TEEN JOIN: A Scalable Weight Control Intervention for Adolescents

描述（由申请人提供）：儿童和青少年中超重/肥胖的流行仍然是公共卫生的优先事项。干预治疗目前与超重作斗争的儿童和青少年对于预防成年后肥胖至关重要。越来越多的证据支持综合生活方式干预对青少年的有效性。尽管出现了这些治疗方法，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隶属于学术医疗中心的专业/三级临床环境中提供的。2010年，美国预防服务工作组（USPSTF）为临床医生提供了B级建议（即建议该服务具有中等/高度肯定的益处），以筛查6-17岁的儿童是否肥胖，并将确定的青少年转介到综合行为项目。实现这一目标的挑战是缺乏可参考的以社区为基础的肥胖治疗方法，特别是对青少年而言。联合健康集团和Y-USA合作开发的JOIN项目是一项针对6-17岁青少年的儿童体重控制干预措施，它是：1)基于完善和基于证据的原则；2)由YMCA辅导员在社区环境中提供；3)有可能在全国推广。一项为期6个月的试点研究对JOIN的有效性进行了检验，结果表明学龄儿童的体重状况发生了令人印象深刻的变化，但对青少年的影响较为温和。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。BMI指数为> 85%和< >的青少年（13-17岁）将被随机分配到16周的强化JOIN计划（TEEN JOIN）或传统的JOIN干预中，随后是6个月的维持期。将在基线、4个月和10个月时对青少年的身高、体重、群体凝聚力、客观体育活动、{饮食摄入量}和心理社会结果进行评估。其他结果将包括治疗可行性，包括出勤、饮食和身体活动监测日志的完成情况，以及与青少年和父母就干预进行的退出访谈。我们也将取得成本效益的初步指标。假设被随机分配到TEEN JOIN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到JOIN的青少年。我们进一步假设，与接受标准JOIN条件的青少年相比，随机分配到TEEN JOIN的青少年在参与中等强度的体育活动方面表现出更大的增加，在自我概念、体育活动相关的自我效能和群体凝聚力方面也有更大的改善。该研究的下一个目标是进行大规模的推广试验（R18），以评估TEEN JOIN对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.