire de considérer également le délai entre l’exercice et le repas qui le précède. Nos résultats suggèrent que ces adaptations nutritionnelles à l’exercice puissent, de surcroît, être optimisées à travers une interaction timing – intensité, avec un effet potentialisé via un exercice de haute intensité. Nos études expérimentales étant les premières au niveau mondial chez l’adolescent en situation d’obésité, elles appellent à la réalisation de travaux supplémentaires pour en confirmer les résultats. Il semble cependant primordial aujourd’hui de considérer le timing de l’exercice comme un élément essentiel de nos prescriptions en activité physique pour optimiser la prise en charge des adolescents en situation d’obésité

Optimizing interdisciplinary strategies for the management of pediatric obesity : from clinical assessment to the effects of exercise-meal timing on dietary control in the obese adolescent

L'augmentation de la surcharge pondérale, de l'obésité et de leurs complications métaboliques chez les enfants nécessite le développement de stratégies de gestion du poids innovantes, efficaces et intégratives. L'exercice physique est une composante essentielle des interventions multidisciplinaires de perte de poids, et il n'est plus considéré comme une simple source de dépense énergétique supplémentaire mais reconnu pour ses effets potentiels sur le contrôle alimentaire. Le but du présent travail a été d'évaluer l'effet du Timing Exercise-Repas (programme TIMEX, pour TIming Meal - EXercice) sur l'apport énergétique, les sensations d'appétit et la récompense alimentaire chez des adolescents en situation d'obésité. Si d’après nos résultats, il semblerait bénéfique de favoriser des exercices plutôt à proximité du repas, il apparaît nécessaire de considérer également le délai entre l’exercice et le repas qui le précède. Nos résultats suggèrent que ces adaptations nutritionnelles à l’exercice puissent, de surcroît, être optimisées à travers une interaction timing – intensité, avec un effet potentialisé via un exercice de haute intensité. Nos études expérimentales étant les premières au niveau mondial chez l’adolescent en situation d’obésité, elles appellent à la réalisation de travaux supplémentaires pour en confirmer les résultats. Il semble cependant primordial aujourd’hui de considérer le timing de l’exercice comme un élément essentiel de nos prescriptions en activité physique pour optimiser la prise en charge des adolescents en situation d’obésité.The rise of pediatric overweight, obesity and of their metabolic complications calls for the development of innovative, effective and integrative weight management strategies. Physical exercise is an essential component of multidisciplinary weight loss interventions that is no longer considered as a simple source of additional energy expenditure but is now recognized for its potential effects on energy intake (EI) and appetite control. The aim of the present work was to assess the effect of the exercise-meal timing (TIMEX program, for Timing Meal - Exercise) on energy intake, appetite sensations and food reward in adolescents with obesity. Based on our results, it would seem beneficial to encourage exercise close to the meal, which will also depend on the time between the exercise and the preceeding meal. Furthermore, our results suggest that these nutritional adaptations to exercise can be further optimized through a timing - intensity interaction, with a potentiated effect through high intensity exercise. As our experimental studies are the first in adolescents with obesity, they call for further works to confirm the present results. However, it seems essential today to consider the timing of exercise as an essential element of our physical activity prescriptions in order to empower our interventions among adolescents with obesity

Physical activity, inactivity, sedentary behaviors and health: What are we talking about?

International audienceWhile there is a growing public health promotion of physical activity altogether with an increasing concern for sedentary time and their respective health implications, confusions remain around these concepts that might limit the understanding and adoption of the actual recommendations by the general population. The aim of this brief paper is to clarify the semantic around physical activity, inactivity and sedentary behaviors, underlying their respective and complementary effects on overall health and to detail the actual recommendations. (C) 2020 Societe francaise de nutrition

A smartphone application as a personalized treatment tool for adolescents with overweight: an explorative qualitative study

BackgroundThe present study is the first step of a 3-year European project in which a tailored smartphone application will be developed and tested as a potential tool in the personalized treatment of children and adolescents with overweight.MethodsIn this study, 10 focus groups (n = 48 participants) were conducted in Belgium, The Netherlands and France with adolescents with overweight (12-16 years; n = 30) and parents of adolescents with overweight (n = 18) to investigate their perceptions on (un)healthy behavior, the drivers of these behaviors, and the needs of an eHealth application for weight loss. A thorough thematic analysis was performed using Nvivo12.ResultsResults show that adolescents with overweight have a well-articulated perspective on (un)healthy behavior and their needs. Parents underestimate their own influence on the (un)healthy behavior of their children and report difficulties in healthy lifestyle parenting, which makes their role as a coach rather ambiguous. Concerning the needs of an eHealth application, both parents and adolescents formulated some challenging expectations regarding the content and the format including information, a monitoring feature and features that increase participants' motivation to behave healthy. The results of this analysis will form the basis for designing a personalized eHealth application, which will be tested in a next phase.ConclusionWe can conclude that adolescents have a well-articulated perspective on healthy and unhealthy behavior and their needs, whereby a new app could be of great help. It could function as a day-by-day diary and as a supportive coach

Can anthropometry and physical fitness testing explain physical activity levels in children and adolescents with obesity?

International audienceObjectives: As time with patients and resources are increasingly limited, it is important to determine if clinical tests can provide further insight into real-world behaviors linked to clinical outcomes. The purpose of this study was to determine which aspects of anthropometry and physical fitness testing are associated with physical activity (PA) levels among youth with obesity.Design: Cross-sectional study.Method: Anthropometry [height, waist circumference, bodyweight, fat percentage], physical fitness [muscular endurance (partial curl-ups), flexibility (sit-and-reach), lower-body power (long-jump), upper-body strength (grip), speed/agility (5×5-m shuttle), cardiorespiratory fitness (VO2-max)], and PA [light (LPA), moderate (MPA), vigorous (VPA), MVPA] was assessed in 203 youth with obesity.Results: The sample was stratified by age <12 yrs (children); 12 yrs (adolescents) and sex. Stepwise regression evaluated associations between PA with anthropometry and physical fitness. Children (57% male) and adolescents (45% male) had a BMI Z-score of 3.5(SD:0.94) and 3.1(SD:0.76) respectively. Long-jump explained 19.5% [(Standardized) Beta=0.44; p=0.001] of variance in VPA for childhood girls and 12.6% (Beta=0.35; p=0.025) of variance in MPA for adolescent boys. 5×5-m shuttle explained 8.4% (Beta=-0.29; p=0.042) of variance in MVPA for childhood girls. Body mass explained 6.3% (Beta=-0.25; p=0.007) of variance in LPA in childhood boys. Fat percentage explained 9.8% (Beta=0.31; p=0.03) of variance in MPA in adolescent girls.Conclusions: In conclusion, tests of lower body power, body mass and fat percentage provide limited information concerning PA levels in youth with obesity. Activity monitoring should be considered in addition to clinical assessments to more fully understand youth health

Development of the Children and Adolescents Physical Activity and Sedentary Questionnaire (CAPAS-Q): Psychometric Validity and Clinical Interpretation

International audienceBackground: Pediatricians’ clinical practice and health interventions in youths require instruments with adequate psychometric properties to assess physical activity (PA), sedentary behaviors (SB), and their subdomains. Objective: To assess the psychometric properties of the Children and Adolescents Physical Activity and Sedentary-Questionnaire (CAPAS-Q) in healthy French children and adolescents. Methods: The CAPAS-Q has been developed through a rigorous collective procedure and consists of a 31 items self-administered questionnaire evaluating children’s 7-day PA and SB dimensions and subdomains. Participants (n = 103, aged 8–18 years old) completed the questionnaire twice (7 days apart) and wore an ActiGraph GT3X + accelerometer for 7 days. Anthropometric measurements and body composition were assessed. Results: Cronbach alpha for PA and SB dimensions were 0.71 and 0.68, respectively. Reproducibility was found moderate to good, with Lin’s coefficients of 0.69 and 0.68 for PA and SB dimensions, respectively. Reproducibility was higher for adolescents compared to children. PA dimension was positively correlated with moderate PA, vigorous PA, moderate to vigorous PA, and total PA times and negatively correlated with SB time (p < 0.05). SB dimension and screen time were positively correlated with SB time and negatively correlated with LPA, MPA, MVPA, and total PA times (p < 0.05). Spearman correlation coefficients were fair to moderate, ranging between 0.23–0.45. Conclusion: The CAPAS-Q proposes a reliable and valid evaluation of French children and adolescents’ PA and SB, providing clinicians with potential intervention levels to improve youth movement behaviors

Results from France's 2018 Report Card on Physical Activity for Children and Youth

Results from France's 2018 Report Card on Physical Activity for Children and Yout

Does the severity of obesity influence bone density, geometry and strength in adolescents?

International audienceBackground: Relationships between the severity of obesity and bone health remain underexplored.Objectives: To compare whole-body and localized bone mineral content (BMC) and density (BMD), trabecular bone score (TBS) and hip geometry and strength between adolescents with obesity versus extreme obesity.Methods: This cross-sectional study included 154 adolescents (12-15 years, 62% females) who were classified as having obesity (OG, [95th-99th] percentile) or extreme obesity (EOG, >99th percentile). Fat mass (FM), lean mass (LM), BMC, BMD for total-body-less-head (TBLH), lumbar spine (LS), hip, TBS and geometric and strength indices at the narrow-neck (NN), femoral shaft (FS) and intertrochanteric regions (IT) were assessed by Dual-X-ray Absorptiometry (DXA).Results: There was no significant sex-interaction. For both sexes, TBLH BMC and BMD were not different between groups. TBS was lower in EOG compared with OG in both sexes in univariate analysis and after adjustment with maturation and body weight (p < 0.05). Hip BMD was significantly higher in the EOG compared to OG only after adjustment with maturation and fat mass percentage (p < 0.05 for men, p < 0.01 for women). For both sexes, TBLH, LS and hip BMC and BMD positively correlated with weight, BMI, LM and FM. TBS negatively correlated with BMI-percentile in both sexes, with a negative correlation with FM for males alone. Hip BMC and BMD, BMD, ACT and CSA at the three hip sites positively correlated with BMI-percentile in males.Conclusions: Extreme obesity impacts bone health depending on anatomical sites, altering lumbar trabecular bone in both males and females adolescents

Aqua Walking as an Appropriate and Healthy Winter and Summer Physical Practice? An Exploratory Study

International audience(1) Background: Aqua-walking in a natural environment is a health promoting physical activity that is gaining popularity and appropriate for a variety of populations, however, to date, there is little scientific evidence supporting the efficacy and safety of this activity for older adults. The objective was to propose a preliminary exploration of psychometric and metabolic responses to an acute Aqua walking session either during winter or summer in older adults Aqua walking exercisers. (2) Methods: Heart rate, body temperature, glycemia, and blood pressure were monitored in 37 (30 women, 7 men) participants aged 52 to 83 years old in two Aqua walking sessions (water at 13 °C and 18.5 °C, respectively). Anthropometry (body weight, waist, and hip circumferences), body composition, physical activity level, sedentary time, sleep quality, quality of life, physical self-perception, and perceived health and feelings on various parameters were also assessed. (3) Results: Present results revealed a greater quality of life, physical self-perception, and perceived health in aging Aqua walking exercisers compared to those found in the literature in younger populations. None of the metabolic or psychometric measurements were found to be different between classically calibrated Aqua walking sessions performed in winter compared to summer. By contrast, there was a time effect during the sessions for body temperature (p < 0.001), SBP (p = 0.17), perceived mental and physical well-being (p = 0.006 and p < 0.001, respectively), and anxiety (p < 0.001). Leg discomfort also showed a time effect (p = 0.0009) and interaction effect (p = 0.025). (4) Conclusion: Aqua walking appears here to be an accessible practice that can be performed all year long with a range of physical and mental benefits for older adults. Future studies should investigate the metabolic responses of Aqua walking in different populations