Pediatric quality of life multidimensional fatigue scale (PedsQL-MFS) detects the effects of a 3-week Inpatient body weight reduction program for children and adolescents with obesity

Background Fatigue is a frequent complaint amongst children and adolescents with obesity, and it interferes with adherence to dietary and exercise regimes that could reduce obesity. The present study evaluated the effect of an inpatient 3-week body weight reduction program on body weight and fatigue. Method One hundred children and adolescents with obesity (64% female; aged 11–18 years) undertook an inpatient program of personalized diet, daily exercise, education, and counselling. Results The sample evidenced a mean reduction in body mass (females: ΔM = 4.3 (sd = 2.1) kg, p < .001), males: ΔM = 6.2 (sd = 2.6) kg, p < .001), BMI standard deviation score (females: ΔM = 0.17 (sd = 0.07), males: ΔM = 0.24 (sd = 0.08), p < .001) and fatigue (females: ΔM = 7.8 (sd = 9.7), males: ΔM = 5.0 (sd = 6.9), p < .001) as measured by the Pediatric Quality of Life Multidimensional Fatigue Scale (PedsQL-MFS) and improvements on the Attention problems subscale of the Youth Self Report (total sample: ΔM = 0.89 (sd = 2.44), p < .001). Reliable change analyses revealed fatigue changes were achieved by up to 34% females and 17% males, but the majority did not achieve reliable change and changes in fatigue were not correlated with changes in body mass. Conclusions The program achieved clinically significant improvements in some children and adolescents. Future studies should explore predictors of treatment responsiveness. Trial registration Observational study. Not registered.

Effects of a 3-Week Inpatient Multidisciplinary Body Weight Reduction Program on Body Composition and Physical Capabilities in Adolescents and Adults with Obesity.

Background The aim of the present study was to examine the short-term changes in body composition and physical capabilities in subjects with obesity during a multidisciplinary inpatient body weight reduction program (BWRP). Methods One hundred thirty-nine adolescents (56 boys and 83 girls; BMI: 37.1±6.5 kg/m2; Fat Mass, FM: 45.3±7.2 %) and 71 adults (27 males and 44 females; BMI: 44±4.7 kg/m2; FM: 51.4±4.7 %) followed a 3-week inpatient BWRP consisting of regular physical activity, moderate energy restriction, nutritional education and psychological counseling. Before (T0) and after the end of the BWRP (T21), body composition was assessed with an impedancemeter, lower limb muscle power with Margaria Stair Climbing Test (SCT), lower limb functionality with Short Physical Performance Battery (SPPB) and the capacity of performing activity of daily living (ADL) with Physical Performance Test (PPT). Results At T21, obese adolescents showed a 4% reduction in body mass (BM) (p<0.001), associated with a FM (kg) reduction in boys (-10%) and girls (-6%) (p<0.001) and with a 3% reduction in fat-free mass (FFM, kg) recorded only in boys (p=0.013). Obese adults showed a 5% BM reduction (p<0.001), associated with a 2% FFM (kg) reduction (p<0.001) and a reduction of 9% FM (kg) in males and 7% in females (p<0.001). Regarding physical capabilities, at T21 in obese adolescents, PPT score increased by ~4% (p<0.001), SCT (s) decreased by ~5% (boys) and ~7% (girls) (p<0.001), while SPPB score did not significantly change. In obese adults at T21, PPT score increased by 9% (p<0.001), SCT (s) decreased by ~16% (p<0.001) only in females, and SPPB score increased by ~7% (males) and ~10% (females) (p<0.01). Conclusions In conclusion, moderate energy restriction and regular physical activity determine a 4-5% BM reduction during a 3-week inpatient BWRP, improve physical capabilities and induce beneficial changes in body composition in adolescents and adults with obesity. Trial registration: This study was was approved by the Ethical Committee of the Istituto Auxologico Italiano (Milan, Italy; research code: 01C124; acronym: PRORIPONATFIS). Registered 11 November 2020 - Retrospectively registered.

Frequent Medical Supervision Increases the Effectiveness of a Longitudinal Multidisciplinary Body Weight Reduction Program: A Real-World Experience in a Population of Children and Adolescents with Obesity

Regular medical supervision represents a fundamental component of the clinical management of obesity. In fact, when frequently supplied it reduces the risk of failure associated with any body weight reduction program (BWRP), resulting in body weight gain. The aim of the present study was to establish the potential beneficial effects of increasing medical supervision on weight loss and other auxometric and cardiometabolic parameters in a population of children and adolescents with obesity (n = 158; F/M = 94/64; age range 9.7–17.3 years; body mass index, BMI = 37.8 ± 6.9 kg/m2), followed up for one year in a real-world setting, after and before a 3-week in-hospital BWRP. Weight loss was significantly associated with medical supervision and changes in several auxometric and cardiometabolic parameters such as fat mass, fat-free mass, waist and hip circumferences, total and LDL cholesterols, triglycerides, glucose, insulin, HOMA-IR, systolic blood pressure and IDF criteria for the diagnosis of metabolic syndrome. As expected, weight loss and, congruently, medical supervision, were significantly higher in responsive and stable subjects than in those belonging to the non-responsive group and in responsive subjects than those belonging to the stable group. While weight loss was significantly higher in subjects having class 2 and 3 obesity than those belonging to class 1 obesity group, medical supervision was significantly higher in subjects having class 3 than those having class 1 obesity. Weight loss was significantly higher in subjects suffering from metabolic syndrome than those without; nevertheless, no significant difference was found in medical supervision between these groups. Finally, sex was associated with no differences in weight loss and medical supervision. In conclusion, based on the results of a real-world experience, frequent medical supervision increases the weight loss associated with a longitudinal multidisciplinary BWRP, with a parallel improvement of a set of auxometric and cardiometabolic parameters. Prospectively, incentivising regular medical supervision should reduce the risk of BWRP failure and body weight gain, thus contributing to counteract the detrimental transition from simple obesity to metabolic syndrome in pediatric patients.

Energy cost of walking and body composition changes during a 9-month multidisciplinary weight reduction program and 4-month follow-up in adolescents with obesity

The purpose of the present study was to investigate changes in the energy cost of locomotion during walking (Cw) related to the changes in body mass (BM, kg) and body composition in adolescents with obesity. Twenty-six (12 boys and 14 girls) obese adolescents (mean: BMI, 33.6±3.7 kg/m2; 42.7±4.5 % fat mass) followed a 9-month multidisciplinary inpatient weight-reduction program consisting of lifestyle education, moderate energy restriction, and regular physical activity in a specialized institution. At baseline (M0), by the end of the 9-month program (M9) and after 4-months follow-up (M13), V’O2 and V’CO2 of standardized activity program were assessed by whole-body indirect calorimetry over 24 hours, and body composition was assessed by DXA. At M9, adolescents showed a 18% reduction in BM (p<0.001), 40% in total FM; while FFM (kg) remained stable in boys but decreased by ~6% in girls (p=0.001). Similarly, the mean Cw decreased by 20% (p<0.001). At M13, BM, FM and Cw were slightly higher compared than at M9. In conclusion, moderate energy restriction and regular moderate physical activities improved walking economy, improved exercise tolerance and induced beneficial changes in body composition of adolescents with obesity. Novelty bullets • Reduction of FM in the trunk region, and consequently reducing the work carried out by respiratory muscles, contribute to reduce Cw in adolescents with obesity. • A lower cost of walking can be effective in improving exercise tolerance and quality of life in obese adolescents.

Effects of a 3-Week In-Hospital Multidisciplinary Body Weight Reduction Program in Obese Females: Is Measured Resting Energy Expenditure Essential for Tailoring Adequately the Amount of Energy Intake?

In the obese population, the prescription of a proper diet plan is essential to ensure an appropriate and gradual weight loss, reduce the risk of weight cycling and favor an overall improvement of health conditions. Energy needs are commonly estimated using predictive equations, even if their accuracy is still debated, especially in severely obese subjects. In the present study, 850 severely obese females admitted to our hospital for a multidisciplinary body weight reduction program (BWRP) were divided into three subgroups, “hypo-,” “normo-,” and “hyper-metabolic,” based on the comparison between estimated resting energy expenditure (eREE, using the Mifflin equation) and measured REE (mREE, using indirect calorimetry). The majority of this study population was considered normo-metabolic (59.4%, mREE between 90 and 110% of eREE), 32.6% was hyper-metabolic (mREE &gt; 110% of eREE) and only 8% was hypo-metabolic (mREE &lt; 90% of eREE). The three subgroups were evaluated before and after a 3-week BWRP, entailing energy restricted diet, adapted physical activity, psychological counseling and nutritional education. Since the diet plan during the BWRP consisted of a 30% reduction of total energy expenditure (obtained by multiplying mREE by the physical activity level), each subgroup responded positively to the BWRP independently from the difference between mREE and eREE, the extent of BMI reduction and clinical, metabolic and physical amelioration being comparable among the three subgroups. By contrast, the restriction of the energy intake based on eREE during the BWRP would have determined a slighter caloric restriction in the hypo-metabolic subgroup, thus determining a smaller body weight reduction, and, by contrast, a more marked caloric restriction in the hyper-metabolic subgroup, probably difficult to be tolerated and maintained for prolonged period. In conclusion, the percentage of subjects with “slow metabolism” in a Caucasian female obese population seeking hospitalization for a BWRP is actually lower than expected, finding controverting the common notion that obesity is mostly due to reduced REE. The high percentage (40%) of inadequate eREE in these female obese populations further underlines the absolute need to include the measurement of REE in the clinical practice for the correct prescription of energy intake in severely obese populations.

Liraglutide-Induced Hepatotoxicity

A 52-year-old woman with a BMI of 31.2 kg/m2 was treated with the glucagon-like peptide 1 (GLP-1) agonist liraglutide as part of her weight-reduction program. Following this, she developed an idiosyncratic drug-related liver injury (IDILI). Advances in noninvasive techniques enabled this diagnosis to be established. By employing easily quantifiable methods based on serum biomarkers, we could explore a wide variety of endpoints in assessing personalized DILI. In addition, we can test endpoints that are associated with the drug’s mechanism of action. Personalized medicine and therapeutic pharmacovigilance of incretin-based hypoglycemic agents are needed to ensure the safety of patients.

P348Motivation of overweight patients with atrial fibrillation to lose weight or to follow a weight loss management program: a cross-sectional study

Funding Acknowledgements none Background Overweight and obesity increase the risk of recurrence and progression of atrial fibrillation (AF). Studies evaluating weight reduction programs in AF patients have shown benefits in AF burden, symptoms and quality of life. Despite this proof, AF patients often lack the will to tackle overweight and they do not commonly participate in cardiac rehabilitation programs. Purpose The objective of this study was to assess the motivation of AF patients with overweight or obesity to lose weight and/or to follow weight reduction programs. Methods A multicenter descriptive cross-sectional study was performed at three Belgian hospitals. A self-developed questionnaire was presented to AF patients with a BMI &gt;27kg/m2 who presented for an outpatient cardiology visit or were hospitalized at the cardiology ward. The questionnaire was validated for its content by an expert panel and it addressed the following topics: knowledge about the relation between weight and AF; patients’ history of weight reduction efforts and its success; current motivation to reduce weight; factors related to motivation; interest in following weight reduction programs. Results A total of 143 patients (mean age 65.7 ± 9.2 years; mean BMI 32.3 ± 4.7kg/m2; 68.5% males; 47.6% hospitalized; mean duration of AF history 5.7 ± 6.0 years) out of 560 screened AF patients completed the questionnaire (figure 1). Only 69.9% of patients was aware of the positive effect of weight reduction on the progression of AF. Prior attempts to reduce weight were made by 76.2% of the patients in which a minority participated in a hospital-based weight reduction program (9.2%) or a structured fitness program (10.1%). Of the study patients, 75.5% were currently motivated to reduce weight, mainly driven by health considerations (78.7%). Univariate analysis showed that a higher educational degree, higher income, living with a partner, and higher BMI were positively correlated with motivation to reduce weight (p &lt; 0.05). Multivariate regression analysis showed that a higher BMI (OR = 1.20; CI = 1.05-1.38; p = 0.010), younger age (0.96 (0.91-1.01); p = 0.108), a college/university degree (5.03 (1.57-16.16); p = 0.007) and living with a partner (4.31 (1.55-11.95); p = 0.005) were associated with greater odds ratio of motivation for weight reduction. A completely home-based program (including tele-rehabilitation) was the preferred approach for 57.9% of the patients, and 57.3% would consider a weight reduction program only if reimbursement was available. Conclusions AF patients with overweight still need to be better informed about overweight as a risk factor for AF. AF patients with a lower degree of education, living alone and a lower BMI need more external motivation to lose weight. A tailored weight reduction program, mainly home based, is the preferred option for patients. This will require further development and validation of tele-coaching programs for this patient group. Abstract Figure 1: Enrollment procedure