Neuroendocrine Control, Inflammation, and Psychological Aspects After Interdisciplinary Therapy in Obese Women

Abstract

Obesity is a chronic and multifactorial disease promoted by positive energy balance. The objective was to evaluate the effects of interdisciplinary therapy in the neuroendocrine control of food intake, inflammatory markers, and psychological aspects in obese women. Forty-seven obese women (43.32±5.82 years, 34.86±3.08 kg/m²), aged 30–50 years, participated in an interdisciplinary lifestyle change therapy, consisting of nutritional counseling, physical exercises, and psychological therapy for 36 weeks. After the long-term therapy, there was a decrease in body weight (Δ –5.36 kg), BMI (Δ –2.01 kg/m²), abdominal (Δ –9.09 cm), hip (Δ –5.03 cm), and thigh (Δ –5.07 cm) perimeters. There was also a significant improvement in body composition, with an increase in fat-free mass (Δ 1.60%) and reduction of body fat (Δ –3.74 kg). The therapy proposed also provided an improvement in depression scores (Δ –6.63), anxiety (Δ –4.07), body image (Δ –25.25), and binge eating (Δ –5.25). There was a significant reduction in serum levels of leptin (Δ –15.62 ng/ml). The interdisciplinary therapy was able to provide both, physical and psychological benefits in energy balance, which enables the use of this model as a feasible clinical strategy for the treatment of obesity.

Key words

obesity - interdisciplinary therapy - hormone - neuropeptides - energy balance

• References

• 1 World Health Organization (WHO). 10 facts on obesity. Reviewed March 2013. Available at: http://www.who.int/features/factfiles/obesity/facts/en/index.html Accessed 2018
• 2 World Health Organization. Programs and Projects (WHO). Media Center, 2012. Available at: http://www.who.int/mediacentre/factsheets/fs311/en/ Accessed May 2018
• 3 Brazil, Ministry of Health (Brasília). Department of Health Surveillance Estimates on the frequency and socio-demographic distribution of risk factors and protection for chronic diseases in the capitals of the 26 Brazilian states and in the federal district in 2016. Vigitel Brasil 2016: Surveillance of Risk Factors and Protection for Chronic Diseases by Telephone Inquiry. Brasilia 2017
• 4 World Health Organization (WHO). Adherence to long-term therapies. Evidence for action. 2003; Available at: http://whqlibdoc.who.int/publications/2003/9241545992.pdf Accessed May 2018
• 5 Simpson KA, Martin NM, Bloom SR. Hypothalamic regulation of food intake and clinical therapeutic applications. Arq Bras Endocrinol Metab 2009; 53: 120-128
• 6 Ribeiro EB. Fisiologia Endócrina. São Paulo: Editora Manole; 2012
• 7 Booth DA. Physiological regulation through learnt control of appetites by contingencies among signals from external and internal environments. Appetite 2008; 51: 433-431
• 8 Booth DA. The basics of quantitative judgment. How to rate the strength of appetite for food and its sating. Appetite 2009; 53: 438-441
• 9 Zheng H, Patterson LM, Berthoud HR. Orexin signaling in the ventral tegmental area is required for high-fat. Appetite induced by opioid stimulation of the nucleus accumbens. J Neurosci 2007; 27: 11075-11082
• 10 Janssen P, Vanden BS, Verschueren A. et al. Review article: Role of gastric motility in controlling food intake. Food Pharmacol Ther 2011; 33: 880-894
• 11 Monro JA, Mishra S. Glycemic impact as a property of foods is accurately measured by an available carbohydrate method that mimics the glycemic response. J Nutr 2010; 140: 1328-1334
• 12 Renaldi O, Pramono B, Sinorita H. et al. Hypoadiponectinemia: A risk factor for metabolic syndrome. Acta Med Indones 2009; 41: 20-24
• 13 Rogers K. The Digestive System. 1^st Ed. New York: Britannica Educational Publishing; 2011
• 14 Ioanna P, Niki K, Dorothea K. et al. The role of psychobiological and neuroendocrine mechanisms in appetite regulation and obesity. Open Cardiovasc Med J 2012; 6: 147-155
• 15 Benoit SC, Clegg DJ, Seeley RJ. et al. Insulin and leptin as adiposity. Signals Recent Prog Horm Res 2004; 59: 267-285
• 16 Brazilian Association for the Study of Obesity and Metabolic (ABESO). Brazilian obesity guidelines 2009/2010 /ABESO – Brazilian Association for the Study of Obesity and Metabolic syndrome. AC Pharmaceuticals 2009
• 17 Pan A, Sun Q, Czernichow S. et al. Bidirectional association between depression and obesity in middle- aged and older women. Int J Obes 2012; 36: 595-602
• 18 Gibson EL. Emotional influences on food choice: Sensory, physiological and psychological pathways. Physiol Behav 2006; 89: 53-61
• 19 Hunot V, Moore TH, Caldwell DM. et al. Interpersonal, cognitive analytic and other integrative therapies versus other psychological therapies for depression (Protocol). Cochrane Libr 2010; 1-18
• 20 Ferreira JP. Efeitos da terapia interdisciplinar sobre sintomas de compulsão alimentar e insatisfação com a imagem corporal em adultos com sobrepeso e obesidade (dissertação de mestrado )São Paulo. Universidade Federal de São Paulo 2012
• 21 Van der Valk ES, Savas M, van Rossum EFC. Stress and Obesity: Are There more susceptible individuals?. Curr Obes Rep 2018; 7: 193-203
• 22 Van RD, Giltay EJ, VanVeen T. et al. Longitudinal relationship of depressive and anxiety symptoms with dyslipidemia and abdominal obesity. Psychosom Med 2013; 75: 83-89
• 23 Cecile H, Sandeep S, Stephanie EF. Metabolic disturbances connecting obesity and depression. Front Neurosci 2013; 7: 177. doi:10.3389/fnins.2013.00177
• 24 International Association for the Study of Obesity (IASO). World Gastroenterology Organization Global Guideline,2011. Available at: http://www.worldgastroenterology.org/assets/export/userfiles/2012_Obesity-Master_PT.pdf Accessed December 2018
• 25 Dâmaso AR. Nutrition and exercise in disease prevention. 2^nd ed . Rio de Janeiro: Guanabara Koogan; 2012
• 26 World Health Organization . Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee, 854. Geneva, Switzerland: WHO; 1995
• 27 World Health Organization . Obesity: Preventing and managing the global epidemic. Report of a WHO consultation, 894. Geneva, Switzerland: WHO; 2000
• 28 Beck AT. Thinking and depression. 1: Idiosyncratic content and cognitive distortions. Arch Gen Psychiatr 1963; 9: 324-333
• 29 Cunha JA. Manual of the Portuguese version of the Beck Scales. Are Paulo: House of the Psychologist 2001
• 30 Cooper PJ, Taylor MJ, Cooper Z, Fairbum CG. The development and validation of the Body Shape Questionnaire. Int J Eating Disord 1987; 6: 485-494
• 31 Freitas S, Lopes CS, Coutinho W, Appolinario JC. Translation and adaptation to Portuguese of the periodic eating compulsion scale. Brazilian Journal of Psychiatry 2001; 23: 15-20
• 32 Chiara T, Argano C, Corrao S. et al. Hypoadiponectinemia: A link between visceral obesity and metabolic syndrome. J Nutr Metab 2011; 2012: 175245. doi:10.1155/2012/175245
• 33 Myers MG, Cowley MA, Münzberg H. Mechanisms of leptin action and leptin resistance. Annu Rev Physiol 2008; 70: 537-556
• 34 Damaso AR, de Piano A, Campos RM. et al. Multidisciplinary approach to the treatment of obese adolescents: Effects on cardiovascular risk factors, inflammatory profile, and neuroendocrine regulation of energy balance. Int J Endocrinol 2013; 541032
• 35 de Carvalho-Ferreira JP, Masquio DC, da Silveira Campos RM. Is there a role for leptin in the reduction of depression symptoms during weight loss therapy in obese adolescent girls and boys?. Peptides 2015; 65: 20-28
• 36 Romain K, Webb T, Kumar M. Depression and obesity: Can the cycle be broken?. B J Psych Adv 2018; 24: 132-140
• 37 Lofrano-Prado MC, Antunes HKM, do Prado WL. et al. Quality of life in Brazilian obese adolescents: Effects of a longterm multidisciplinary lifestyle therapy. Health Qual Life Outcomes 2009; 7: 61
• 38 Wang B, Cheng KY. Hypothalamic AMPK as a Mediator of Hormonal Regulation of Energy Balance. Int J Mol Sci 2018; 19: 3552
• 39 Sande-Lee SV, Velloso LA. Hypothalamic dysfunction in obesity. Arq Bras. Endocrinol Metab 2012; 56: 341-350
• 40 Dyck DJ, Heigenhauser GJ, Bruce CR. The role of adipokines as regulators of skeletal muscle fatty acid metabolism and insulin sensitivity. Acta Physiol 2006; 186: 5-16
• 41 Petervari E, Balasko M, Garami A. et al. Suppression of food intake by intracerebroventricular injection of alpha-MSH varies with age in rats. Acta Physiol Hung 2009; 96: 483-487
• 42 Rodrigues A, Almeida H, Gouveia A. Obesidade: O Papel das Melanocortinas na regulação da Homeostasia Energetica. Revista Portuguesa de Endocrinologia: Diabetes Metabol 2011; 76-86
• 43 Berthoud HR. Interations between the “cognitive” and “metabolic” brain in the control of food intake. Physiol Behav Elmsford 2007; 91: 486-498
• 44 Farr OM, Li CSR, Mantzoros CS. Central nervous system regulation of eating: Insights from human brain imaging. Metabolism 2016; 65: 699-713
• 45 Lofrano-Prado MC, Prado WL, de Piano A. et al. Eating disorders in adolescents: correlations between symptoms and central control of eating behavior. Eating Behav 2011; 12: 78-82
• 46 Hoggard N, Rayner DV, Johnston SL. et al. Peripherally administered [Nle4,D-Phe7]–melanocyte stimulating hormone increases resting metabolic rate,while peripheral agouti-related protein has no effect, in wild type C57BL/6 and ob/ob mice. J Mol Endocrinol 2004; 33: 693-703
• 47 Oyama LM, Nascimento CMOD, Carnier J. et al. The role of anorexigenic and orexigenic neuropeptides and peripheral signals on quartiles of weight loss in obese adolescents. Neuropeptides 2010; 44: 467-474
• 48 Simpson KA, Martin NM, Bloom SR. Hypothalamic regulation of food intake and clinical therapeutic application. Arquiv Brasil Endocrinol Metabol 2009; 53: 120-128. doi:10.1590/S0004-27302009000200002
• 49 Martins EM. “Coaching”: A behavioral strategy based on goals for the acquisition of a more satisfactory body image in women Master's Dissertation, Department of Psychobiology, Federal University of São Paulo (SP). 2010
• 50 American Psychiatric Association (APA) . Diagnostic and statistical analysis of mental disorders: DSM-5. 5^th ed. Porto Alegre: Artmed; 2014
• 51 Beck AT, Alford BA. The integrative power of cognitive therapy. Port Alegre: Medical Arts; 2000
• 52 Knapp P, Beck AT. Fundamentals, conceptual models, applications and cognitive therapy research. Rev Bras Psiquiatr 2008; 30: 54-64
• 53 Fabricatore AN, Wadden TA, Higginbotham AJ. et al. Intentional weight loss and changes in symptoms of depression: a systematic review and meta-analysis. Int J Obes 2011; 35: 1363-1376
• 54 Mooreville M, Shomaker LB, Reina SA. et al. Depressive symptoms and observed eating in youth. Appetite; 2014. 75 141-149 doi: 10.1016/j.appet.2013.12.024.
• 55 Deuschle M, Blum WF, Englaro P. et al. Plasma leptin in depressed patients and healthy controls. Horm Metab Res 1996; 28: 714-717
• 56 Jow GM, Yang TT, Chen CL. Leptin and cholesterol levels are low in major depressive disorder, but high in schizophrenia. J Affect Disord 2006; 90: 21-27
• 57 Bacon L, Aphramor L. Weight science: evaluating the evidence for a paradigm shift. Nutr J 2011; 9-10
• 58 Sybille K, Andrea K, Knut M. et al. Abstract Attachment style contributes to the outcome of a multimodal lifestyle intervention. Bio Psycho Social Med 2012; 6: 3
• 59 Melo WV, Bergmann C, Neufeld CB. et al. A terapia Cognitiva Comportamental e a cirurgia bariátrica como tratamentos para obesidade. Rev Brasil Terap Cognit 2014; 10: 84-92
• 60 Poli VFS, Sanches RB, dos Santos MA. et al. The excessive caloric intake and micronutrient deficiencies related to obesity after a long-term interdisciplinary therapy. Nutrition 2017; 38: 113-119