Background
Paediatric obesity is a public health concern worldwide1 and one of the greatest health challenges of the 21st century.2 According to the observations from the Health Behaviour in School-aged Children from the WHO, the prevalence of obesity has increased between 2002 and 2014 in more than half of the European countries.3 In Portugal, it is estimated that about 3% of adolescents are obese and 30% are overweight.4
Even at younger ages overweight is associated with several adverse health conditions, such as cardiovascular,5 metabolic6 and psychosocial comorbidities.7 8 In addition, adolescent overweight is recognised as an independent risk factor for adult overweight and increased mortality.9–11
Weight management is particularly complex, and is crucial in adolescence since there is evidence that (1) physical activity (PA) levels tend to decline in adolescence12 13; (2) adolescence represents a transitional stage from child to adulthood associated with a substantial energy efficiency and a decrease in the resting metabolic rate14; (3) adolescence is the last critical period of adipocyte differentiation,15 with the number of adipocytes remaining unchanged thereafter16; and (4) adolescence is associated with significant psychological changes,17 being recognised as a critical period for acquisition of healthy behaviours.18
Recently, several authors and international associations, such as the European Association for the Study of Obesity, have considered obesity as a chronic condition, highlighting the idea that the management of obesity, prior to the appearance of overweight-related comorbidities, is crucial.2
Health institutions play a crucial role in the management of obesity. It has been suggested that a chronic care model may be implemented, with integration of healthcare, community resources and promotion of patient self-management for an effective management of obesity.19 According to the Expert Committee recommendations regarding the prevention, assessment and treatment of child and adolescent overweight and obesity (2007), healthcare institutions should be organised in multidisciplinary teams including paediatricians, nutritionists, psychologists and exercise physiologists in order to be able to screen and handle co-occurring morbidities, and for diet and PA counselling.20 PA has been recognised as having a beneficial effect on energy expenditure and as having an independent effect on physiological21 and psychological health.22
The Pediatric Obesity Clinic at Hospital de Santa Maria (Lisbon, Portugal) follows these recommendations since 2007. The team comprises paediatricians, nutritionists, psychologists and exercise physiologists. To the best of our knowledge, this is the first and only Portuguese tertiary healthcare centre including an exercise physiologist in their multidisciplinary team and having established the PA consultation into routine care.
PA consultation is a structured form of PA counselling based on the transtheoretical model.23 It has been suggested to be an effective and inexpensive24 method of enhancing PA behaviours, weight status25 26 and self-management/autonomy,27 as well as improving several biochemical markers among overweight youth.28 However, due to the inconsistent results reported in the literature on the effect of PA counselling on PA behaviours and weight status, a further understanding of the benefits of including PA consultation as part of a paediatric obesity management programme is needed.