Overweight and Obesity
Conditions
Brief summary
While the prevalence of overweight and obesity among children and adolescents has plateaued, national data indicate that approximately 35% of children and adolescents continue to struggle with overweight/obesity. While considerable attention has been given to comprehensive behavioral interventions to address obesity in children, there is less empirical evidence demonstrating efficacy of interventions with adolescents. Additionally, there is great variability and limited impact of adolescent weight control interventions which may be attributable to the failure of these interventions to explicitly address emotion regulation abilities that are necessary for weight loss. Notably, adolescents with poorer general emotion regulation have been found to consume more snack/junk food and report greater amounts of sedentary behavior. Poor emotion regulation among adolescents has also been associated with more rapid weight gain and greater BMI. This project adapts a previously validated Emotion Regulation intervention (TRAC) for at-risk adolescents, targeting sexual risk reduction, to focus on weight loss among a sample of overweight and obese adolescents (ages 12 to 18). While sexual risk and weight management are distinct health behaviors, this same model of emotion regulation could be applied to overweight/obese adolescents attempting to lose weight. In fact, data from overweight/obese adolescents attending a past outpatient weight management program (N=124) indicate that 82% of these youth report emotion regulation scores that are comparable to youth with significant mental health problems. Furthermore, higher levels of emotional dysregulation was associated with greater BMI within this same sample. These data suggest that emotion regulation is related to health decision making and will be relevant to the majority of overweight/obese adolescents seeking to lose weight. The current study will be carried out across Phase 1a and 1b. During Phase 1a, the initial acceptability and feasibility of the adapted intervention (HEALTH TRAC) with eight adolescents in an open pilot trial will be evaluated. During Phase 1b, 48 adolescents between the ages of 13-17 years will be randomized to receive either the HEALTH TRAC or standard behavioral weight control intervention (SBWC) and examine the impact on emotion regulation abilities and BMI status over an eight-month period. The information gained in this project will improve understanding of strategies to improve weight loss outcomes among overweight/obsess adolescents and how improving emotion regulation abilities can enhance these interventions.
Sponsors
Rhode Island Hospital
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
13 Years to 17 Years
Healthy volunteers
Yes
Inclusion criteria
* 13-17 years of age * \> 85th percentile for BMI but \< a BMI of 50 * speak English * agree to participation and randomization
Exclusion criteria
* they are currently in another weight loss program * have a medical condition that precludes participation in physical activity or adherence to dietary recommendations * are developmentally delayed such that the intervention will not be appropriate * are in treatment for a major psychiatric disorder. * cannot understand English
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| BMI decrease | baseline, 4 months, and 8 month follow up | A significant decrease in participant BMI due to weight loss |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Emotion Regulation Strategy Usage | baseline, 4 month, and 8 month follow up | Emotion Regulation Behavior Scale (ERBS)- assesses use of emotion regulation strategies taught in intervention. items include in the last week, when you were having a strong feeling (e.g., sad, upset, etc.) how often did you...get away from whatever was causing your feeling?...participants respond on a scale of 1 (never) to 5 (all the time) across 8 items, with higher scores indicating more regulatory behaviors (range: 8-40) |
| Distress Tolerance | baseline and 4 months | Behavior Indicator of Resiliency to Distress (BIRD)- Manipulation/measure of distress-tolerance. The first level of the BIRD test lasts 3 minutes. The level begins with a 5 second latency between dot presentations and changes this latency based on performance (correct answers will reduce the latency by 0.5 seconds whereas incorrect answers or non-responses increase the latency by 0.5 seconds). At the conclusion of this level an average latency is calculated to index skill level. The second level lasts five total minutes. Following a brief rest period the final level begins and lasts for 5 minutes. At all points in the final level the participant will have an escape option. The quit game on the screen can be clicked at any time. Therefore making the total time for this game roughly 10-15 minutes long. (Amstadter et al, 2011) |
| Emotional Eating | baseline, 4 month, and 8 month follow up | Emotional Eating Scale (EES)- 25 item self report measure used to assess the propensity to cope with negative affect by eating. Subjects rate their desire to eat in response to each emotion on 5 point scale from 1I have no desire to eat through 5I have a very strong desire to eat (Range 25- 125, with higher scores indicating more coping with affect by eating) |
| Emotion Regulation | baseline, 4 month, and 8 month follow up | Difficulties in Emotion Regulation Scale (DERS)- a 36-item questionnaire designed to assess multiple aspects of emotion regulation (scale: 1 strongly disagree- 5 strongly agree). Measure yields a total score as well as six scales derived through factor analysis: (1. Nonacceptance of emotional response, 2. Difficulties engaging in goal directed behavior \[goals\], 3. Impulse control difficulties \[impulse\], 4. Lack of emotion awareness \[awareness\], 5. Limited access to emotion regulation strategies \[strategies\] 6. Lack of emotional clarity \[clarity\] ). |
| Eating Habits Confidence | baseline to 8 months | Eating Habits Confidence Questionnaire (EHCQ)- 27-item scale questionnaire asks participants to rate confidence in their ability to adhere to specific dietary behaviors. Response set consisted of a 5 point-linkert type scale ranging from 1, I know I cannot to 5, I know I can. Possible scores of this survey range from 27 to 135, with higher scores indicating higher self-efficacy. |
| Eating Behavior | baseline, 4 months, and 8 months | Eating Behaviors Inventory- Instrument for assessing behaviors that have been theoretically implicated in weight loss (self monitoring of food intake and of weight, refusing offers of food, eating at only one place, shopping from a list) 30 items are included that are each rate with a 5 point scale according to how often it was true for the respondent. Items were scored such that the higher scores always reflected more appropriate eating patterns. (Total range: 30- 150) |
| Accelerometer (physical activity) | baseline and 4 months | Majority of studies say at least 5 days per week for at least 8 hours per day to receive accurate data on PA. Device used to measure physical activity using criteria such as time spent in activities performed for various intensities and for the prediction of energy expenditure. |
| Eating Disorders | baseline, 4 month, and 8 month follow up | Eating Disorder Examination Questionnaire (EDEQ)- 28 item questionnaire that has 2 additional questions for males and 5 additional questions for females. Used to measure eating disorder psychopathology, with higher scores indicating higher eating disorder psychopathy. Provides a measure of the range and severity of eating disorder features. Also has the ability to generate operational eating disorder diagnoses. Used to screen potential participants \[Subscales: Restraint (items 1,2,3,4,5), Eating concern (items 7,9,19,20,21), Shape concern (items 6,8,10,11,23,26,27,28), Weight Concern (8,12,22,24,25) \] |
Countries
United States
Outcome results
None listed