School Nurse Intervention and After School Exercise Program for Overweight Teens

描述(由申请者提供)：青少年超重和肥胖在美国受到越来越多的关注。尽管全面的中到高强度行为方案在青年中产生了短期、适度的体重减轻，但在容易获得的环境中没有实际实施的模式，可以将有希望的治疗方法转化为实践。高中处于有利地位，可以提供这样的干预。他们有提供体育锻炼计划的设施和工作人员，有具备解决肥胖问题的技能的学校护士，而且青少年很容易接触到。这项应用建立在一项随机试验(NIH R21HD053371)的基础上，该试验是一项由学校护士提供的低强度、6次会议的咨询干预，旨在让青少年参与并改善关键的自我报告的体重相关行为。在证明了实施这一适度干预的可行性和短期行为改善后，我们现在建议进行为期8个月的扩展干预，进一步利用现有的学校资源来评估长期行为影响以及关键的健康结果，包括体重指数。这种中等强度的干预包括由学校工作人员提供的有组织的课后锻炼计划，每周称重，以及整个学年的学校护士探视。我们将测试这一高强度计划的可行性和能力，以降低BMI，并改善超重和肥胖青少年的饮食质量、体力活动和久坐行为。每对匹配的高中(总共8所)中的一所将被分配到：(1)Lookin‘Good Feelin’Good(LGFG)计划--前两个月由学校护士提供六次30分钟的以学生为中心的咨询课程，然后在接下来的六个月里每周称体重和每月探访，另外还有一个为期8个月的每周3次的校本锻炼计划。或(2)信息注意控制(IC)比较情况--在前2个月与学校护士进行6次单独会议，然后在其余6个月每月访问以检查体重和行为变化，并提供关于体重和体重管理的小册子。我们将招募136名超重或肥胖(年龄/性别为第85个百分位数)的9至12年级青少年(17个/学校)，并进行基线和8个月的评估。我们的主要目的是确定与IC相比，LGFG在降低BMI方面的可行性和有效性。次要目标包括：确定LGFG对调节BMI变化的行为(即饮食质量、体力活动、久坐行为)的坚持以及对次级生理(腰围、体脂、血压、血脂和胰岛素敏感性)和心理社会(例如自我效能、生活质量和抑郁)结果的影响。延长干预时间范围，并在我们之前被广泛接受的计划中增加一个可接受的锻炼计划，应该能够使我们实现统计上和临床上的显著减肥。这种以学校为基础的体重管理干预措施，利用现有的基础设施，在无障碍的环境中，具有广泛传播的巨大潜力，对公共卫生产生重大影响。

DESCRIPTION (provided by applicant): Adolescent overweight and obesity are of great and increasing concern in the US. Although comprehensive moderate-to-high intensity behavioral programs produce short-term, modest weight reductions in youth, there are no models for practical implementation in readily-accessible settings to translate promising treatment approaches into practice. High schools are well-positioned to deliver such interventions. They have the facilities and staff to deliver a physical activity program, school nurses with the skills to address obesity, and easy access for adolescents. This application builds on a randomized trial (NIH R21HD053371) of a minimal- intensity, 6-session, school nurse-delivered counseling intervention that engaged adolescents and improved key self-reported weight-related behaviors. Having demonstrated feasibility of implementation and short term behavioral improvements from this modest intervention, we now propose an 8-month, expanded intervention that further leverages existing school-based resources to assess longer term behavioral effects as well as key health outcomes, including BMI. This moderate-intensity intervention includes a structured after-school exercise program delivered by school staff, weekly weigh-ins, and school nurse visits across the entire school year. We will test this higher intensity program's feasibility and ability to reduce BMI and to improve dietary quality, physical activity, and sedentary behaviors in overweight and obese adolescents. One in each of four matched pairs of high schools (8 schools in all) will be assigned to either: (1) Lookin' Good Feelin' Good (LGFG) program -- six 30-minute individual student-centered counseling sessions delivered by school nurses during the first two months followed by weekly weigh-ins and monthly visits over the subsequent 6 months, plus a school-based exercise program 3 times weekly for the full 8 months, or (2) Information attention-control (IC) comparison condition - six individual sessions with the school nurse over the first 2 months followed by monthly visits over the remaining 6 months to check weight and behavior changes and provide pamphlets on weight and weight management. We will recruit 136 adolescents (17/school) in grades 9 through 12 who are overweight or obese (>85th percentile for age/sex) and conduct baseline and 8-month assessments. Our primary aim is to determine the feasibility and efficacy of LGFG compared to IC in reducing BMI. Secondary aims include: determining the effect of the LGFG on adherence to behaviors that mediate BMI change (i.e., dietary quality, physical activity, sedentary behavior) and on secondary physiologic (waist circumference, body fat, blood pressure, lipids, and insulin sensitivity) and psychosocial (e.g., self-efficacy, quality of life, and depression) outcomes. Extending the intervention time-frame and adding an accessible exercise program to our previous, well-accepted program should enable us to achieve both statistically and clinically significant weight loss. This school-based weight management intervention, leveraging existing infrastructure in an accessible setting, has tremendous potential for wide-scale dissemination with significant public health impact.