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Review
. 2024 Dec;1542(1):25-50.
doi: 10.1111/nyas.15251. Epub 2024 Nov 16.

Effects of multidisciplinary therapy on energy balance, inflammation, and metabolic diseases in adolescents with obesity: A narrative review

Ana Raimunda Dâmaso  1   2 , Deborah Cristina Landi Masquio  1   3 , Raquel Munhoz da Silveira Campos  4 , Flávia Campos Corgosinho  5 , Cintia Cercato  2   6
Affiliations
Review

Effects of multidisciplinary therapy on energy balance, inflammation, and metabolic diseases in adolescents with obesity: A narrative review

Ana Raimunda Dâmaso et al. Ann N Y Acad Sci. 2024 Dec.

Abstract

Obesity is a consequence of multiple factors, including genetics, lifestyle and nutritional choices, physical activity, sleep duration, screen time, and mood disorders. These behavioral elements can impair the regulation of energy balance and obesity management that link obesity to a constellation of chronic conditions that lead to a high prevalence of cardiometabolic risk factors, metabolic syndrome, and nonalcoholic fatty liver disease. Multidisciplinary therapy is defined as an approach delivered by a multidisciplinary-trained health team covering at least two components of behavior, physical activity/exercise, dietary habits, and/or psychological counseling associated with clinical interventions. This narrative review summarizes the effects of multidisciplinary therapy on neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, metabolic syndrome, nonalcoholic fatty liver diseases, behavior, and quality of life. We found that multidisciplinary therapy, including medical, nutritional, exercise, and behavioral counseling, and/or education, was useful for addressing outcomes such as visceral adiposity, neuroendocrine regulation of energy balance, inflammatory biomarkers, cardiometabolic risk factors, nonalcoholic fatty liver disease, and metabolic syndrome. The effects were mediated by improvements in neuroendocrine regulation of energy balance, downregulation of the pro-inflammatory states, and a reduction in comorbidities. Multidisciplinary therapy also improved mood disorders and quality of life.

Keywords: adipose tissue; energy balance; inflammation; metabolic syndrome; multidisciplinary therapy; nonalcoholic fatty liver disease; obesity.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Flowchart of the article screening.
FIGURE 2
FIGURE 2
Effects of multidisciplinary therapy associated with schools, communities, and family interventions on anthropometric variables in children and adolescents with obesity.
FIGURE 3
FIGURE 3
Effects of multidisciplinary therapy on body composition and adipose tissue in children and adolescents with obesity.
FIGURE 4
FIGURE 4
(A) Energy balance homeostasis; (B) energy balance disruption and effects of (C) short and (D) long‐term multidisciplinary therapy on energy balance control. AgRP, agouti related peptide; alpha‐MSH, melanocyte stimulating hormone; CART, cocaine‐ and amphetamine‐regulated transcript; NPY, neuropeptide Y; POMC, proopiomelanocortin.
FIGURE 5
FIGURE 5
(A) Effects of FGF21 on the hypothalamus and adipose tissue favoring energy balance. (B) In obesity, there is FGF21 resistance, favoring energy balance impairment, reduced thermogenesis, and thus, metabolic disorders. (C) After obesity management promoted by long‐term multidisciplinary therapy, there is an improvement in FGF21 sensitivity, which can promote browning of white adipose tissue through corticotropin‐releasing factor (CRF)‐dependent sympathetic nerve activation (SNA) and the hypothalamic–pituitary–thyroid (HPT) axis, leading to greater thermogenesis and improvement in glucose and lipid metabolism. The redistribution of energetic substrates to skeletal muscle might be linked to the increase in lean mass.
FIGURE 6
FIGURE 6
Effects of multidisciplinary therapy on cardiometabolic risk factors in children and adolescents with obesity.
FIGURE 7
FIGURE 7
Potential impact of multidisciplinary therapy in the inflammatory process related to obesity in children and adolescents. CRP, C‐reactive protein; IL‐6, interleukin‐6; M1, M1 macrophage; M2 macrophage; PAI‐1, plasminogen activator inhibitor 1; TNF‐α, tumor necrosis factor‐alpha.
FIGURE 8
FIGURE 8
Suggested link between obesity, metabolic syndrome, and nonalcoholic fatty liver disease. The small red circles surrounding the adipocytes indicate metabolic dysfunction of the tissue. CRP, C‐reactive protein; HDL, high‐density lipoprotein; IL‐6, interleukin‐6; M1, M1 macrophage; PAI‐1, plasminogen activator inhibitor 1; TNF‐α, tumor necrosis factor‐alpha; VLDL, very low‐density lipoprotein.
FIGURE 9
FIGURE 9
Effects of multidisciplinary therapy on obesity and quality of life in childhood. Many behaviors can lead to obesity, such as sedentarism, sleep disorders, and inadequate diet quality. Together, they might lead to obesity and result in disruptions in sleep, eating patterns, body image, and negative psychological states. Depression and anxiety might further impair adherence to obesity treatment, which can be minimized by a multidisciplinary approach. Successful multidisciplinary therapy reduces the pro‐inflammatory condition, which can improve depression symptoms and quality of life.
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