Impact of a Three-Week in-Hospital Multidisciplinary Body Weight Reduction Program on Body Composition, Muscle Performance and Fatigue in a Pediatric Obese Population with or without Metabolic Syndrome

Abstract

Metabolic syndrome is a combination of cardiometabolic risk factors, frequently detected in obese children and adolescents. To date, few clinical studies have evaluated the effectiveness of multidisciplinary body weight reduction programs on body mass index, body composition, muscle performance and fatigue in pediatric obese subjects suffering from metabolic syndrome, which might represent a sub-population that is more difficult to be treated and worthy of more intensive interventions than a population less metabolically complicated. The aim of the present study was to compare the impact of a three-week in-hospital multidisciplinary integrated body weight reduction program (BWRP) on body mass index (BMI), body composition (particularly, fat mass (FM) and fat-free mass (FFM)), motor control (evaluated by one-leg standing balance (OLSB) test), muscle performance (evaluated by the stair climbing test (SCT)) and fatigue (evaluated by fatigue severity scale (FSS)) in a pediatric obese population with or without metabolic syndrome. A pediatric population of 548 obese subjects without metabolic syndrome (F/M = 312/236; age range: 8–18 years; BMI: 36.3 ± 6.7 kg/m2) and 96 obese subjects with metabolic syndrome (F/M = 53/43; age range: 9–18 years; BMI: 38.3 ± 6.9 kg/m2) was recruited. The BWRP significantly reduced BMI, FM (expressed as %), SCT time and FSS score, and increased OLSB time in all subgroups of obese subjects, independent of sex and metabolic syndrome, with preservation of FFM. No significant differences in |ΔBMI|, |ΔFM|, |ΔOLSB| or |ΔSCT| times and |ΔFSS| score were found when comparing subjects (males and females) with or without metabolic syndrome, apart from obese females without metabolic syndrome, who exhibited a lower weight loss and FM (expressed as %) reduction when compared to the corresponding male counterpart. In conclusion, the beneficial effects of a three-week BWRP on BMI, body composition, muscle performance and fatigue in a pediatric obese population were not found to be different in patients with or without metabolic syndrome, thus indicating that the more metabolically compromised patient is as responsive to a short-term BWRP as the patient without metabolic syndrome. More prolonged follow-up studies are, however, necessary in order to verify whether the adherence to the multidisciplinary recommendations at home and the long-term maintenance of the positive effects in the two subgroups of patients will remain similar or not.

Effects of a 3-Week In-Hospital Body Weight Reduction Program on Cardiovascular Risk Factors, Muscle Performance, and Fatigue: A Retrospective Study in a Population of Obese Adults with or without Metabolic Syndrome

“…The above-reported positive results confirm and extend those obtained in another work of ours, which was carried out in an exclusively pediatric obese population with and without metabolic syndrome, who underwent a similar 3-week BWRP and were investigated for the same set of outcomes [9]. The immediate BWRP-induced benefits in obese children/adolescents with metabolic syndrome (in the previous study) might be less evident than those in obese adults with metabolic syndrome (in the present study), but, in a perspective view, the gain in terms of public health should be more important in the former group than the latter group.…”

“…Similarly, in the present study, the BWRP-induced improvement of muscle performance, evaluated by SCT time, a method that we have successfully used in other studies carried out in different obese populations [8,9,25,26], was independent of the status of metabolic syndrome (i.e., same ∆SCT times in obese subjects with or without metabolic syndrome).…”

“…Although pharmacological research is actively seeking new anti-obesity strategies [2][3][4][5], restricted energy intake, combined to moderate aerobic physical activity, represents the most effective treatment of obesity associated with metabolic syndrome, despite that weight loss may be modest over a short-term cycle of treatment and weight regain may rapidly compromise the enormous efforts made to reduce body weight [6]. In fact, the beneficial effects associated with weight loss, even modest weight loss, are manifold, including reduction of total cholesterol and blood pressure, particularly systolic blood pressure, improvement of gluco-metabolic homeostasis, attenuation of the low-grade chronic inflammation, increase in motor control/function and psychological well-being as documented by the perception of fatigue and quality of life [7][8][9][10][11][12]. Being that dyslipidemia, blood hypertension, and diabetes mellitus are some of the most relevant CHD risk factors, weight loss results in a reduction of CHD score [13].…”

The Age-Dependent Increase of Metabolic Syndrome Requires More Extensive and Aggressive Non-Pharmacological and Pharmacological Interventions: A Cross-Sectional Study in an Italian Cohort of Obese Women

“…Medical management of metabolic syndrome does not include only pharmacological interventions. In fact, the administration of a BWRP to obese patients has been demonstrated to be extremely effective in improving most of the cardiometabolic conditions underlying the metabolic syndrome, such as dyslipidemia, glucose intolerance, and hypertension [ 7 , 8 ]. In this respect, the early admission of obese patients to a BWRP (third level of health care) might be a valid solution of public health to interrupt the vicious circle referring to the natural history of metabolic syndrome [ 30 ] and the serious issues of underdiagnosis/undertreatment, which have been evidenced in the present study.…”

The Impact of Social Isolation during the COVID-19 Pandemic on Physical and Mental Health: The Lived Experience of Adolescents with Obesity and Their Caregivers

“…During July 2020, 10 adolescents with obesity referring to a single inpatient clinic (Istituto Auxologico Italiano IRCCS, San Giuseppe Hospital) for a multidisciplinary body weight reduction program, entailing moderate energy restriction, adapted physical activity, psychological counseling, and nutritional education [ 28 , 29 ] (mean duration: 25 ± 3 days), and their primary caregivers, were consecutively recruited and screened for admission into the study.…”