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Motricidade

versão impressa ISSN 1646-107X

Motri. vol.17 no.1 Ribeira de Pena mar. 2021

https://doi.org/10.6063/motricidade.23402 

Research Note

Adolescent obesity facts

Aldo Matos Costa1  2  3  * 
http://orcid.org/0000-0003-0296-9707

Vítor Rodrigues2  4 
http://orcid.org/0000-0002-2795-685X

Maria João Monteiro4 
http://orcid.org/0000-0003-0610-0670

António José Silva2  4 
http://orcid.org/0000-0001-5790-5116

1Universidade de Beira Interior, Departamento de Desporto – Covilhã, Portugal.

2Departramento de Ciências do Desporto, Centro de Investigação em Desporto, Saúde e Desenvolvimento Humano – Vila Real, Portugal.

3Universidade de Beira Interior, Centro de Investigação de Ciências da Saúde – Covilhã, Portugal.

4Universidade de Trás-os-Montes e Alto Douro – Vila Real, Portugal.


Obesity prevalence through childhood and adolescence has been classified as a serious public health problem (Nowick & Flodmark, 2008) among diabetes, hypertension, and psychological disturbances. One can note a worldwide increase in the prevalence of overweight/obesity and, therefore, different etiologically related diseases, particularly cardiometabolic disorders (Huang et al., 2007). In developed countries, current prevalence levels reach 23.8% in boys and 22.6% in girls (Ng et al., 2014), with Portugal showing high prevalence values like other southern European and Mediterranean countries (WHO, 2017).

The need to find better multi-sectoral strategies for current public policies appears to be fundamental for the health of the present generation of young adolescents and future adult populations. Although it is not the main scope of this text, it will be important, in due course, to analyse the effectiveness of the current inter-sectoral health policies applied in some countries, although it is clear that no country until now has been able to reverse this phenomenon definitively.

Our main purpose of this research note is to present the preliminary results of the Causes4adolescentObsesity (C4AO) project (POCI-01-0145-feder-023813), which included a sample of 603 students from the northern and central interior region of Portugal. Still, without a complete inferential statistical analysis, the data show a worrying prevalence of overweight and obesity in this population (Table 1), especially in girls over 15 years old (~28%). Although young adolescents are potentially more likely to be obese than their older peers in most countries and regions, Portugal shows a non-significant positive trend (WHO, 2017), which seems consistent with the results reported here, particularly for females.

Table 1 Obesity prevalence (*) by age-group and gender. 

Males (n= 267) Females (n= 336)
Early adolescence (12–15yrs)
Underweight (%) 8.3 4.6
Normal weight (%) 70.2 73.2
Pre-obesity (%) 15.7 20.3
Obese (%) 5.8 2.0
Late adolescence (15–18yrs)
Underweight (%) 8.2 6.6
Normal weight (%) 76.0 62.8
Overweight (%) 11.6 22.4
Obese (%) 4.1 8.2
P-value 0.684 0.043*

*body mass index (BMI; kg/m2) was calculated, and participants were categorized as underweight, normal weight, overweight or obese according to the cut-off points proposed by Cole et al. (2007).

To face this problem, innovative strategies have started to emerge in Portugal in recent years. We would like to highlight the recent study by Tallon et al. (2020a), which was a complementary study to the C4AO project, showing that school-based interventions, particularly with technology support, appear to be a valid tool for nutrition education and healthy lifestyles for adolescents, although with short-term effects and modest impacts on BMI. According to the authors, factors such as gender and adolescents’ prior knowledge of related content seem to influence the effectiveness of self-learning on this type of digital platform. This seems to reinforce the need to look at this phenomenon from a multifactorial perspective in order to better customize the intervention strategies to the characteristics of each target population.

It is obvious that excessive caloric intake in a small number of daily meals is a focal contributor to the development and maintenance of obesity (Peebles, 2008). However, other crucial mediators should also be considered, involving a complex interaction among social, behavioral, psychological, and several biological factors. This was precisely one of the main objectives of the C4AO project; Table 2 presents the preliminary descriptive data for several mediators.

Table 2 Descriptive characteristics of the sample stratified by gender. 

Girls n (%) Boys n (%) p-value
Biological Demographics - - -
Age (decimal age) 15.11± 1.86 15.22± 1.85 0.36
Anthropometry
BMI (kg/m2) 22.06± 3.87 20.80 (± 3.72) 0.29
Waist circumference (cm) 69.3± 7.66 72.40 ± 8.71 0.17
Fat free mass (kg) 40.56± 5.32 49.35± 9.44 0.00
Maturity offset (years to PHV) 2.08± 1.20 0.60 ± 1.58 0.00
Contextual Maternal education
Low (9th grade or less) 117 (36.7) 101 (41.2) 0.279
Medium (10–12th grade) 94 (29.5) 74 (30.2) 0.123
High (higher education) 108 (33.9) 70 (28.6) 0.004
Family environment (APGAR)1
Moderate to high dysfunction (0–6 points) 49 (15) 26 (10.2) 0.008
Good functioning (7–10 points) 277 (85) 229 (89.8) 0.033
Behaviour Physical activity (IPAQ_categorical)2
High 94 (34.3) 135 (60.3) 0.007
Medium 114 (41.6) 52 (23.2) 0.000
Low 66 (24.1) 37 (16.5) 0.004
Sedentary behavior
Sitting time (hours/week) 38.25± 9.74 36.49± 10.36 0.61
Eating habits3
Food quantity 48.13± 5.63 47.03± 5.71 0.91
Food quality 21.92± 3.90 21.94± 3.77 0.54
Food variety 30.44± 4.44 30.00± 4.29 0.85
Principles of healthy eating 39.93± 4.82 39.47± 4.61 0.39
Total score 140.53± 13.36 138.38± 12.85 0.60

1categorical classification of family functionality according to the portuguese version of the APGAR questionnaire (Vianna, Silva, & Souza-Formigoni, 2007);

2categorical classification of the self-reported activity level/IPAQ (Lee, Macfarlane, Lam, & Stewart, 2011);

3scale of eating habits validated for the portuguese population (Marques, Luzio, Martins, & Vaquinhas, 2011); BMI: body mass index.

With regard to contextual factors, we would like to emphasize the importance of improving our understanding of the effect of the family environment on the prevalence of adolescent obesity. The literature is still very little consistent about the relationship between the family structure and functioning with the risk for child and adolescent obesity (Halliday, Palma, Mellor, Green, & Renzaho, 2014). Data from the C4AO project show gender differences in the perception of family functioning, and it seems that dysfunctional families are related (p< 0.05) to a higher BMI in boys.

Concerning biological and behaviour changes, it is important to describe and monitor eating habits and physical activity over age, their differences between genders, and the conditions of each subpopulation residential environment (e.g., Loureiro, Matos, Santos, Mota, & Diniz, 2010). Our results show that boys are clearly more active than girls, although there is a tendency for their sedentary behaviour to increase with age. Girls, on the other hand, show a significant decrease (p< 0.05) in moderate and vigorous physical activity (MET-min/week) in late adolescence (> 15 years). The data relating to eating habits also suggest a significant relationship between the “adequate food” dimension and the BMI, highlighting the importance of nutritional education mentioned above.

One of the main moderating factors of obesity in adolescence, namely in girls, is age. In fact, early menarche in young adolescents is associated with the risk of developing obesity and metabolic syndrome (e.g., Freedman et al., 2003). Preliminary results from the C4AO project show that predicted maturity offset is a discriminating factor for overweight in girls (p= 0.037), which seems to be a temporal indicator for strengthening the monitoring of this population.

Finally, we would also like to emphasize the importance of clinical monitoring of overweight adolescents, whose initial diagnosis can be clearly made at school. The determination of resting metabolic rate (RMR) is an important issue in designing a weight loss program, allowing for individualized dietary recommendations to reach an optimal nutritional status. Because indirect calorimetry is quite impractical, several equations for predicting RMR have been developed based on normal subjects, with the Harris-Benedict equation (derived in 1919) being amongst the most study equations. However, if this formula effectively addresses basal metabolic rate/resting metabolic rate, it is still unclear as to whether this formula might over-predict or underestimate RMR (Müller et al., 2004). One of the complementary studies to the C4AO project sought to compare Portuguese adolescents/young adults’ energy intake with their energy requirements by gender, age, and BMI category (Tallon et al., 2020b). Results showed that adolescents’/young adults’ energy intake was significantly lower than their requirements for both genders, adolescents, normal weight, overweight and obese individuals, and across all school grades (p< .05). The authors suggest that Harris-Benedict equations (or other commonly used equations) ignore important factors such as lean body mass or fat-free mass. The development of new equations that integrate, for example, the subjects’ body composition is therefore justified, which will improve diet prescription in the clinical setting.

Funding: this review is part of the project “Causes4AdolescentObesity – The multifactorial nature of obesity: a preliminary study on the behavioral, physiological and genetic profile of Portuguese adolescents” (POCI-01-0145-feder-023813), which is funded by the Fundacão para a Ciência e Tecnologia (https://www.fct.pt/) and co-funded by the Fundo Europeu de Desenvolvimento.

REFERENCES

Cole, T. J., Flegal, K. M., Nicholls, D., & Jackson, A. A. (2007). Body mass index cut offs to define thinness in children and adolescents: International survey. BMJ (Clinical research ed.), 335(194), 1-8. https://doi.org/10.1136/bmj.39238.399444.55Links ]

Freedman, D. S., Khan, L. K., Serdula, M. K., Dietz, W. H., Srinivasan, S. R., Berenson, G. S., & Bogalusa heart study. (2003). The relation of menarcheal age to obesity in childhood and adulthood: the Bogalusa heart study. BMC Pediatrics, 3(3), 1-9. https://doi.org/10.1186/1471-2431-3-3Links ]

Halliday, J. A., Palma, C. L., Mellor, D., Green, J., & Renzaho, A. M. N. (2014). The relationship between family functioning and child and adolescent overweight and obesity: A systematic review. International Journal of Obesity, 38(4), 480-493. https://doi.org/10.1038/ijo.2013.213Links ]

Huang, R. C., Burke, V., Newnham, J. P., Stanley, F. J., Kendall, G. E., Landau, L. I., Oddy, W. H., Blake, K. V., Palmer, L. J., & Beilin, L. J. (2007). Perinatal and childhood origins of cardiovascular disease. International Journal of Obesity, 31(2), 236-244. https://doi.org/10.1038/sj.ijo.0803394Links ]

Lee, P. H., Macfarlane, D. J., Lam, T. H., & Stewart, S. M. (2011). Validity of the International Physical Activity Questionnaire Short Form (IPAQ-SF): A systematic review. The International Journal of Behavioral Nutrition and Physical Activity, 8(115), 1-11. https://doi.org/10.1186/1479-5868-8-115Links ]

Loureiro, N., Matos, M. G., Santos, M. M., Mota, J., & Diniz, J. A. (2010). Neighborhood and physical activities of Portuguese adolescents. International Journal of Behavioral Nutrition and Physical Activity, 7(33), 1-9. https://doi.org/10.1186/1479-5868-7-33Links ]

Marques, Á. A. G., Luzio, F. C. M., Martins, J. C. A., & Vaquinhas, M. M. C. M. (2011). Eating habits: Scale validation for the portuguese population. Escola Anna Nery, 15(2), 402-409. https://doi.org/10.1590/S1414-81452011000200025Links ]

Müller, M. J., Bosy-Westphal, A., Klaus, S., Kreymann, G., Lührmann, P. M., Neuhäuser-Berthold, M., Noack, R., Pirke, K. M., Platte, P., Selberg, O., & Steiniger, J. (2004). World Health Organization equations have shortcomings for predicting resting energy expenditure in persons from a modern, affluent population: Generation of a new reference standard from a retrospective analysis of a German database of resting energy expenditure. The American Journal of Clinical Nutrition, 80(5), 1379–1390. https://doi.org/10.1093/ajcn/80.5.1379Links ]

Ng, M., Fleming, T., Robinson, M., Thomson, B., Graetz, N., Margono, C., … & Gakidou, E. (2014). Global, regional, and national prevalence of overweight and obesity in children and adults during 1980-2013: A systematic analysis for the Global Burden of Disease Study 2013. Lancet, 384(9945), 766-781. https://doi.org/10.1016/S0140-6736(14)60460-8Links ]

Peebles, R. (2008). Adolescent obesity: Etiology, office evaluation, and treatment. Adolescent Medicine: State of the Art Reviews, 19(3), 380-405. Available at: https://www.researchgate.net/publication/24025306_Adolescent_obesity_Etiology_office_evaluation_and_treatmentLinks ]

Tallon, J. M., Dias, R. S., Costa, A. M., Narciso, J., Barros, A., & Silva, A. J. (2020). Pilot evaluation of an interactive multimedia platform to provide nutrition education to Portuguese adolescents. European Journal of Public Health, 30(2), 353-357. https://doi.org/10.1093/eurpub/ckz231Links ]

Tallon, J. M., Narciso, J., Saavedra, R., Barros, A., Silva, A. J., & Costa, A. M. (2020). Reported energy intake versus estimated energy requirements of Portuguese adolescents and young adults. Progress in Nutrition, 22(3), e2020022-e2020022. https://doi.org/10.23751/pn.v22i3.8309Links ]

Vianna, V. P. T., Silva, E. A., & Souza-Formigoni, M. L. O. (2007). Portuguese version of the Family Environment Scale: Aplication and validation. Revista de Saúde Pública, 41(3), 419-426. https://doi.org/10.1590/S0034-89102007000300014Links ]

World Health Organization. [WHO]. (‎2017)‎. Adolescent obesity and related behaviours: trends and inequalities in the WHO European Region, 2002–2014. World Health Organization. Regional Office for Europe. Available at: https://apps.who.int/iris/handle/10665/329417Links ]

Received: January 07, 2021; Accepted: February 17, 2021

*Corresponding author: Departamento de Ciências do Desporto, Rua Marquês de Ávila e Bolama – CEP: 6201-001 – Covilhã, Portugal. E-mail: mcosta.aldo@gmail.com

Conflict of interests: nothing to declare.

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