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BACKGROUND: Metabolic and bariatric surgery (MBS) is the preferred method to achieve significant weight loss in patients with Obesity Class V (BMI > 60 kg/m2). However, there is no consensus regarding the best procedure(s) for this population. Additionally, these patients will likely have a higher risk of complications and mortality. The aim of this study was to achieve a consensus among a global panel of expert bariatric surgeons using a modified Delphi methodology. METHODS: A total of 36 recognized opinion-makers and highly experienced metabolic and bariatric surgeons participated in the present Delphi consensus. 81 statements on preoperative management, selection of the procedure, perioperative management, weight loss parameters, follow-up, and metabolic outcomes were voted on in two rounds. A consensus was considered reached when an agreement of ≥ 70% of experts' votes was achieved. RESULTS: A total of 54 out of 81 statements reached consensus. Remarkably, more than 90% of the experts agreed that patients should be notified of the greater risk of complications, the possibility of modifications to the surgical procedure, and the early start of chemical thromboprophylaxis. Regarding the choice of the procedure, SADI-S, RYGB, and OAGB were the top 3 preferred operations. However, no consensus was reached on the limb length in these operations. CONCLUSION: This study represents the first attempt to reach consensus on the choice of procedures as well as perioperative management in patients with obesity class V. Although overall consensus was reached in different areas, more research is needed to better serve this high-risk population.

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Resumen Esta ponencia examina las evidencias para la actividad física en la pérdida de peso y de adiposidad, la prevención del aumento de peso y la adiposidad, así como la recuperación de peso en adultos, y provee orientación sobre las implicaciones para los profesionales del ejercicio. La evidencia de la investigación indica que se requieren > 150 minutos, pero preferiblemente 300 minutos por semana de actividad aeróbica de intensidad al menos moderada para prevenir el aumento de peso y adiposidad, y al menos el extremo superior de esta gama de actividad para prevenir la recuperación de peso después de la pérdida de peso. Para que la pérdida de peso y adiposidad total sea significativa, se requiere un mínimo de 300 a 400 minutos por semana de actividad aeróbica de intensidad, al menos, moderada. La evidencia en torno al volumen de actividad física aeróbica requerida para reducir la adiposidad central está surgiendo, y las investigaciones apuntan a que puede ser sustancialmente menor que la que se requiere para la pérdida de peso. El impacto de la actividad física de alta intensidad y el ejercicio de resistencia para la gestión del peso es incierto. Durante las consultas para la gestión del peso, los profesionales en ejercicio deben aconsejar que se pueden lograr beneficios para la salud metabólica y cardiovascular por medio de la actividad física a cualquier peso, e independientemente del cambio de peso.

Abstract This Position Statement examines the evidence for physical activity in weight and adiposity loss, prevention of weight and adiposity gain, and in weight regain in adults, and provides guidance on implications for exercise practitioners. Research evidence indicates that >150 min but preferably 300 min per week of aerobic activity of at least moderate intensity is required to prevent weight and adiposity gain, and at least the upper end of this range of activity to prevent weight regain after weight loss. For meaningful weight and total adiposity loss, a minimum of 300-420 min per week of aerobic activity of at least moderate intensity is required. The evidence around the volume of aerobic physical activity required to reduce central adiposity is emerging, and research suggests that it may be substantially less than that required for weight loss. The impact of high-intensity physical activity and resistance exercise for weight management is uncertain. During consultations for weight management, exercise practitioners should advise that metabolic and cardiovascular health benefits can be achieved with physical activity at any weight, and irrespective of weight change.

Resumo Este documento examina as evidências da atividade física na perda de peso e adiposidade, na prevenção do ganho de peso e adiposidade e na recuperação de peso em adultos, e fornece orientações sobre as implicações para os profissionais do exercício físico. As evidências da pesquisa indicam que são necessários mais de 150 minutos, mas preferencialmente 300 minutos por semana de atividade aeróbica de intensidade moderada para evitar o ganho de peso e adiposidade, e pelo menos o extremo superior dessa gama de atividade para evitar o ganho de peso após a perda de peso. É necessário um mínimo de 300 a 400 minutos por semana de atividade aeróbica de intensidade moderada para uma perda significativa de peso e adiposidade total. Estão surgindo evidências sobre a quantidade de atividade física aeróbica necessária para reduzir a adiposidade central, e pesquisas sugerem que ela pode ser substancialmente menor do que a necessária para a perda de peso. O impacto da atividade física de alta intensidade e dos exercícios de resistência no controle de peso é incerto. Durante as consultas de controle de peso, os profissionais do exercício físico devem informar que os benefícios metabólicos e cardiovasculares à saúde podem ser obtidos por meio da atividade física em qualquer peso, independentemente da mudança de peso.

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BACKGROUND: In some occupational groups, prolonged standing is associated with adverse symptoms. While the introduction of sit-stand workstations in office workers is increasingly common, the profile of symptom development is not known. OBJECTIVES: To identify and describe the location, intensity, quality, and timing of symptoms experienced by office workers while standing at a sit-stand workstation. METHODS: This cross-sectional observational study was performed in an university campus laboratory simulated as an office with a sit-stand workstation. Sixty-three office workers without low back pain or prior exposure to a sit-stand workstation participated. For primary outcome measures, participants recorded any symptoms of pain, stiffness, and/or fatigue on a body chart every 15 min during a 2-hour standing task. Participants rated symptom intensity on an 11-point numerical rating scale (NRS). RESULTS: Fifty-three participants (84%) experienced symptoms during the 2-hour standing task, with 30 participants (48%) reporting at least one symptom within 30 min of standing. A greater number of participants reported symptoms rated ≥2 on the NRS in the lumbar spine, lower extremity, and feet/ankle than the upper quadrant (odds ratios from 3.84 to 6.86). Mean maximal symptom intensity for the lumbar spine was greater than that for the upper quadrant and feet/ankles (incidence rate ratios: 1.46 to 1.79). CONCLUSION: Symptoms of pain, stiffness, and fatigue, especially those affecting the lumbar spine, lower extremity and feet/ankles are common in office workers who stand at a workstation. Study findings suggest that physical therapists should advise workers using sit-stand workstations to monitor symptoms and consider changing position within 30 min.

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BACKGROUND: Physical activity levels decrease during pregnancy, and the time course of return to prepregnancy levels is unclear. This study aimed to describe changes in leisure-time physical activity (LTPA) and sitting time from 16 to 24 weeks of pregnancy to 12, 24, and 48 months postpartum in women with different education levels in Brazil. METHODS: Data from 4000 mothers of children enrolled in the 2015 Pelotas (Brazil) Birth Cohort were analyzed. The women were interviewed between 16 and 24 weeks of pregnancy and when their children were aged 12, 24, and 48 months. The LTPA and sitting time were self-reported. RESULTS: Only 15.7% of the women reported any LTPA during pregnancy; this declined to 7.9% at 12 months postpartum; it was 16.8% at 24 months and 23.2% at 48 months. On average, participants spent a mean (SD) of 6.4 (3.9), 4.2 (3.2), 4.3 (3.3), and 4.4 (3.3) hours per day sitting during pregnancy, and at 12, 24, and 48 months after the birth, respectively. Both any LTPA and high sitting (8+ h/d) were consistently higher among women with higher education. CONCLUSION: After 24 months postpartum, LTPA levels had returned to or exceeded pregnancy levels, but sitting time remained lower than during pregnancy.

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BACKGROUND: Few studies have examined relationships between physical activity (PA) during mid-age and health costs in women. The aim of this study was to investigate associations between PA levels and trajectories over 12 years with medical and pharmaceutical costs in mid-age Australian women. METHODS: Data from 6953 participants in the Australian Longitudinal Study on Women's Health (born in 1946-1951) were analysed in 2019. PA was self-reported in 2001 (50-55y), 2007 (56-61y) and 2013 (62-67y). PA data were linked with 2013-2015 data from the Medicare (MBS) and Pharmaceutical (PBS) Benefits Schemes. Quantile regression was used to examine associations between PA patterns [always active, increasers, decreasers, fluctuaters or always inactive (reference)] with these medical and pharmaceutical costs. RESULTS: Among women who were consistently inactive (< 500 MET.minutes/week) in 2001, 2007 and 2013, median MBS and PBS costs (2013 to 2015) were AUD4261 and AUD1850, respectively. Those costs were AUD1728 (95%CI: 443-3013) and AUD578 (95%CI: 426-729) lower among women who were consistently active in 2001, 2007 and 2013 than among those who were always inactive. PBS costs were also lower in women who were active at only one survey (AUD205; 95%CI: 49-360), and in those whose PA increased between 2001 and 2013 (AUD388; 95%CI: 232-545). CONCLUSION: Maintaining 'active' PA status was associated with 40% lower MBS and 30% lower PBS costs over three years in Australian women. Helping women to remain active in mid-life could result in considerable savings for both women and the Australian government.

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BACKGROUND: One-anastomosis gastric bypass (OAGB-MGB) is currently the third performed primary bariatric surgical procedure worldwide. However, the procedure is hampered by numerous controversies and there is considerable variability in surgical technique, patient selection, and pre- and postoperative care among the surgeons performing this procedure. This paper reports the results of a modified Delphi consensus study organized by the International Federation for Surgery of Obesity and Metabolic Disorders (IFSO). METHODS: Fifty-two internationally recognized bariatric experts from 28 countries convened for voting on 90 consensus statements over two rounds to identify those on which consensus could be reached. Inter-voter agreement of ≥ 70% was considered consensus, with voting participation ≥ 80% considered a robust vote. RESULTS: At least 70% consensus was achieved for 65 of the 90 questions (72.2% of the items), 61 during the first round of voting and an additional four in the second round. Where consensus was reached on a binary agree/disagree or yes/no item, there was agreement with the statement presented in 53 of 56 instances (94.6%). Where consensus was reached on a statement where options favorable versus unfavorable to OAGB-MGB were provided, including statements in which OAGB-MGB was compared to another procedure, the response option favorable to OAGB-MGB was selected in 13 of 23 instances (56.5%). CONCLUSION: Although there is general agreement that the OAGB-MGB is an effective and usually safe option for the management of patients with obesity or severe obesity, numerous areas of non-consensus remain in its use. Further empirical data are needed.

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BACKGROUND: Although evidence on the health effects of sedentary behavior (SB) has grown systematically in recent years, few developing countries have reported population levels of SB, especially in South America. Our objective was to describe time spent sitting in a representative sample from Chile categorized by age, gender, educational level, and body mass index (BMI). METHODS: A national health survey was conducted in Chile in a nationally representative sample (n = 5411) in 2009-2010. Sitting time (ST) was measured with the Global Physical Activity Questionnaire Version 2. RESULTS: Data were from 5031 participants (43.26 ± 0.41 years, mean ± SE; 40.3% male). Overall, there were no gender differences in mean ST (men: 158.10 ± 5.80 min/day, women 143.45 ± 4.77 min/day; p = 0.05). ST was lower in those who lived in rural areas compared with urban areas (99.4 min/day vs. 160.0 min/day; p = 0.001). ST increased significantly with increasing BMI, but only in men (p = 0.009), and was positively related to years of education in both men and women (p < 0.0001). CONCLUSION: The findings were different from those reported in other countries and contexts, reinforcing the need for international surveillance and monitoring over time to inform policy makers. Differences in ST across different groups emphasize the need to develop tailored messages and interventions for reducing ST in different population subgroups.

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Accurate estimation of energy expenditure (EE) from accelerometer outputs remains a challenge in older adults. The aim of this study was to validate different ActiGraph (AG) equations for predicting EE in older adults. Forty older adults (age = 77.4 ± 8.1 yrs) completed a set of household/gardening activities in their residence, while wearing an AG at the hip (GT3X+) and a portable calorimeter (MetaMax 3B - criterion). Predicted EEs from AG were calculated using five equations (Freedson, refined Crouter, Sasaki and Santos-Lozano (vertical-axis, vectormagnitude)). Accuracy of equations was assessed using root-mean-square error (RMSE) and mean bias. The Sasaki equation showed the lowest RMSE for all activities (0.47 METs) and across physical activity intensities (PAIs) (range 0.18-0.48 METs). The Freedson and Santos-Lozano equations tended to overestimate EE for sedentary activities (range: 0.48 to 0.97 METs), while EEs for moderate-to-vigorous activities (MVPA) were underestimated (range: -1.02 to -0.64 METs). The refined Crouter and Sasaki equations showed no systematic bias, but they respectively overestimated and underestimated EE across PAIs. In conclusion, none of the equations was completely accurate for predicting EE across the range of PAIs. However, the refined Crouter and Sasaki equations showed better overall accuracy and precision when compared with the other methods.

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The overall aim of this study was to examine the association of physical activity (PA) and screen time (ST) on indicators of cardio-metabolic risk during adolescence, by examining the combined association of PA and ST at ages 11, 15 and 18 on cardio-metabolic risk factors at 18 years. Data from the 1993 Pelotas (Brazil) Birth Cohort Study (N = 3613) were analysed in 2017. Self-reported PA and ST data were collected at 11, 15 and 18 years. Cardio-metabolic risk factors (fat mass index, waist circumference, triglycerides, blood glucose, non-HDL cholesterol and resting diastolic blood pressure) were examined at age 18. Multivariate linear regression was used to examine the associations between four mutually exclusive PA/ST groups: 1) active (≥1 h/day PA) and low ST (<5 h/day ST); 2) active (≥1 h/day PA) and high ST (≥5 h/day ST); 3) inactive (<1 h/day PA) and low ST (<5 h/day ST); 4) inactive (<1 h/day PA) and high ST (≥5 h/day ST) at each age, and outcomes at age 18. There were no significant associations between PA/ST at ages 11 and 15 with outcomes at 18 years. In the cross-sectional analyses, adolescents in the most active group had significantly better levels of all the outcomes, regardless of ST. Inactive participants with high ST had the highest levels of glucose and non-HDL-C. For diastolic blood pressure, values were higher among inactive participants. Overall, higher levels of physical activity appeared to be more important than low levels of ST for cardio-metabolic health in adolescents.

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Socioeconomic position (SEP) is a potential correlate of sedentary behavior in adolescents. The aim of this study was to examine the associations between SEP and self-reported and objective measures of sedentary behavior in adolescents, using a life-course approach. Data from the 1993 Pelotas (Brazil) Birth Cohort Study were analyzed (N=5249). Cross-sectional and longitudinal associations between multiple SEP indicators (maternal education, family income, SEP composite, cumulative family income) at birth, 11, 15 and 18years, and five sedentary behavior outcomes (≥4h/day screen time; ≥4h/day TV; ≥2h/day computer; ≥2h/day video game; ≥12.7h/day objectively measured sedentary time) at 11, 15 and 18years, were examined. In cross-sectional analyses, higher SEP was positively associated with more screen time at ages 11 and 15years. There was a consistent and positive association between higher SEP with time spent using a computer, and with sedentary time assessed through accelerometry. SEP at birth had a positive and direct effect on screen, computer and total sedentary time at 18years. Participants in the highest cumulative income group had higher odds of high sedentary behavior in screen (OR: 2.40; 95% CI: 1.50-3.54), computer (OR: 7.35; 95% CI: 4.19-12.89) and total sedentary time (OR: 5.40; 95% CI: 3.53-10.35), respectively, compared with their counterparts with lower cumulative income. Our findings showed that SEP is an early determinant of sedentary behavior in adolescents.

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BACKGROUND: The body of evidence on associations between socioeconomic status (SES) and sedentary behaviors in adolescents is growing. OBJECTIVES: The overall aims of our study were to conduct a systematic review and meta-analysis of this evidence and to assess whether (1) the associations between SES and sedentary behavior are consistent in adolescents from low-middle-income and from high-income countries, (2) the associations vary by domain of sedentary behavior, and (3) the associations vary by SES measure. METHODS: We performed a systematic literature search to identify population-based studies that investigated the association between SES and sedentary behavior in adolescents (aged 10-19 years). Only studies that presented risk estimates were included. We conducted meta-analyses using random effects and univariate meta-regression and calculated pooled effect sizes (ES). RESULTS: Data from 39 studies were included; this provided 106 independent estimates for meta-analyses. Overall, there was an inverse association between SES and sedentary behavior (ES 0.89; 95 % confidence interval [CI] 0.81-0.98). However, the direction of the association varied: in high-income countries, SES was inversely associated with sedentary behavior (ES 0.67; 95 % CI 0.62-0.73), whereas in low-middle-income countries, there was a positive association between SES and sedentary behavior (ES 1.18; 95 % CI 1.04-1.34). In high-income countries, the associations were strongest for screen time (ES 0.68; 95 % CI 0.62-0.74) and television (TV) time (ES 0.58; 95 % CI 0.49-0.69), whereas in low-middle-income countries, the associations were strongest for 'other' screen time (i.e., computer, video, study time, but not including TV time) (ES 1.38; 95 % CI 1.07-1.79). All indicators of SES were negatively associated with sedentary behavior in high-income countries, but only resources (income and assets indexes) showed a significant positive association in low-middle-income countries. CONCLUSION: The associations between SES and sedentary behavior are different in high- and low-middle-income countries, and vary by domain of sedentary behavior. These findings suggest that different approaches may be required when developing intervention strategies for reducing sedentary behavior in adolescents in different parts of the world.

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