Longitudinal changes in activity patterns, physical capacities, energy expenditure, and body composition in severely obese adolescents during a multidisciplinary weight-reduction program

Objective: To determine the longitudinal changes in body composition, physical capacities, and time and energy expenditure (EE) devoted to various activities in the course of a 9-month weight-reduction period. Design: Longitudinal, clinical intervention including lifestyle education, moderate energy restriction, progressive training, and psychological follow-up. Subjects: A total of 27 (13 boys and 14 girls) severely obese adolescents (mean BMI: 33.9 kg/m(2); 41.5% fat mass ( FM)), aged 12-16 y. Measurements: Before the beginning and after the weight-reduction program, body composition was assessed by dual-energy X-ray absorptiometry (DXA), physical capacities by multistage treadmill test, and EE both by whole-body calorimetry and in free-living conditions using the heart rate-recording method. During 8 months of the weight-reduction period, type and duration of each activity were recorded using a daily controlled activity diary. Results: One boy resigned after 5 months. Body weight (BW) and FM decreased (-19 and -42%, respectively, P<0.001) both in boys and in girls, but fat-free mass (FFM) decreased only in girls (-6%, P<0.001). VO(2)max (l/min) did not vary significantly, but strength and fitness were improved (P<0.001). Time and EE spent at sedentary activities decreased significantly (P<0.001) to the benefit of moderate (recreational) activities and total physical activities (P<0.001) at the institution during the weekdays, and at home during the weekends and holidays. Conclusion: The great BW and FM losses, preservation of FFM, and improvement of physical capacities of obese adolescents obtained under experimental conditions were associated with increases in leisure physical activities in free-living conditions at the expense of sleep and sedentary activities.