Examining the Feasibility of Collaborative Care Treatment for Overweight Adolescents
Condition: Obesity; Overweight
MeSH terms: Overweight
Study type: Interventional
Phase: Phase 2

Summary: 
      This project will examine the effectiveness of a primary care based intervention to help
      overweight teen girls adopt healthy lifestyle practices. Participants will be adolescent
      females from Kaiser Permanente Northwest primary care clinics with a body mass index above
      the 90th percentile. Teens will be randomly assigned to (1) a behavioral weight control
      program (enriched intervention), (2) brief primary care counseling (low intensity
      intervention), or (3) usual-care (control). For both of the project's active intervention
      arms, teens' primary care providers will be given customized plans describing the teen's
      eating and physical activity habits and instructions on how to best work with these teens and
      their families. The behavioral weight control program will be specifically tailored for teen
      girls and will include separate group meetings for teens and parents, follow-up telephone
      contacts with their group leader, and coordinated feedback from the teen's primary care
      provider.
    

Detailed description: 
      Overweight / obesity among youth has recently been declared a "public health crisis" in the
      United States and other Western countries due to its alarming increase in prevalence (Flegal,
      1999; Kohn & Booth, 2003; Lobstein et al., 2004; Sokol, 2000). Over the past decade,
      overweight in youth (Body mass index [BMI] > 95th percentile) has increased 4% for school-age
      children, 6 - 11 years old. Adolescents, 12 - 19 years of age are even more overweight (5%)
      (Ogden et al., 2002). Further, American adolescents had the highest prevalence of overweight
      among 15 western countries included in a cross-sectional, nationally representative
      school-based study (Lissau et al., 2004). Such trends are particularly troubling given the
      psychosocial and physical health risks associated with being overweight in childhood (Must &
      Strauss, 1999). Overweight among youth appears to confer longer-term health risks even among
      later normative weight adults (Must et al., 1992). Further, both longer-term health risks and
      the probability of adult obesity is greater for overweight adolescents than for those
      developing weight problems earlier in childhood (Must et al., 1992; Whitaker et al., 1997).
      Collectively, these factors suggest adolescent weight control is an important public health
      priority.

      Clinic-based weight control treatments for youth have demonstrated some success, however,
      most empirically-supported interventions have been designed for younger school-age children
      and their families (see Epstein et al., 1998 for a review). Even though a large volume of
      research explores adult-weight control (see NIH-NHLBI, 1998 for a review) and (though more
      limited) substantial research examines childhood obesity (see Epstein et al., 1998 for a
      review), obesity treatments for adolescents have not been adequately studied. Furthermore,
      almost all empirically tested weight control interventions among youth have been based in
      academic research clinics rather than the primary care medical settings, in which weight
      problems among these youth are most often identified and, arguably, in which they could be
      most efficiently treated. Placing adolescent weight-related interventions within primary
      medical care settings could make such interventions both more cost-effective and easier to
      disseminate. The purpose of this study is to assess the feasibility, acceptability, relative
      cost, and efficacy of a collaborative primary care-based behavioral lifestyle intervention
      (Enriched Intervention - EI) for overweight adolescent females and their families. This
      multi-component intervention, adapted for gender and developmental stage, will include a
      combination of assessment, group teen and parent sessions, individual telephone-based
      coaching contact, and a distinct collaborative care component with follow-up visits to the
      youth's primary care provider [PCP]. Further, we will compare the EI to a low intensity
      intervention [LII] (assessment and information about healthy diet and activity, and follow-up
      visits with the youth's PCP) and a usual care control condition.

      We hypothesize that:

        1. Adolescents participating in the Enriched Intervention (EI) will have a greater decrease
           in BMI percentile scores than adolescents receiving the Low Intensity Intervention (LII)
           or Usual Care.

        2. Adolescent in EI will have improved healthy lifestyle skills (e.g., more physical
           activity, less junk food and sodas) compared with those receiving LII or Usual Care.

        3. Adolescents in EI will report higher psychosocial functioning and quality of life
           outcomes than those receiving LII or Usual Care.

        4. Neither intervention will result in increases in problematic eating or weight-related
           behaviors or beliefs.
    

Intervention name(s): Enriched lifestyle intervention
Intervention type(s): Behavioral
Intervention description(s): Multi-component lifestyle intervention
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Nutrition; Exercise; Body mass index; Lifestyle change; Obesity; Overweight; Adolescents; Teens