Impact of a management strategy on child and adolescent overweight

Lisete Griebeler Souza, Zilda Elizabeth de Albuquerque Santos, Mariur Gomes Beghetto, Elza Daniel de Mello

Abstract


AIMS: To evaluate, through anthropometric and biochemical parameters, the impact of an overweight management strategy implemented in an outpatient clinic for childhood obesity in a public hospital.
METHODS: Retrospective analysis of a cohort of 206 children and adolescents with a diagnosis of obesity or overweight, aged between 5 and 17 years, attended between 2010 and 2014 with an average period of three months during one year. The strategy evaluated consisted of counseling, with guidelines aimed at reducing sedentary activity time and increased physical activity and nutritional guidelines for healthier food choices. Were evaluated anthropometric parameters (body mass index, z-escore of body mass index by age, waist circumference, hip circumference and waist hip ratio) and biochemistry (fasting glucose, fasting insulinemia, homeostasis model assessment, total cholesterol (CT), high density lipoprotein (HDL-c), low density lipoprotein (LDL-c), triclycerides (TG) at the baseline, at 6 and 12 months of follow-up. Statistical analyzes were performed in the IBM SPSS Statistics 22.0, using the Generalized Estimating Equations model.
RESULTS: In 12 months, there was a significant reduction in BMI, Z score of BMI/age, percentage of individuals with BMI/age z score ≥ +2, WHR, percentage of individuals with WC > p90 and HC (p<0,001). Serum glycemia and insulin levels did not show significant reduction, only a trend, as did TC, LDL-c and TG, but HDL-c levels had a significant increase (p=0.035).
CONCLUSIONS: This strategy of management of childhood and adolescent overweight, based on counseling, made it possible to reduce significantly the levels of overweight, although the biochemical parameters were not reduced in the same proportion.


Keywords


Pediatric obesity; food and nutrition education; weight loss.

References


WHO. World Health Organization. Obesity and overweight. [Internet]. [cited 2019 June]. Available from: https://www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight

IBGE. Instituto Brasileiro de Geografia e Estatística. Pesquisa de Orçamentos Familiares 2008-2009: Antropometria e Estado Nutricional de Crianças, Adolescentes e Adultos no Brasil. Rio de Janeiro: IBGE, 2010. [Internet]. [cited 2019 June]. Available from: https://biblioteca.ibge.gov.br/visualizacao/livros/liv45419.pdf

Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: The Bogalusa Heart Study. J Pediatr. 2007;150(1):12-7. https://doi.org/10.1016/j.jpeds.2006.08.042

Carvalho MA, Carmo I, Breda J, Rito AI. Análise comparativa de métodos de abordagem da obesidade infantil. Rev Port Saúde Pública. 2011;29(2):148-56. https://doi.org/10.1016/S0870-9025(11)70019-0

Fernandes SP, Conterato EV, Mello ED. Manejo do paciente obeso pediátrico na atenção primária: proposta de uma abordagem terapêutica prática. Rev HCPA. 2012;32(4):461-72.

BRASIL. Ministério da Saúde, Secretaria de Atenção à Saúde, Departamento de Atenção Básica. Estratégias para o cuidado da pessoa com doença crônica: obesidade [Internet]. Brasília; 2014 [cited 2019 June]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/estrategias_cuidado_doenca_cronica_obesidade_cab38.pdf

Fisberg RM, Marchioni DML, Colucci ACA. Assessment of food consumption and nutrient intake in clinical practice. Arq Bras Endocrinol Metab. 2009;53:617-24. https://doi.org/10.1590/S0004-27302009000500014

BRASIL. Ministério da Saúde. Norma Técnica do Sistema de Vigilância Alimentar e Nutricional – SISVAN. Orientações para a coleta e análise de dados antropométricos em serviços de saúde [Internet]. Brasília; 2011. [cited 2019 June]. Available from: http://bvsms.saude.gov.br/bvs/publicacoes/orientacoes_coleta_analise_dados_antropometricos.pdf

Freedman DS, Serdula MK, Srinivasan SR, Berenson GS. Relation of circumferences and skinfold thicknesses to lipid and insulin concentrations in children and adolescents: the Bogalusa Heart Study. Am J Clin Nutr. 1999; 69:308-17. https://doi.org/10.1093/ajcn/69.2.308

Xavier HT, Izar MC, Faria Neto JR, Assad MH, Rocha VZ, Sposito AC, Fonseca FA, dos Santos JE, Santos RD, Bertolami MC, Faludi AA, Martinez TLR, Diament J, Guimarães A, Forti NA, Moriguchi E, Chagas ACP, Coelho OR, Ramires JAF. V Brazilian guidelines on dyslipidemias and prevention of atherosclerosis. Arq Bras Cardiol. 2013;101:1-22. https://doi.org/10.5935/abc.2013S010

SBP. Sociedade Brasileira de Pediatria. Obesidade na Infância e Adolescência: Manual de Orientação [Internet]. Rio de Janeiro; 2012. [cited 2018 Nov 3]. Available from: http://www.sbp.com.br/publicacoes/para-a-familia/obesidade-nainfancia-e-adolescencia-manual-de-orientacao-2-edicao-revisada-e-ampliada/

Keskin M, Kurtoglu S, Kendirci M, Atabek ME, Yazici C. Homeostasis model assessment is more reliable than the fasting glucose/insulin ratio and quantitative insulin sensitivity check index for assessing insulin resistance among obese children and adolescents. Pediatrics. 2005;115:e500-3. https://doi.org/10.1542/peds.2004-1921

Brufani C, Fintini D, Nobili V, Patera PI, Cappa M, Brufani M. Use of metformin in pediatric age. Pediatr Diabetes. 2011;12:580-88. https://doi.org/10.1111/j.1399-5448.2010.00741.x

Guimarães LSP, Hirakata VN. Use of the Generalized Estimating Equation Model in longitudinal data analysis. Rev HCPA. 2012;32:503-11.

Ludwig DS. Weight loss strategies for adolescents a 14-year-old struggling to lose weight. Jama 2012; 307:498-508. https://doi.org/10.1001/jama.2011.2011

Andela S, Burrows TL, Baur LA, Coyle DH, Gow ML. Efficacy of very low energy diet programs for weight loss: A systematic review with meta analysis of intervention studies in children and adolescents with obesity. Obesity Reviews. 2019;20(6). https://doi.org/10.1111/obr.12830

Farpour-Lambert NJ, Baker JL, Hassapidou M, Holm JC, Nowicka P, O”Malley G, Weiss R. Childhood obesity is a chronic disease demanding specific health care – a position statement from the Childhood Obesity Task Force (COTF) of the European Association for the Study of Obesity (EASO). Obes Facts. 2015;8:342-9. https://doi.org/10.1159/000441483

Zolotarjova J,Velde G, Vreugdenhil ACE. Effects of multidisciplinary interventions on weight loss and health outcomes in children and adolescents with morbid obesity. Obesity Reviews. 2018;19(7). https://doi.org/10.1111/obr.12680

Most SW, Hojgaard B, Teilmann G, Andersen J, Valentiner M, Gamborg M, Holm JC. Adoption of the Children’s Obesity Clinic’s Treatment (TCOCT) protocol into another Danish pediatric obesity treatment clinic. Bmc Pediatr. 2015;15:1-8. https://doi.org/10.1186/s12887-015-0332-9

Serodio KJ, Berall GB, Flanders DI, Kuk JL. Effectiveness of a publicly funded clinical paediatric weight management program on obesity outcomes. Paediatr Child Health. 2015;20:425-8. https://doi.org/10.1093/pch/20.8.425

Geller JS, Dube ET, Cruz GA, Stevens J, Bench KK. Pediatric Obesity Empowerment Model Group Medical Visits (POEM-GMV) as treatment for pediatric obesity in an underserved community. Childhood Obesity. 2015;11:638-46. https://doi.org/10.1089/chi.2014.0163

Fonvig CE, Chabanova E, Ohrt JD, Nielsen LA, Pedersen O, Hansen T, Thomsen HS, Holm JC. Multidisciplinary care of obese children and adolescents for one year reduces ectopic fat content in liver and skeletal muscle. Bmc Pediatr. 2015;15:1-9. https://doi.org/10.1186/s12887-015-0513-6

Coelho M, Oliveira T, Fernandes R. Biochemistry of adipose tissue: an endocrine organ. Arch Med Sci. 2013;9(2):191-200. https://doi.org/10.5114/aoms.2013.33181

Freedman DS, Dietz WH, Srinivasan SR, Berenson GS. The relation of overweight to cardiovascular risk factors among children and adolescents: the Bogalusa Heart Study. Pediatrics. 1999;103:1175-82. https://doi.org/10.1542/peds.103.6.1175

Mastroeni SSBS, Mastroeni MF, Gonçalves MC, Debortoli G, Silva NN, Bernal RTI, Adamovski M, Veujelers PJ, Rondó PHC. Cardiometabolic risk markers of normal weight and excess body weight in Brazilian adolescents. Appl Physiol Nutr Metab. 2016;41:659-65. https://doi.org/10.1139/apnm-2015-0632

Verduci E, Lassandro C, Giacchero R, Miniello VL, Banderali G, Radaelli G. Change in metabolic profile after 1-year nutritional-behavioral intervention in obese children. Nutrients. 2015;7:10089-99. https://doi.org/10.3390/nu7125520

Parente EB, Guazzelli I, Ribeiro MM, Silva AG, Halpern A, Villares SM. Obese children lipid profile: effects of hypocaloric diet and aerobic physical exercise. Arq Bras Endocrinol Metab. 2006;50:499-504. https://doi.org/10.1590/S0004-27302006000300013

Brufani C, Crino A, Fintini D, Patera PI, Cappa M, Manco M. Systematic Review of Metformin use in obese nondiabetic children and adolescents. Horm Res Paediatr. 2013; 80:78-85. https://doi.org/10.1159/000353760

Park MH, Kinra S, Ward KJ, White B, Viner RM. Metformin for obesity in children and adolescents: a systematic review.(META-ANALYSIS: Reviews/Commentaries/ADA Statements). Diabetes Care. 2009;32:1743-5. https://doi.org/10.2337/dc09-0258




DOI: http://dx.doi.org/10.15448/1980-6108.2019.3.33486

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