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Including Cognitive Therapies Helps Treat Obesity

Publicado em 02 setembro 2021

Por Luciana Constantino, FAPESP Agency

Quality of life related to physical and psychological health can be a fundamental element in the treatment of adults with obesity. Therefore, clinical actions that include, in an interdisciplinary way, cognitive and behavioral therapies can offer more significant results for these individuals, reducing not only their weight but also symptoms of depression.

This is the main conclusion of a survey carried out by the Obesity Study Group (GEO) of the Federal University of São Paulo (Unifesp), on the Baixada Santista campus. The results were published in the journal Frontiers in Nutrition.

Considered one of the main public health problems in the world, obesity has more than doubled in Brazil in 17 years, also affecting more and more children and young people. Between 2002 and 2019, the percentage of obese adults increased from 12.2% to 26.8%. Among women, this index reached 29.5% (compared to 21.8% for males). If overweight adults are counted, the rate increased from 43.3% to almost 62.1%, representing practically two-thirds of Brazilians, according to the 2019 National Health Survey.

In addition to helping to reduce weight, interdisciplinary action reduces symptoms of depression and improves quality of life and eating behavior (image: Vidmir Raic/Pixabay)

“The interdisciplinary and cognitive-behavioral therapy program was more effective than the physical exercise and education and health programs. This program promoted greater behavioral changes than the other two in factors relevant to weight control, such as the level of physical activity and food intake. Changes were also observed in almost all variables, including body mass index (BMI), absolute fat mass and reduction in waist, hip and neck circumferences. It has been shown to be effective in increasing the quality of life in all domains. [físico, psicológico, social, ambiental] and in reducing depressive symptoms,” the researchers conclude in the article.

The study involved professionals from the fields of nutrition, psychology, physical education and physiotherapy. It was supported by FAPESP through two projects (11/51723-7 and 15/06630-1), by the Coordination for the Improvement of Higher Education Personnel (Capes) and by the National Council for Scientific and Technological Development (CNPq).

For Amanda dos Santos Moraes, first author of the research, psychological aspects are proving essential in the treatment of obesity. “This is an innovative factor, uniting interdisciplinary therapy with the cognitive-behavioral approach for the treatment of obesity. Cognitive aspects are increasingly being considered for the treatment of adults with obesity”, he says.

He adds: “Cognitive-behavioral therapy is the most accepted intervention for weight loss in the clinical practice of psychology. This approach works primarily on the thoughts and core belief systems of individuals who may maintain inappropriate feelings and behaviors triggered by dysfunctional thoughts about body weight and obesity. In our study, we observed that the group with cognitive-behavioral therapy had a higher frequency of interventions, as well as a greater reduction in symptoms of depression than the other two groups”.

Professor Danielle Arisa Caranti, one of the study’s supervisors along with Ricardo José Gomes, says that interdisciplinary treatment is still scarce in the Unified Health System (SUS), but it would be important to focus on interprofessionalism and on the issue of mental health for future policies in tackling the obesity epidemic.

“The reality in SUS is very different today. We have few physical education professionals, for example. Interdisciplinary therapy, in addition to being more costly, requires knowledge of interprofessionalism, working in an integrated manner, with articulation of objectives and collaborative practices. When thinking about the applicability of the study, this is an aspect that needs to be worked on for models of health care and treatment of chronic diseases”, evaluates Caranti.

In the article, the researchers highlight that obesity treatments represent a major expense to health systems in several countries. Estimates by the World Federation of Obesity indicate that the medical consequences of the disease will cost more than US$ 1 trillion in 2025. According to the organization, there are about 800 million obese people in the world.

In the case of Brazil, the costs of procedures associated with overweight and obesity are estimated at US$ 2.1 billion per year. Only in 2019, for example, the Health Information System for Primary Care, of the Ministry of Health, pointed out that, of the more than 105 million consultations, 20.6% of the evaluated conditions/problems corresponded to arterial hypertension, 8, 3% to diabetes and 2.5% to obesity.

Characteristics

Obesity is a chronic disease characterized by the excessive accumulation of fat in the body. For diagnosis in adults, the most common parameter is the BMI, obtained by dividing the patient’s weight by the height squared. According to the World Health Organization (WHO), overweight people have a BMI of 25 to 29.9 kg/m² and obese people, equal to or above 30 kg/m².

Elevated BMI is an important risk factor for cardiovascular disease, musculoskeletal disorders (especially osteoarthritis), psychological problems, cancer and, more recently, it is linked to the worsening of COVID-19 in obese patients.

Several factors are pointed out as causes of obesity, including genetic, individual/behavioral and environmental. Other elements that have contributed to the high prevalence of the disease are the reduction or absence of healthy eating habits and regular physical activity.

“The most common paradigm in relation to weight loss is the imbalance between food intake and physical activity, with a positive energy balance being the main cause of overweight and obesity. However, this simple view does not take into account many other factors, such as the influence of the modern lifestyle, which encourages a diet based on ultra-processed foods, or the role of adipose tissue in body homeostasis and energy balance”, writes the group in the article.

According to the researchers, “it is essential to develop more powerful strategies to face this obesity epidemic and help individuals to lose weight, as well as assisting them in adopting and maintaining a healthy lifestyle in an obesogenic environment that promotes consumption excess of food”.

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A recent meta-analysis examining the worldwide prevalence of weight-control attempts showed that 42% of the general adult population was trying to lose weight and 23% was trying to maintain it. Other studies have also shown that a 5% weight reduction improves health outcomes.

Methodology

The study of the Brazilian group included a quantitative and qualitative research and had the format of a randomized clinical trial. It analyzed and compared the effects of three different long-term treatments on anthropometric profiles, eating behaviors, levels of anxiety and depression, and quality of life.

The Obesity Study Group, from the Interdisciplinary Laboratory of Metabolic Diseases at Unifesp, recruited the volunteers. Of the 150 initial candidates, 98 were selected after applying the criteria established in the research.

The age group was from 30 to 50 years old, and the BMI ranged between 30 and 39.9 kg/m². The sample was predominantly women, generally more likely to seek treatment for obesity than men.

The volunteers were randomly divided into three groups: education and health (which had lectures on health topics), physical exercise (which underwent physical training) and interdisciplinary and cognitive-behavioral therapy (which received physical training, guidance nutritional and physical and psychological therapy).

After 30 weeks, 43 volunteers remained until the end. In the education and health group, the quality of life increased significantly. On the other hand, physical exercise registered, in addition to an improvement in quality of life, a significant weight reduction.

The interdisciplinary and cognitive-behavioral therapy group had the most significant changes: there was an improvement in the anthropometric profile and quality of life in all domains (physical, psychological, social and environmental), in addition to a positive change in eating and reduction in depression. It also had the lowest dropout rate (around 42%).

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