PAPO (AN ACTIVITY PROJECT FOR OBESE ADOLESCENT): A TREATMENT PROPOSAL
Cecilia Lacroix de Oliveira1, Isa de Pádua Cintra2, Ana Paula Vilar1, Elaine Silva Souza3, Lísia Carla Toniazzo3, Mauro Fisberg4
1-Post graduate student in the Center for Adolescent Support and Treatment (CAAA) – Department of Pediatrics Paulista School of Medicine –Federal University of São Paulo, 2-Assitant Professor of CAAA, 3-Especializando CAAA, 4-Assitant Professor and Chief of CAAA.
National data show that the prevalence of obesity has been increasing in our society. Recent studies about adolescents, conducted in Florianópolis (1999)1 and Recife (2001)2, show that obesity and overweight affect, respectively, 23% and 35% of the assessed students. Therefore, it is necessary to implement therapeutic and preventive measures to fight this nutritional disorder in younger individuals. Among the main factors in the policies for a healthy life for adolescents, one should highlight the increase in physical activity and the acquisition of healthy food habits.
Obesity in children and adolescents is one of the most difficult diseases to treat. Several factors contribute to this negative results, such as the lack of family involvement in the treatment, patient’s low self-esteem, which negatively affects compliance to treatment, as well as the lack of a psychological follow-up that we consider of utmost importance, and the lack of physical activity in combination with food orientation. Thus, the Center for Adolescent Support and Treatment (CAAA), developed a follow-up project for the obese adolescent, PAPO (Activity Project for the Obese). Its main goal is to provide the obese adolescent with a group treatment, followed up by a multidiscipline team, (pediatricians, nutritionists, physical education teachers, psychologists, and physical therapists). The expectation is that through this teamwork effort, adolescents would show more encouragement and involvement toward their treatment.
Individual appointments on nutrition are held every three weeks. They consist of patient’s food history, including record and frequency of food intake. Then, energy need and a reduction of 30% of total calories are estimated, according to current weight. The supplied diet consists of 55 to 60% carbohydrates, 15% protein, and 25 to 30% lipids. Yet, in the same meeting, group activities are developed, such as classes with dynamic activities about nutrition and health. Subjects range from food pyramid to the importance of a balanced diet, difference between "diet" and "light" foods, and alterations that might be associate to obesity such as dislipidemias, diabetes, and hypertension.
Adolescents in those groups participate in "recreational" or non-systematized activities, with physical-education teachers’ orientation for 1 hour, three times a week, where they play games such as basketball, volleyball, soccer, among others, and they walk and have rhythmic gym.
Psychological follow-up is conducted in-group, where they discuss body self-image, common problems related to obesity and they play interactive games.
In the beginning of 2001, 37 girls with ages between 14 and 17 started the project, with body mass index (weight (Kg)/height (m2) – BMI) above percentile 95 of the percentile curve extracted from Second National Health and Nutrition Examination Survey (NHANESII). After four months of intervention, 22 girls (60%) remained in the program. Main reasons for treatment cessation were financial, since the subjects needed to work and did not have available time; there were also problems related to health and lack of encouragement, since they expected a substantial weight loss in a short period of time.
Charts 1 and 2 present the mean values of weight and BMI before and after 4 months of treatment. In order to evaluate the difference in those variables during treatment, a delta percentage was used (D %= ((final value– initial value) / initial value) x 100), showing that adolescents lost, in average, 3.6 ± 3.6 Kg of body mass and 3.6 ± 3.3 Kg/m2 of BMI. There was also a reduction in the adequacy index of current BMI as compared to BMI in percentile 95 (the so-called gravity percentage of percentile 95 BMI), according to age and gender (124.2 ± 17.8% x 119.1 ± 17.4%).
Those results show the difficulties in treating obesity in adolescents with a BMI higher than percentile 95, according to age and gender, throughout a short period of treatment. Some adolescents presented a very positive result, losing 9,0Kg in those 4 months of treatment; nevertheless, other adolescents kept their initial weight.
Several factors might contribute to a negative result in the treatment of obesity during adolescence. One of them is that many adolescents, when they start treatment, believe they will reach the ideal weight in a short period of time. However, after some months they become aware of the difficulties involved and get discouraged. Another major factor is treatment duration, since some of the adolescents lose interest. The financial aspect becomes unfeasible through a long treatment period.
An additional finding of this study was that girls that are post puberty at a mean age of 16 years, and present a BMI much above percentile 95, could have their treatment success jeopardized. It is believed that the earlier the treatment for obesity is conducted, the better the results would be.
The psychological aspect seems to play an important role in the results of treatment, because there is a positive relation between anxiety levels and difficulty in carrying on the prescribed diet. This subject should be more thoroughly analyzed due to its importance for a successful treatment.
Another major factor is family involvement. Throughout the treatment period there was no effective participation of the parents, which might have affected the achievement of better results.
Nonetheless, although the goal of losing weight was not achieved, there was a significant improvement in the life of those adolescents. They replaced the habit of watching TV for a recreational activity, and presented a better social life. Therefore, it was verified that to treat obese adolescents it is necessary to combine several factors, such as the nutritional, social, and psychological aspects, and physical activity.
References
Balaban, G. & Silva, G.A.P. Prevalência de sobrepeso em crianças e adolescentes de uma escola da rede privada de Recife. J. Pediatr, v.77, n.2, p.96-100, 2001.