Outcomes From a Sequential Multiple Assignment Randomized Trial of Weight Loss Strategies for African American Adolescents With Obesity

Abstract

Background Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity. Purpose The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design. Methods Fit Families was a SMART where 181 African American adolescents (67% female) aged 12–17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight. Results All adolescents reduced percent overweight by −3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (−4.90% compared with −.02%). Conclusions Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.

Motivating Children and Adolescents in Obesity Treatment

“…intervention with an average of 21 sessions applied over 7 months. 5 The results imply that brief forms of MI counseling may be useful in treating pediatric obesity. [52][53][54] Brief interventions were effective, and more intensive intervention was not more beneficial.…”

“…Three of the four studies were relatively brief, ranging from 3 to 10 sessions, 52 - 54 while the Fit Families trial was a more intensive intervention with an average of 21 sessions applied over 7 months. 5 The results imply that brief forms of MI counseling may be useful in treating pediatric obesity. 52 - 54 Brief interventions were effective, and more intensive intervention was not more beneficial.…”

“…45 A brief review of recent studies on the effectiveness of MI in pediatric obesity are presented in Table 4. 5,[52][53][54][55] Two trials each on adolescents and children were identified. Three of the four studies were relatively brief, ranging from 3-10 sessions, [52][53][54] while the Fit Families trial was a more intensive…”

“… 45 A brief review of recent studies on the effectiveness of MI in pediatric obesity are presented in Table 4 . 5 , 52 - 55 …”

“… 1 , 2 There are critical issues to consider when applying lifestyle changing interventions to the pediatric population: limited effectiveness, high dropout rate, and low level of motivation to change are important considerations in pediatric obesity. 3 - 5 To ensure treatment effectiveness, it is crucial to assess a patient’s motivation to change and provide adequate strategies to enhance motivation for enacting lifestyle changes.…”