A School Nurse-Delivered Intervention for Overweight and At Risk Adolescents
Condition: Overweight; Obesity
MeSH terms: Overweight
Study type: Interventional
Phase: Phase 1

Summary: 
      Overweight in adolescents has nearly tripled in the past two decades and has serious physical
      and psychosocial consequences, both during adolescence and into adulthood. School nurses have
      tremendous potential to prevent and treat overweight in this population, as over 95% of
      adolescents have contact with the school health system each year and school nurses have the
      credibility and skills to provide guidance regarding weight, diet and physical activity. The
      goals of the proposed exploratory study are to adapt an innovative, theory-based school
      nurse-delivered counseling intervention model used effectively for smoking cessation for the
      treatment of adolescent overweight, and test its feasibility and potential efficacy in
      reducing BMI, improving diet, increasing physical activity and decreasing sedentary behavior.
      If the results of this exploratory study prove promising, the efficacy of the intervention
      will be evaluated in a large scale randomized controlled trial.
    

Detailed description: 
      Overweight in adolescents has nearly tripled in the past two decades and has serious physical
      and psychosocial consequences, both during adolescence and into adulthood. School nurses have
      tremendous potential to identify, prevent, and treat overweight in this population, as over
      95% of children and adolescents have contact with the school health system each year and
      school nurses have the credibility and skills to provide guidance regarding weight, diet and
      physical activity. However, to our knowledge there have been no randomized controlled
      school-based trials that have utilized the school nurse to deliver weight-related
      intervention to adolescents. In a RCT conducted by the investigators, we found a school
      nurse-delivered smoking cessation intervention was successful in assisting adolescent smokers
      to quit, being both feasible to deliver in the school health setting and very well received
      by adolescents.

      This two-year exploratory study will adapt this innovative, theory-based school
      nurse-delivered intervention model for the treatment of adolescent overweight, and test its
      feasibility and potential efficacy in reducing BMI, improving diet, increasing physical
      activity and decreasing sedentary behavior. The content of the intervention will be based on
      current clinical guidelines for the treatment of overweight in adolescents and Social
      Cognitive Theory (SCT), employing cognitive-behavioral techniques to facilitate changes in a
      set of very focused self-management behaviors: diet (at least 5 fruits vegetables a day;
      avoid soda and sugar sweetened drinks), physical activity (at least 1 hour on most days), and
      sedentary behavior (less than 2 hours of TV, video, and computer time a day). Four high
      schools in Massachusetts will be pair matched on demographics, school size, and percent low
      income and randomly assigned to one of two conditions: (1) Counseling Intervention (CI)
      consisting of six 30-minute individual student-centered counseling sessions delivered by
      school nurses over 2 months (weekly in month 1, biweekly in month 2); or (2) Information
      Intervention (II) attention-control comparison condition consisting of six individual
      sessions with the school nurse over 2 months (weekly in month 1, biweekly in month 2) to
      check status regarding weight and behavior changes and deliver a series of standardized
      pamphlets on weight and weight management. Adolescents (n=84) enrolled in grades 9 through 12
      at-risk for overweight (body mass index (BMI) between the 85th and 94th percentile for age
      and gender) or overweight (BMI at or greater than the 95th percentile) will be recruited from
      the four schools. Assessments will be conducted at baseline and at 3-and 6-month follow-up.
      Should the results of this exploratory study prove promising the efficacy of the intervention
      will be evaluated in a large scale RCT. If found to be effective, such a school
      nurse-delivered intervention for adolescent overweight would have tremendous potential for
      wide-scale dissemination.
    

Intervention name(s): Counseling Intervention; Information Intervention
Intervention type(s): Behavioral; Behavioral
Intervention description(s): Six 30-minute individual student-centered counseling sessions based on the 5A approach to assist adolescents in making changes in their diet and level of physical activity delivered by school nurses over 2 months (weekly in month 1, biweekly in month 2); Six individual sessions with the school nurse over 2 months to check weight and behavioral changes and provide a series of six pamphlets on weight and weight management
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Treatment
Keywords: Overweight; Obesity; Adolescents; Youth; School health; Randomized controlled trial; Intervention study