Primary Care Treatment for Overweight Adolescent Females

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DESCRIPTION (provided by applicant): In the past two decades, the percentage of adolescents who are overweight or obese has almost tripled, from 5.to 14%. Although considerable research has focused on adult-weight control, and a growing body of research examines childhood obesity, treatments for adolescents have not been adequately studied. We will examine the clinical efficacy and incremental cost-effectiveness of a primary care-based, multi-component lifestyle intervention for overweight adolescent females and their families. Participants will be 250 females aged 13-15 with a body mass index (kg/m2) between the 95th and 99th percentile for the year 2000 national norms. Participants will be randomly assigned to a multi-component, behaviorally-based, weight control intervention or a usual care control condition. The intervention will be tailored for gender and developmental stage, and will include coordinated feedback and ongoing counseling from the adolescent's pediatrician. In addition, the intervention will include group meetings for teens, group meetings for parents, and follow-up telephone contacts with counselors. The trial examines the impact of lifestyle modification (changes in eating and activity) on weight and associated morbidity, with an emphasis on energy balance. The activity portion of our intervention includes a yoga-based component to promote body awareness in a no threatening manner for overweight adolescents. Follow-up data collection for all participants will be conducted at 6, 12, and 24 months following randomization. The primary outcome measure will be change in BMI z scores. Secondary outcomes include changes in physical activity, dietary intake, depression, disordered eating, selected physiological and psychological measures, and cost of medical care utilization. This application provides the following novel advances of existing youth obesity research: a) the intervention is developmentally adapted for the specific needs of adolescent females, b) it extends the reach of the intervention to include a focus on mood regulation and disordered eating, where appropriate, c) this multi-component includes pediatricians, group meetings, and individual telephone contacts, d) it fully utilizes the unique features of a primary care setting in an integrated health plan, and d) the pediatrician has an enduring involvement in the intervention, consistent with the chronic disease model of care