Multisystemic Therapy (MST) for Obesity in African American Youth
Condition: Obesity
MeSH terms: Obesity
Study type: Interventional

Summary: 
      Despite the dramatic increase in obesity and Type II Diabetes in adolescents, documented
      effective treatments for obesity and the consequential prevention of Type II Diabetes are
      scarce. Modification of food and activity choices is the foundation of obesity treatment;
      however, adolescents may find it difficult to follow recommended diet and exercise programs.
      This study uses a home-based treatment, Multisystemic Therapy (MST), to target change within
      the individual, family and environmental contexts. Participants are 49 obese (BMI>95th
      percentile) African American adolescents (ages 12-17). 24 were randomized to receive the MST
      intervention and 25 were placed in Shapedown, a family group program. Families were recruited
      from the only university-affiliated medical center in Detroit, Michigan. Michigan's youth
      have higher rates of obesity, overweight, hypertension, and elevated cholesterol compared to
      the national average, and Detroit has the highest percentage of African Americans of any
      major city in the US. Families complete measurements at the start of the treatment, at the
      end of the treatment and one year after enrollment. We expect to find that youth in the MST
      group will show more weight loss and greater improvements in diet (e.g., caloric intake and
      exercise behaviors than will youth in Shapedown. These changes in food choices, activity
      levels, and weight are expected to remain after the end of treatment. This intervention is
      intended to provide immediate assistance to a vulnerable population disproportionately
      affected by obesity and its long-term health complications.
    

Detailed description: 
      Despite the increase in pediatric obesity, controlled intervention trials among adolescents
      are rare and fail to address vital socio-ecological factors, particularly in minority youth.
      Modification of food and activity choices is the foundation of obesity treatment; however,
      adherence to these recommendations is a major barrier. We have adapted the home-based
      Multisystemic Therapy (MST) to successfully improve outcomes in urban adolescents with
      diabetes. The objective of the present study is to adapt MST to improve adherence to
      recommended food and activity choices and reduce BMI in obese (BMI>95th percentile) African
      American adolescents (ages 12-17). Additional aims are to determine if MST changes the
      individual, family, and environmental variables related to poor food choices (e.g., parental
      monitoring). Families are recruited from the only university-affiliated medical center in
      Detroit, Michigan. Michigan's youth have higher rates of obesity, overweight, hypertension,
      and elevated cholesterol compared to the national average. Detroit has the highest percentage
      of African Americans of any major city in the US. The design is a randomized controlled trial
      with 49 obese African American adolescents, 24 of whom receive MST and 25 of whom receive
      Shapedown, a family-based behavioral group intervention. Families complete a baseline data
      collection, a 7-month post-test coinciding with treatment completion, and a 12-month
      post-test. The primary aim of this project is Despite the increase in pediatric obesity,
      controlled intervention trials among adolescents are rare and fail to address vital
      socio-ecological factors, particularly in minority youth. Modification of food and activity
      choices is the foundation of obesity treatment; however, adherence to these recommendations
      is a major barrier. We have adapted the home-based Multisystemic Therapy (MST) to
      successfully improve outcomes in urban adolescents with diabetes. The objective of the
      present study is to adapt MST to improve adherence to recommended food and activity choices
      and reduce BMI in obese (BMI>95th percentile) African American adolescents (ages 12-16).
      Additional aims are to determine if MST changes the individual, family, and environmental
      variables related to poor food choices. Families will be recruited from the only
      university-affiliated medical center in Detroit, Michigan. Michigan's youth have higher rates
      of obesity, overweight, hypertension, and elevated cholesterol compared to the national
      average. Detroit has the highest percentage of African Americans of any major city in the US.
      The design is a randomized controlled trial with 49 obese African American adolescents, 24 of
      whom receive MST and 25 of whom receive a family-based behavioral group intervention.
      Families complete a baseline data collection, a 7-month post-test coinciding with treatment
      completion, and a 12-month post-test. If successful, this intervention will provide immediate
      assistance to a vulnerable population disproportionately affected by obesity and its
      long-term health complications. The project will also provide the foundation for a larger
      clinical trial as well as future interdisciplinary studies combining behavioral and medical
      interventions. If successful, this intervention will provide immediate assistance to a
      vulnerable population disproportionately affected by obesity and its long-term health
      complications. The project will also provide the foundation for a larger clinical trial as
      well as future interdisciplinary studies combining behavioral and medical interventions.
    

Intervention name(s): Multisystemic Therapy (MST); Shapedown
Intervention type(s): Behavioral; Behavioral
Intervention description(s): MST is an intensive, family centered, community based treatment originally designed for use with adolescents presenting with serious mental health problems. In this study, MST interventions are aimed at increasing adolescent and family adherence to dietary and exercise recommendations and targeting barriers within the family system, and the broader community systems within which the family is embedded (peers, schools, health care). Decreasing caloric consumption consistent with recommended intake targets, increasing daily exercise and decreasing sedentary activity, are treatment focuses depending on whether the adolescent has difficulty with this aspect of weight management or not.; Shapedown, is a clinic-based, adolescent weight loss intervention. Shapedown utilizes psycho educational, behavior, and family therapy techniques in a 10-week group intervention. In order to match MST's length of intervention (6 months), three follow-up sessions are added at monthly intervals.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment