Families Improving Together (FIT) For Weight Loss

描述(由申请者提供)：肥胖率的上升已经成为一个主要的公共卫生问题，全国报告显示，40%的非裔美国青少年现在超重或肥胖。对少数民族青少年有效的减肥干预措施知之甚少。这在一定程度上是因为研究表明，与高加索人相比，少数民族参加干预会议的次数更少，流失率更高，体重减轻更少。与缺乏进展相关的两个基本问题是：1)针对非裔美国青少年的减肥干预缺乏适当的内容，融合了文化问题、育儿技能和长期变化的激励战略；2)由于参与者疲劳和辍学，减肥干预的剂量很低。以前在青少年中进行的减肥研究持续时间相对较长，持续12-25周，然而，我们的团队开发了一个相对短暂(8周简短)的面对面干预计划，将激励(自主支持)和积极的育儿技能(监控、社会支持、积极的沟通技能)相结合，以减少超重的非裔美国青少年的z-BMI。我们的团队最近还进行了一项试点研究，测试为期8周的在线干预的可行性，这是为非裔美国家庭量身定做的。因此，该项目的目标是进行一项随机对照疗效试验，通过1)缩短面对面的团体干预，2)使用在线组件来补充基于团体的干预以增加剂量，以及3)直接根据父母和青少年的技能水平和文化背景定制动机和育儿技能计划，以解决过去研究中存在的问题。520名超重的非洲裔美国青少年及其父母将被招募参加。试验的第一阶段将测试为期8周的面对面随机试验的有效性，比较激励加基于家庭的减肥(M+FWL)和基本健康(BH)教育计划在超重的非裔美国青少年中减少z-BMI和改善饮食和体力活动(PA)的效果。在试验的第二阶段，参与者将被重新随机分配到为期8周的在线干预或对照在线计划中，结果是2(M+FWL与BH组)×2(干预与对照在线计划)析因设计。这一设计将使我们能够测试M+FWL课程的效果，以及在线干预部分在减少非裔美国青少年及其父母的z-BMI方面的附加效果。为期6个月的跟踪调查将检查8周M+FWL组和8周在线干预计划的青少年是否会在减少z-BMI方面表现出最大的维持性。将检查治疗效果的心理社会中介因素，以及与父母z-BMI和健康行为(饮食和PA)变化相关的治疗效果。 公共卫生相关性：拟议的功效试验将解决一个重要的公共卫生问题，以开发具有成本效益的干预措施，减少服务不足的青少年(低收入、少数族裔)的肥胖。

DESCRIPTION (provided by applicant): The increasing rate of obesity has become a major public health concern with national reports indicating 40% of African American adolescents are now overweight or obese. Little is known about effective weight loss interventions in ethnic minority adolescents. In part, this is because research has shown that ethnic minorities attend fewer intervention sessions, have higher attrition rates and lose less weight compared to Caucasians. Two fundamental problems related to this lack of progress are 1) the lack of appropriate content of weight loss interventions for African American adolescents that integrate cultural issues, parenting skills, and motivational strategies for long-term change and, 2) the poor dose of weight loss interventions because of participant fatigue and drop out. Previous weight loss studies among adolescents have been of relatively long duration lasting 12-25 weeks, however, our team has developed a weight loss program that is a relatively brief (8-week brief) face-to-face intervention that integrates motivational (autonomy-support) and positive parenting skills (monitoring, social support, positive communication skills) for reducing z-BMI in overweight African American adolescents. Our team has also recently conducted a pilot study testing the feasibility of an 8-week on-line intervention that is culturally tailored fr African American families. Thus, the goal of this project is to conduct a randomized controlled efficacy trial to address the problems with past studies by 1) making the face-to-face group intervention shorter, 2) using an on-line component to compliment the group- based intervention for increasing dose, and by 3) tailoring a motivational and parenting skills program directly to parents and adolescents skill levels and cultural background. 520 overweight African American adolescents and their parents will be recruited to participate. Phase I of the trial will test the efficacy of an 8-week face-to-face group randomized trial comparing motivational plus family-based weight loss (M+FWL) to a basic health (BH) education program on reducing z-BMI and improving diet and physical activity (PA) in overweight African American adolescents. In phase II of the trial participants will be re-randomized to either an 8-week on-line intervention or a control on-line program resulting in a 2 (M+FWL vs. BH group) x 2 (intervention vs. control on-line program) factorial design. This design will allow us to test the effects of the M+FWL curriculum and the added effects of the on-line intervention component on reducing z-BMI in African American adolescents and their parents. A 6-month follow-up will examine whether adolescents in the 8-week M+FWL group plus 8-week on-line intervention program will show the greatest maintenance in reducing z- BMI. Psychosocial mediators of treatment effects will be examined as well as treatment effects related to parent changes in z-BMI and health behaviors (diet and PA). PUBLIC HEALTH RELEVANCE: The proposed efficacy trial will address an important public health problem for developing cost-effective interventions to decrease obesity in underserved adolescents (low income, minorities).