TEEN JOIN: A Scalable Weight Control Intervention for Adolescents

描述（由申请人提供）：儿童和青少年超重/肥胖的流行仍然是公共卫生的优先事项。治疗目前正在与超重作斗争的儿童和青少年的干预措施对于预防肥胖进入成年至关重要。越来越多的证据支持对青少年进行综合生活方式干预的有效性。尽管出现了这样的治疗，但很少有青少年受益，因为这些干预措施主要是通过精心控制的临床试验或在学术医疗中心附属的专业/三级临床环境中提供。2010年，美国预防服务工作组（USPSTF）为临床医生提供了等级建议B（即建议该服务具有中等/高度的益处确定性），以筛查6-17岁儿童的肥胖并将其推荐给确定的青少年接受全面的行为计划。实现这一目标的挑战是缺乏以社区为基础的肥胖症治疗方法，特别是青少年。联合健康集团和Y-USA合作开发的JOIN计划是一项儿科体重控制干预措施，针对6-17岁的广泛年龄范围的青少年，即：1）基于完善的循证原则; 2）由YMCA促进者在社区环境中提供; 3）可能在全国范围内扩展。一项为期6个月的试点研究检查了JOIN的有效性，结果显示学龄儿童的体重状况发生了令人印象深刻的变化，但青少年的结果较为温和。拟议研究的目标是修改JOIN计划，以提高其对青少年的有效性，同时保留其可扩展性的潜力。将BMI > 85th%且< {50}的总计{120}名青少年（年龄13-17）随机分配至16周的增强JOIN计划（TEEN JOIN）或传统JOIN干预，随后进行6个月的维持会话。将在基线、4个月和10个月时获得青少年身高、体重、群体凝聚力、客观体力活动、{饮食摄入}和心理社会结局的评价。其他结果将包括治疗的可行性，包括出勤率，完成饮食和身体活动监测日志，以及与青少年和家长就干预措施进行的离职面谈。我们还将获得成本效益的初步指标。假设随机分配至TEEN JOIN组的青少年在4个月和10个月时的BMI下降幅度大于随机分配至JOIN组的青少年。进一步假设，与接受标准JOIN条件的青少年相比，随机分配至TEEN JOIN的青少年将表现出参与中度剧烈体育活动的更多增加，以及自我概念、与体育活动相关的自我效能和群体凝聚力的更大改善。这一系列研究的下一个目标是进行一项大规模的传播试验（R18），以评估青少年体重控制的有效性。

DESCRIPTION (provided by applicant): The prevalence of overweight/obesity among children and adolescents remains a public health priority. Interventions to treat children and adolescents currently struggling with excess weight are critical for prevention of obesity into adulthood. There is increasing evidence to support the efficacy of comprehensive lifestyle interventions for adolescents. Despite the emergence of such treatments, few adolescents benefit because these interventions are available primarily through carefully controlled clinical trials or delivered in specialized/tertiary clinical settings affiliated with academic medical centers. In 2010, the U.S. Preventive Services Task Force (USPSTF) provided a Grade recommendation B (i.e. the service is recommended with moderate/high certainty of benefit) for clinicians to screen children ages 6-17 years for obesity and refer identified youth to comprehensive behavioral programs. The challenge in meeting this objective is the lack of community-based obesity treatments to which to refer, particularly for adolescents. The JOIN program, developed as a collaboration between United HealthGroup and Y-USA is a pediatric weight control intervention targeted toward a broad age range of youth from 6-17 years that is: 1) based on well established and evidence based principles; 2) delivered by YMCA facilitators within a community setting: and 3) potentially scalable nationally. Findings from a 6-month pilot study examining the effectiveness of JOIN demonstrated impressive changes in weight status for school age children, but more modest results for adolescents. The goal of the proposed study is to modify the JOIN program to increase its effectiveness with adolescents while retaining its potential for scalability A tota of {120} adolescents (ages 13-17) with BMI > 85th% and < {50} will be randomly assigned to a 16-week enhanced JOIN program (TEEN JOIN), or the traditional JOIN intervention, followed by 6 monthly maintenance sessions. Evaluation of adolescent height, weight, group cohesion, objective physical activity, {dietary intake} and psychosocial outcomes will be obtained at baseline, 4 months, and 10 months. Additional outcomes will include treatment feasibility, including attendance, completion of diet and physical activity monitoring logs, and exit interviews with adolescents and parents regarding the intervention. We will also obtain preliminary indicators of cost effectiveness. It is hypothesized that adolescents who are randomized to TEEN JOIN will demonstrate greater decrease in BMI at 4 and 10 months than those randomized to JOIN. It is further hypothesized that adolescents randomized to TEEN JOIN will demonstrate greater increases in participation in moderate-vigorous physical activity and greater improvements in self-concept, self-efficacy related to physical activity, and group cohesion than adolescents who receive the standard JOIN condition. The next objective in this line of research is to conduct a large scale dissemination trial (R18) to evaluate the effectiveness of TEEN JOIN for adolescent weight control.