Obesity, Associated Diseases and Potential Complications: Prevention and Treatment Strategy through Nutritional Intervention Combined with Physical Activity

Research Article

Austin J Nutri Food Sci. 2021; 9(3): 1159.

Obesity, Associated Diseases and Potential Complications: Prevention and Treatment Strategy through Nutritional Intervention Combined with Physical Activity

Souza LP¹*, Alves HHO¹, Santos LC¹, Fernandes L¹, Manoel R¹, Souza RP², Levada-Pires AC¹, Martins POF¹, Gorjao R¹ and Cury-Boaventura MF¹

1Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Brazil

2Incor-HCFMUSP, Brazil

*Corresponding author: Souza LP, Institute of Physical Activity and Sport Sciences, Cruzeiro do Sul University, Brazil

Received: September 21, 2021; Accepted: October 20, 2021; Published: October 27, 2021


Obesity modulate the production of hormones and adipokines such as leptin, adiponectin, and resistin, thereby favoring the development of chronic Noncommunicable Diseases (NCDs). Nutritional intervention is a strategy used for its prevention and/or treatment. We analyzed the benefits of a nutritional intervention program combined with the practice of physical activity on body composition and NCD markers. Eighteen people with a mean age of 58 ± 8 years, weight of 73.68 ± 16.57 kg, Body Mass Index (BMI) of 28.30 ± 4.88 kg/m2, Waist Circumference (WC) of 95.72 ± 13.57 cm, waist/hip ratio of 0.80 ± 0.07, and body fat percentage of 35.22% ± 4.84% who practiced aquatic aerobics and/or swimming participated in a six-month nutritional intervention program with weekly meetings. Data collection was performed before and after the intervention. We evaluated BMI, body fat percentage, WC, and hip circumference as well as the levels of leptin, resistin, adiponectin, and insulin. Nutritional intervention combined with physical activity contributed to a reduction in weight by 1.47% (p < 0.05), BMI by 1.32% (p < 0.05), and the plasma concentration of leptin by 18.04% (p < 0.05) and resistin by 8.70% (p < 0.05). There was no significant change in the hormones adiponectin and insulin. Total cholesterol decreased by 22% (p < 0.01) and low-density lipoprotein cholesterol (LDL-c) by 51.80% (p < 0.0001). During the follow-up period we observed a reduction in weight, BMI, leptin, resistin, total cholesterol, and LDL-c. Therefore, we conclude that changes in eating habits along with the performance of physical activity assist in the treatment of overweightness and obesity and, thus, prevent associated diseases.

Keywords: Obesity; Adipokines; Nutritional intervention; Physical activity; Inflammation; Covid-19


Each year, 2.8 million people die from obesity-related diseases such as hypertension, dyslipidemia, and metabolic syndrome. Economic burden is one of the various negative aspects of obesity because the expenditure on healthcare to meet the needs of individuals with chronic Noncommunicable Diseases (NCDs) is high both in developed countries, including the United States of America, and developing countries such as Brazil [1]. Studies show that in 2018, Brazil spent 3.45 billion reais in the Unified Health System for the treatment and follow-up of patients with obesity, hypertension, and diabetes [2].

Obesity is characterized by the accumulation of triacylglycerol inside adipocytes caused by an imbalance between food intake and total energy expenditure [3,4]. The accumulation of visceral fat leads to increased metabolic risk, causing problems such as diabetes and liver steatosis, in addition to the risk of developing triglyceride storage dysfunction, which contributes to the development of dyslipidemia [5]. Because white adipose tissue is the largest endocrine organ, obesity leads to an imbalance in the production of some adipokines such as IL-6, adiponectin, leptin, resistin, apelin, and visfatin [6].

Hypertrophy and hyperplasia of adipocytes result in local hypoxia leading to cell death and increased flow of fatty acids. These metabolic processes combined with the imbalance of adipokines, including IL-6, leptin, and resistin, which have proinflammatory properties, contribute to the development of subclinical inflammation in people with obesity and favor the development of comorbidities [7,8].

Leptin is one of the hormones responsible for the increased activity of the sympathetic nervous system, which in turn controls renal and vascular blood pressure. As a result, the increase in plasma leptin levels is associated with the occurrence of hypertension in people with obesity [9,10].

Resistin plays a role in the storage and use of energy in the form of triacylglycerol and has been associated with the development of chronic diseases linked to obesity, such as type 2 diabetes and cardiovascular diseases [11].

On the other hand, in addition to influencing insulin sensitivity, adiponectin has anti-inflammatory and antiatherogenic properties and is therefore considered as an antidiabetic hormone. Obesity, insulin resistance, diabetes, hypertension, coronary artery disease, and high risk for myocardial infarction are associated with low serum levels of adiponectin [12].

Since the beginning of 2020, obesity, along with NCDs, is a matter of increasing concern due to the COVID-19 pandemic, and several studies show that obese patients tend to have worse disease progression, a long period of hospitalization, and high morbidity and mortality [13]. Compared to eutrophic individuals and patients without comorbidities, obese individuals are in a subclinical inflammatory state, and the presence of another inflammatory stimulus, such as COVID-19 infection, facilitates an inflammatory burst that promotes complications [14]. In addition, individuals with obesity elicit a delayed and ineffective immune response [15].

Furthermore, the SARS-CoV-2 virus binds to target cells through the spike protein, which in turn comes into contact with the Angiotensin-Converting Enzyme 2 (ACE2). Both lung and adipose tissues have high expression of ACE2, which makes obese individuals highly vulnerable to infection [16].

Inadequate dietary choices, such as having a high intake of foods with high calorie, high sucrose, and low fiber levels, are closely related to obesity. Strategies that alter these behaviors can positively influence the nutritional status of the population and reduce the incidence of obesity and NCDs [17]. However, nutrition education has been shown to be more effective when it focuses on behavior/action and not just on knowledge acquisition by the individuals; therefore, any strategy needs to be based on three pillars-theory, research, and practice [18].

In addition to changes in food consumption and physical activity, aerobic exercises are strategies that especially contribute both to weight loss and the maintenance of this loss [19]. Aquatic exercise activities are shown to be effective for weight loss and anthropometric changes in previously sedentary adults, even in a short period of intervention [20]. However, a previous study by our group showed that aquatic exercises performed for a long period did not promote changes in body composition, despite improving the inflammatory subclinical state and NCD markers [21].

In this study, we evaluated the benefits of a nutritional intervention program on body composition and NCD markers in individuals who practice aquatic exercise.



The participants were screened and recruited in a structured aquatic physical activity program at a community-based health and fitness center at the Institute of Physical Activity and Sport Sciences of the Cruzeiro do Sul University. The study included 18 participants (16 women and 2 men) with a mean age of 58 ± 8 years, weight of 73.68 ± 16.57 kg, Body Mass Index (BMI) of 28.30 ± 4.88 kg/m2, Waist Circumference (WC) of 95.72 ± 13.57 cm, Waist/Hip Ratio (WHR) of 0.80 ± 0.07, and body fat percentage of 35.22 ± 4.84%.

The participants underwent a supervised 12-month nutritional intervention program which involved performing 60 min of exercise twice a week. The training sessions were supervised by trainers qualified in the modalities of swimming (x participants) and/or water aerobics (y participants), and the sessions were conducted in the Sports Center of the Institute of Physical Activity and Sports Sciences as described by Gondim [21].

With regard to the nutritional status, before the start of the nutritional intervention program, most participants (76%) were overweight (according to BMI) and 62% were classified as obese (according to body fat percentage). In addition, 19% of the participants were at a high risk and 76% were at a very high risk for developing Cardiovascular Diseases (CVDs) according to their WCs, and 43% participants were at a high risk for developing CVD according to their WHRs.

The participants were excluded from the study if they did not obtain at least 80% attendance in the training sessions and nutrition workshops, did not participate in the three steps proposed by our study (at baseline and after 6 and 12 months of regular exercise), and had not fasted for 8 h prior to blood collection.

With respect to medication, 11% of them had previously received a prescription for dyslipidemia, 38% for hypertension, 11% for diabetes mellitus, 22% for hypothyroidism, and 16% for anxiety and depression.

The nutrition workshops and data collection were conducted in the Sports Center of the Institute of Physical Activity and Sports Sciences. An informed consent form was obtained from all the participants before enrolling them in the study. Additionally, the study was approved by the Human Ethics Committee of the Cruzeiro do Sul University (approval number: 1179/CEPSH).

The study lasted for 10 months, and the nutritional intervention and data collection were performed in this period. Two data collections were performed in 2015, the first at the beginning of March before the nutritional intervention [pre-nutritional intervention (pre-NI)] and the last at the end of the nutritional intervention in early November (post-NI).

Anthropometric data (weight, height, hip circumference, WC, body composition, body fat percentage, and lean mass percentage) were recorded, and 10 mL blood samples were collected in sterile vacuum tubes by healthcare professionals. Nutritional anamnesis was performed using the Food Frequency and Habitual Diet Questionnaire.

Nutritional intervention

After the first data collection, the participants were recruited in a group nutritional intervention program that included nutrition workshops conducted for 50 min once a week before or after the practice of physical activity for a total duration of 6 months and a total of 16 nutrition workshops.

The nutritional intervention strategies included nutritional guidance (dietary choices, questions about specific food, adequate substitutes, etc.), assessment of food intake (by maintaining records in a food diary), and development of a dietary plan (on an individual basis).

The workshops addressed various topics and included a theoretical background and language appropriate to the public. The topics were addressed following a planned and consistent line of reasoning for the assimilation and understanding of the contents according to the Food Guide for the Brazilian Population and other recommendations [22- 24]. To facilitate engagement and understanding, practical activities such as tastings, competitions, and games were carried out.

In the first 3 months, the topics covered general concepts of nutrition such as the classification of foods according to the food pyramid and correct food portioning and labeling. In the next 3 months, the workshops addressed topics related to illnesses resulting from inadequate nutrition with a sequence of meetings on NCDs, as shown in Table 1.