The purpose of this study was to explore the lives of overweight/obese adolescent boys. A qualitative case study focused on depth of understanding. Four boys volunteered to participate in the study. Findings further our understanding of the adolescent boys’ lifescapes; viable and non-viable recruitment strategies among this population; ethical obligations of ending research after establishing trust and rapport; and “Avoidance” as an Idiom of Distress among this sample of boys. Suggestions for future research are addressed in the study. / vi, 102 leaves ; 29 cm

Nos dias de hoje, a obesidade se caracteriza como uma doença de causas múltiplas, sendo uma enfermidade grave e com alta incidência em países desenvolvidos e em desenvolvimento. Dessa maneira, é possível considerar que a obesidade pode ser analisada por vários aspectos multifatoriais como os genéticos, sociais e afetivos. Nesse sentido, esta dissertação aborda alguns aspectos afetivos presentes na problemática da obesidade e sobrepeso em adolescentes mulheres, procurando verificar possíveis falhas na relação afetiva mãe e filha, nos estágios precoces do desenvolvimento da menina. Este estudo está fundamentado em concepções teóricas de Winnicott (1983; 2000; 2005; 2006), Levisky (1995), Barbosa Silva (2005), Bruno (2011) e Cardoso (2008). Foi utilizada como procedimento metodológico a abordagem qualitativa da História Oral de Vida que privilegia as narrativas do sujeito como compreensão de suas vivências afetivas. Desse modo, foram feitas entrevistas gravadas com as adolescentes obesas ou com sobrepeso de 13 a 18 anos que fazem parte da triagem ou estão em tratamento nutricional na Clínica-Escola de Nutrição da Faculdade de Ciências Biológicas e da Saúde do Centro Universitário (Cesmac) em Maceió, Alagoas. Diante disso, as narrativas das adolescentes entrevistadas teceram sua história de vida, apresentando dados significativos como a relação com a mãe, o contexto familiar, o próprio ato de adolescer e o lidar com os conflitos existentes no dia a dia como aspectos importantes e como hipóteses possíveis de ocasionar o aparecimento da obesidade e do sobrepeso nessas adolescentes mulheres. Cada contexto estudado, revela singularidades da relação mãe e filha e se destaca como fundamental para o desenvolvimento e a construção do amadurecimento da menina na infância e, principalmente, na adolescência. / Nowadays, obesity is characterized as a disease of multiple causes, its a serious illness and with high incidence in developed and developing countries. This way, it is possible to consider that obesity can be analyzed by various multifactorial features as genetic, social, and affective. In this sense, this dissertation says some affective aspects in obesity and overweights problematic in adolescent women, seeking to verify possible failures in affective relation mother and daughter, in the early stages of development of the girl. This study, is based on theoretical conceptions of Winnicott (1983, 2000, 2005, 2006), Levinsky (1995), Barbosa Silva (2005), Bruno (2011) and Cardoso (2008). It was used as methodological procedure the qualitative approach of Oral Life History that privileges the narratives of the subject as knowledge their affective experiences. Thus, they have been recorded interviews with obese adolescents or overweight 13 to 18 years who are part of the screening or are in the nutritional treatment Clinic-School of Nutrition of Biological Sciences and Health College (Cesmac) in Maceió, Alagoas. In this way, the narratives of the interviewed adolescents wove their life story, they are presenting significant data such as the relationship with the mother, the family context, the own act of adolescent and the dealing with conflicts in daily life as important aspects and as possible hypotheses to bring on the onset of obesity and overweight in these adolescent women. Each studied context, reveals singularities mother and daughter relationship and it stands as fundamental to the development and the construction girls maturing in childhood, and mainly, in youth.

Thesis (PhD)--Stellenbosch University, 2012. / Includes bibliography / ENGLISH ABSTRACT: Background/Aims: Obesity has increased rapidly in South African children and adolescents with significant variability observed among racial groups. Genes that regulate appetite have been studied in different populations worldwide, but their role in obesity among South African adolescents is unknown. The present study aimed at investigating the role of these genes, and their combined effect with physical activity in the development of obesity among South African adolescents. Methods: A total of 1564 South African school learners of Caucasian (n= 146), Mixed Ancestry (n= 872) and Black African (n= 537) ethnic groups were recruited for a research project that aimed to elucidate diabetes and the metabolic syndrome in children and adolescents attending schools in periurban areas of the Western Cape. The present case-control study included 227 obese-overweight (115 Black Africans and 112 Mixed Ancestry), and 204 normal weight (94 Black Africans and 110 Mixed Ancestry) adolescents learners. The learners were genotyped for nine polymorphisms (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) using allele-specific restriction enzyme analysis and automated sequencing. Genotype and haplotype associations with anthropometric variables such as body mass index (BMI), waist, hip, and mid-upper-arm circumferences (WC, HC, MUAC), and metabolic traits (fasting blood glucose, high density lipoproteincholesterol, total cholesterol), and blood pressure were further conducted. Furthermore, the type and frequency of physical activity was assessed by means of structured questionnaires; and its effect on obesity-related variables investigated in learners that were genotyped for the MC3R Thr6Lys and Val81Ile polymorphisms. Results: In a stepwise backward logistic regression analysis (containing age, gender, and LEP, LEPR, CART and GHRL polymorphisms), CART c.517A>G was independently significantly associated with obesity (OR= 5.98; 95%CI= 2.02, 21.27). CART c.517G carriers had higher MUAC (b coefficient= 1.88; 95%CI= 0.31, 3.44) while the LEPR 109Arg allele was significantly associated with decreased BMI (b coefficient = -2.36; 95%CI= -4.24, -0.47), WC (b coefficient = -5.66; 95%CI= -9.89, -1.44) and MUAC (b coefficient = -1.61; 95%CI= -3.00, -0.22); after adjusting for age, gender, and ethnicity. The haplotype containing the three LEP polymorphisms (A-A-A compared to the reference G-A-G haplotype) increased BMI (p= 0.0155), MUAC (p= 0.0146), and HC (p= 0.0128). The minor alleles of the MC3R polymorphisms decreased BMI, HC, WC, MUAC and TC; whilst only the Thr6Lys was associated with systolic and diastolic blood pressure (p= 0.0047 and 0.0027, respectively) in Mixed Ancestry learners. Doing house chores was associated with lower total cholesterol, independently and in the presence of the 81Ile allele (b coefficient = -0.355; 95%CI= 0.148, 0.561). Conclusion: To our knowledge, this is the first study that reports CART c.517A>G polymorphism as a risk factor for obesity in adolescents. Furthermore, the present study demonstrated that the MC3R polymorphisms had a positive effect on total cholesterol, which was further enhanced in physically active individuals. Similar to other studies, LEPR Lys109Arg and LEP polymorphisms were associated with variations in obesity-related variables among Black African and Mixed Ancestry South African learners. / AFRIKAANSE OPSOMMING: Agtergrond/Doelwitte: Vetsug het drasties toegeneem in Suid-Afrikaanse kinders en adelossente met ‘n beduidende variasie opgemerk tussen verskillende rassegroepe. Gene verantwoordelik vir regulering van eetlus is reeds wêreldwyd in verskillende bevolkingsgroepe bestudeer, maar hul rol in oorgewig Suid-Afrikaanse adolessente is onbekend. Die huidige studie was daarop gerig om ondersoek in te stel na die rol van hierdie gene en hul gekombineerde effek met fisiese aktiwiteit in die ontwikkeling van vetsug onder Suid-Afrikaanse adolessente. Metodes: ‘n Totaal van 1564 Suid-Afrikaanse leerders van Kaukasiese Afkoms (n=146), Gemengde Afkoms (n=872) en Swart Afkoms (n= 537) was gewerf in die navorsingsprojek wat ten doel gehad het om kinders en adolosente met diabetes en die metaboliese sindroom te identifiseer wat skole bygewoon het in semi-voorstedelike gebiede van die Wes-Kaap. Die huidige gevalle studie het 227 vetsugtige-oorgewig (115 Swart Afkoms en 110 Gemengde Afkoms) en 204 normale gewig (94 Swart Afkoms en 110 Gemengde Afkoms) leerders ingesluit. Die leerders was gegenotipeer vir nege polimorfismes (LEP: 19G>A, Lys36Arg, Val94Met; LEPR: Lys109Arg; Gln223Arg, Lys656Asn; CART: c.160-33G>A, c.499delA, and c.517A>G; GHRL: Leu72Met; and MC3R: Thr6Lys, Val81Ile) met die gebruik van alleel-spesifieke restriksie ensiem analises en geoutomatiseerde DNA volgorde bepalings tegnieke. Genotipiese en haplotipiese assosiasies met antropometriese veranderlikes soos liggaamsmassa indeks (BMI), middel-, heup- en mid-boarm omtrek (WC, HC, MUAC), metaboliese tendense (vastende bloed glukose, hoë-digtheid lipoproteïen-cholesterol, totale cholesterol) en bloeddruk was ook uitgevoer. Die tipe en frekwensie fisiese aktiwiteit was geassesseer deur middel van gestruktureerde vraelyste; en die uitwerking daarvan op vetsugverwante veranderlikes ondersoek in leerders wat vir die MC3R Thr6Lys en Val81Ile polimorfismes gegenotipeer was. Resultate: Statistiese ontleding (‘‘stepwise backward logistic regression analysis”), wat ouderdom, geslag en polimorfismes (LEP, LEPR, CART GHRL) ingesluit het, het getoon dat CART c.517A>G betekenisvol onafhanklik geassosiasieer was met vetsug (OR= 5.98; 95% CI= 2.02, 21.27). CART c.517G draers het ‘n hoër MUAC waarde gehad (b koeffisient = 1.88; 95%CI= 0.31, 3.44), terwyl die LEPR 109Arg alleel betekenisvol geassosieer was met verlaagde BMI ((b koeffisient = -2.36; 95%CI= -4.24, -0.47), WC (b koeffisient = -5.66; 95%CI= -9.89, -1.44) en MUAC (b koeffisient = -1.61; 95%CI= -3.00, -0.22) na die aanpassing van ouderdom, geslag en etnisiteit. Die haplotipe met die drie LEP polimorfismes (A-A-A teenoor die G-A-G verwysingshaplotipe) het die BMI (p= 0.0155), MUAC (p= 0.0146) en HC (p= 0.0128) verhoog. Die mindere allele van die MC3R polimorfismes het die BMI, HC, WC, MUAC en TC verlaag; terwyl slegs die Thr6Lys polymorfisme met sistolies en diastolies bloeddruk (p= 0.0047 en p= 0.0027, onderskeidelik) geassosieer was in Gemengde Afkoms leerders. Die verrigting van algemene huistake was geassosieer met laer totale kolesterol vlakke, onafhanklik en in die teenwoordigheid van die 81lle alleel (b koeffisient= -0.355; 95%CI= 0.148, 0.561). Gevolgtrekking: Na ons wete is hierdie die eerste studie wat die CART c.517A>G polimorfisme as ‘n risikofaktor vir vetsug in adolessente aantoon. Die huidige studie toon ook dat die MC3R polimorfisme ‘n positiewe effek op totale kolesterol gehad het, wat ook verder versterk was in fisiese aktiewe individue. Soortgelyk aan ander studies, was die LEPR Lys109Arg en LEP polimorfismes geassosieer met variasies in vetsug-verwante veranderlikes onder Suid-Afrikaanse Swart en Gemengde Afkoms leerders. / This research was supported by a grant from the University Research Fund of the Cape Peninsula University of Technology, Harry Crossley, University of Stellenbosch, Faculty of Health Sciences, Medical Research Council, and the National Health Laboratory Services, South Africa.

Made available in DSpace on 2017-06-01T18:08:53Z (GMT). No. of bitstreams: 1 silvana_maria_barros_santos.pdf: 1040372 bytes, checksum: 535cf6f879a0fe744c32c78db0ded9a9 (MD5) Previous issue date: 2013-10-16 / Nowadays, obesity is characterized as a disease of multiple causes, it´s a serious illness and with high incidence in developed and developing countries. This way, it is possible to consider that obesity can be analyzed by various multifactorial features as genetic, social, and affective. In this sense, this dissertation says some affective aspects in obesity and overweight s problematic in adolescent women, seeking to verify possible failures in affective relation mother and daughter, in the early stages of development of the girl. This study, is based on theoretical conceptions of Winnicott (1983, 2000, 2005, 2006), Levinsky (1995), Barbosa Silva (2005), Bruno (2011) and Cardoso (2008). It was used as methodological procedure the qualitative approach of Oral Life History that privileges the narratives of the subject as knowledge their affective experiences. Thus, they have been recorded interviews with obese adolescents or overweight 13 to 18 years who are part of the screening or are in the nutritional treatment Clinic-School of Nutrition of Biological Sciences and Health College (Cesmac) in Maceió, Alagoas. In this way, the narratives of the interviewed adolescents wove their life story, they are presenting significant data such as the relationship with the mother, the family context, the own act of adolescent and the dealing with conflicts in daily life as important aspects and as possible hypotheses to bring on the onset of obesity and overweight in these adolescent women. Each studied context, reveals singularities mother and daughter relationship and it stands as fundamental to the development and the construction girl s maturing in childhood, and mainly, in youth. / Nos dias de hoje, a obesidade se caracteriza como uma doença de causas múltiplas, sendo uma enfermidade grave e com alta incidência em países desenvolvidos e em desenvolvimento. Dessa maneira, é possível considerar que a obesidade pode ser analisada por vários aspectos multifatoriais como os genéticos, sociais e afetivos. Nesse sentido, esta dissertação aborda alguns aspectos afetivos presentes na problemática da obesidade e sobrepeso em adolescentes mulheres, procurando verificar possíveis falhas na relação afetiva mãe e filha, nos estágios precoces do desenvolvimento da menina. Este estudo está fundamentado em concepções teóricas de Winnicott (1983; 2000; 2005; 2006), Levisky (1995), Barbosa Silva (2005), Bruno (2011) e Cardoso (2008). Foi utilizada como procedimento metodológico a abordagem qualitativa da História Oral de Vida que privilegia as narrativas do sujeito como compreensão de suas vivências afetivas. Desse modo, foram feitas entrevistas gravadas com as adolescentes obesas ou com sobrepeso de 13 a 18 anos que fazem parte da triagem ou estão em tratamento nutricional na Clínica-Escola de Nutrição da Faculdade de Ciências Biológicas e da Saúde do Centro Universitário (Cesmac) em Maceió, Alagoas. Diante disso, as narrativas das adolescentes entrevistadas teceram sua história de vida, apresentando dados significativos como a relação com a mãe, o contexto familiar, o próprio ato de adolescer e o lidar com os conflitos existentes no dia a dia como aspectos importantes e como hipóteses possíveis de ocasionar o aparecimento da obesidade e do sobrepeso nessas adolescentes mulheres. Cada contexto estudado, revela singularidades da relação mãe e filha e se destaca como fundamental para o desenvolvimento e a construção do amadurecimento da menina na infância e, principalmente, na adolescência.