Does aberrant decision-making prevent success in adolescent behavioral weight loss treatment?

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PROJECT SUMMARY/ABSTRACT This K23 application aims to support Dr. Stephanie Manasse in her overarching goal of becoming an independent clinical researcher focused on developing and evaluating novel treatments for obesity. The proposed application will strengthen the candidate’s ability to meet this goal by providing advanced training to: (1) Gain expertise in theoretical models and measurement of decision-making; (2) develop expertise in nutritional and meal pattern analysis; (3) design and execute clinical trials for adolescent obesity; (4) Build proficiency with multilevel and longitudinal data analytic approaches related to clinical trial research. To achieve these goals, an expert team of mentors has been assembled, consisting of primary mentor Dr. Evan Forman (for conducting obesity clinical trials); co-mentors Dr. Adrienne Juarascio (for training in conduct of clinical trials for individuals with disordered eating), Dr. Joseph Kable (for training in models and measurement of decision-making), Dr. Tanja Kral (for training in meal pattern and nutritional analysis in pediatric obesity), Dr. Tanofsky-Kraff (for training in assessment and clinical trial methods in adolescent obesity and loss-of-control eating) and Dr. Zoe Zhang (for training in longitudinal statistical methods); and consultants Dr. Robert Berkowitz (biological considerations of adolescence on weight and weight change) and Dr. Laurence Steinberg (for training in models of adolescent decision-making). As part of this training, Dr. Manasse will complete a project that will examine the predictive role of aberrant decision-making processes (i.e., delay discounting, affect-driven impulsivity, and perseverative decision-making) in weight loss outcomes from behavioral treatment for adolescent obesity. Second, the study will also examine the influence of aberrant decision-making on problematic eating behaviors during treatment that are likely driving poor weight loss outcomes: reward-driven overeating, loss-of-control eating, and problematic dietary restriction. Third, the study will examine whether these problematic eating behaviors mediate the influence of aberrant decision-making on weight loss outcomes. We will recruit 60 adolescents (ages 14-18) with (n=30) and without (n=30) clinically significant LOC eating who will complete a behavioral weight loss program and complete measures of decision-making at baseline. Problematic eating behaviors and weight outcomes will be evaluated at mid-treatment (6 weeks), post-treatment (16 weeks), 6-month follow-up, and 12-month follow-up. The current study will provide critical information that will directly lead into the development of a novel adolescent obesity intervention augmentation that will be poised reduce aberrant decision-making and improve weight loss outcomes. Given the poor efficacy of weight loss treatments in adolescents, novel augmentations that target the unique developmental factors of adolescence are necessary. Therefore, in addition to helping launch the candidate into an independent research career, this project will meet a critical need by providing much-needed knowledge for adolescent obesity treatment development.