Adolescent obesity is a multifactorial condition influenced by many factors. Previous studies have demonstrated that this type of multidisciplinary lifestyle therapy is effective to treat physical problems such as non-alcoholic fat liver disease [26
], metabolic syndrome [28
] and eating disorders [29
], while others have shown that this kind of approach could be considered more effective than regular treatments that involve interventions in health alone [30
Thus, we sought to examine several variables associated with psychological aspects. The main findings of this study were significant improvement in scores of depression, anxiety, binge eating, body image dissatisfaction, as well as domains of QOL. This is particularly important once several studies indicate that obese adolescents have a higher incidence of mental health problems, such as depression, anxiety, poor self-esteem and low QOL than non-obese adolescents, suggesting that this condition has a global impact on their daily life [32
There is solid evidence in the literature supporting the assumption that cognitive behavioral interventions with adolescents are effective in decreasing depression and anxiety symptoms [36
]. It is essential to understand the relationship between depression and obesity during adolescence, when both conditions may have their origins. Theoretically, depressed individuals eat to provide comfort or distraction from negative emotions [37
]. Boys and girls have different patterns of depressive symptoms during puberty. Although they have an increase in depressive symptoms during adolescence, these symptoms are more dramatic in girls [33
The significantly lower scores observed for depression and anxiety after short and long-term multidisciplinary lifestyle treatment and, consequently, the improvement observed in scores of mean dimensions of QOL can be explained by numerous factors, including increased self-esteem, stronger beliefs about the ability to engage in a healthy lifestyle related to healthier living attitudes, choices and behaviors [3
A study comparing obese and non obese boys indicated that 44% of obese boys were not satisfied with their weight and 21% with their appearance. Therefore, obese boys reported more somatic and psychological symptoms, poor self-esteem and less healthy lifestyle. They feel unsuccessful and unhappy, and use drugs as a temporary medication [8
]. As proposed in this study, we demonstrated a significant improvement of adverse effects on self-esteem and body image satisfaction in both genders. Nevertheless, body image dissatisfaction in girls was higher than in boys. Our results were in agreement with other findings in the literature [39
], suggesting that a multidisciplinary therapy including psychological approaches, which encourages patients to change the way they think about themselves and their bodies in a more positive and realistic way, may help them to achieve crucial lifestyle changes needed for a better QOL.
Previous studies showed a positive correlation between binge eating disorders and obesity [37
]. The present study revealed a statistically significant decrease in binge eating scores both in girls and boys after a long-term multidisciplinary therapy. These results can be attributed, at least in part, to a decrease in anxiety scores, since an anxious individual is more likely to develop binge eating disorders [4
An important aspect observed in the present research was the beneficial effects of lifestyle intervention on QOL. In fact, obese boys had a significant improvement in physical functioning, role physical after the short and the long-term therapy; role emotional dimension after the short-term therapy; and after the long-term therapy they also presented an improvement in vitality. In girls, the beneficial effects observed were significant improvements in physical functioning and in general health. Another study found that obese adolescents present poor QOL when compared with normal weight adolescents, as demonstrated in all functioning domains, suggesting that their daily life is globally affected by this condition [44
Aerobic exercise programs are related to better QOL scores, but physical exercise alone is not enough to promote a complete improvement. For any successful treatment, it is necessary to consider the individual in his/her totality (psychological, physical, social and behavioral aspects), and this is only possible in a multidisciplinary life-style therapy [26
In addition, a multidisciplinary intervention may enhance health, facilitate and promote social contact, and favorably affect QOL, thus leading to improved social life and interaction [47
]. Furthermore, it motivates people to adopt better lifestyle habits and it is an alternative treatment for stress since it has favorable impacts on every aspect of life.
Is important to note that the adolescents remained obese (at a lower degree) even losing weight. Therefore, we can attribute the improvements here described not only for weight loss, but a positive effect of the long-term multidisciplinary lifestyle therapy (24 weeks). John et al (2006) [48
] failed in found an association between obesity and psychological disorders These findings should motivate obese individuals to seek for lifestyle interventions to treat obesity, focus on improved self-esteem, healthier choices, attitudes and healthier lifestyle behaviors, which can, at least, induce a better QOL, especially for subjects who do not respond to weight loss.
The drop out rate observed in our sample is consistent with other pediatric weight management programs [49
]. Once the program was costless, we did not evaluate the socioeconomic status at the beginning of therapy. However, we identified, by phone calls that the drop out rate had been caused mainly due to the high cost of transportation, as the program center was distant from some of the volunteers' house. The hours demanded to complete each multidisciplinary session, can also be seen as a limitation of our study.
Other relevant limitations of this study are the lack of a control group, the relative small sample size, the lack of randomization and the absence of a follow-up. However, the original objective of the present study was to verify the effects of a long-term lifestyle therapy in obese adolescents. Despite these possible limitations, the effect size of our study is in accordance to the expectations of this type of therapy.