Behavioral Weight Control Treatment with Supervised Exercise or Peer-Enhanced Adventure for Overweight Adolescents

Department of Psychiatry, Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI, USA.
The Journal of pediatrics (Impact Factor: 3.79). 12/2010; 157(6):923-928.e1. DOI: 10.1016/j.jpeds.2010.05.047
Source: PubMed

ABSTRACT To evaluate the efficacy of behavioral weight control intervention with a peer-enhanced activity intervention versus structured aerobic exercise in decreasing body mass index (BMI) and z-BMI in overweight adolescents.
Participants were randomized to 1 of 2 group-based treatment conditions: (1) cognitive behavioral treatment with peer-enhanced adventure therapy or (2) cognitive behavioral weight control treatment with supervised aerobic exercise. Participants included 118 overweight adolescents, ages 13 to 16 years, and a primary caregiver. Changes in BMI, standardized BMI, percent over BMI, and waist circumference were examined.
Analysis of variance on the basis of intent-to-treat indicated significant decreases in all weight change outcomes at the end of treatment, with significant decreases maintained at the 12-month follow-up. No differences in treatment conditions were observed. Secondary analyses indicated that adherence with attendance and completion of weekly diet records contributed significantly to reductions in BMI.
A cognitive behavioral weight control intervention combined with supervised aerobic exercise or peer-enhanced adventure therapy is equally effective in short-term reduction of BMI and z-BMI in overweight adolescents. Adherence, as measured with session attendance and self-monitoring, is a key dimension of weight change.

Download full-text


Available from: Robyn S. Mehlenbeck, Feb 12, 2014
12 Reads
    • "Additional predictors are included next. Other predictors of improved outcomes include early treatment response (Goldschmidt et al., 2012; Jelalian et al., 2008), greater social support (Braet, 2006; Epstein et al., 1994; Moens et al., 2010), lower parental psychopathology (Epstein et al., 1994; Frohlich, Pott, Albayrak, Hebebrand, & Pauli-Pott, 2011; E. Moens et al., 2010), higher session attendance (Jelalian et al., 2010), and self-monitoring (Epstein, Valoski, Wing, & McCurley, 1990; Jelalian et al., 2010). It has also been shown that, whereas boys and girls show similar weight loss outcomes in the initial stages of treatment, girls are more successful at longer term weight loss and maintenance (5-and 10- year follow-up; Epstein et al., 1990). "
    [Show abstract] [Hide abstract]
    ABSTRACT: Childhood obesity is associated with increased medical and psychosocial consequences and mortality and effective interventions are urgently needed. Effective interventions are urgently needed. This article reviews the evidence for psychological treatments of overweight and obesity in child and adolescent populations. Studies were identified through searches of online databases and reference sections of relevant review articles and meta-analyses. Treatment efficacy was assessed using established criteria, and treatments were categorized as well-established, probably efficacious, possibly efficacious, experimental, or of questionable efficacy. Well-established treatments included family-based behavioral treatment (FBT) and Parent-Only Behavioral Treatment for children. Possibly efficacious treatments include Parent-Only Behavioral Treatment for adolescents, FBT-Guided Self-Help for children, and Behavioral Weight Loss treatment with family involvement for toddlers, children, and adolescents. Appetite awareness training and regulation of cues treatments are considered experimental. No treatments are considered probably efficacious, or of questionable efficacy. All treatments considered efficacious are multicomponent interventions that include dietary and physical activity modifications and utilize behavioral strategies. Treatment is optimized if family members are specifically targeted in treatment. Research supports the use of multicomponent lifestyle interventions, with FBT and Parent-Only Behavioral Treatment being the most widely supported treatment types. Additional research is needed to test a stepped care model for treatment and to establish the ideal dosage (i.e., number and length of sessions), duration, and intensity of treatments for long-term sustainability of healthy weight management. To improve access to care, the optimal methods to enhance the scalability and implementability of treatments into community and clinical settings need to be established.
    Journal of Clinical Child & Adolescent Psychology 12/2014; 44(4):1-17. DOI:10.1080/15374416.2014.963854 · 1.92 Impact Factor
  • Source
    • "Adolescents were excluded if they were already enrolled in a weight control program; met criteria for a major psychiatric disorder; had a medical condition that interfered with the prescribed dietary or exercise plan; or were developmentally delayed such that intervention materials would not have been appropriate. As described by Jelalian et al. (2010), of the 152 adolescents who met basic eligibility criteria via a phonescreen and then attended an in-person family evaluation, 20 were found to be ineligible. Of the remaining 132 eligible adolescents, 123 completed the dietary run-in period. "
    [Show abstract] [Hide abstract]
    ABSTRACT: To evaluate associations between parent behaviors (i.e., parent weight change, self-monitoring of their behavior, and feeding practices and attitudes) and changes in adolescent BMI and weight following 16-weeks of behavioral weight control (BWC) intervention. Adolescents (N = 86) 13-16 years old and 30-90% overweight (M = 60.54%, SD = 15.10%) who completed BWC intervention and their parents. Adolescents were randomized to 1 of 2 interventions involving 16 consecutive weeks of active treatment with 4 biweekly maintenance sessions. Adolescent weight and BMI were measured at baseline and 16-weeks. Feeding practices were measured at baseline. Parent self-monitoring was measured during the intervention. The only independently significant predictor of adolescent BMI change (p < .01) was parent BMI change. Greater parent self-monitoring (p < .01) predicted greater adolescent weight loss. Greater parent pressure to eat predicted less adolescent weight loss (p < .01). Findings highlight the potential importance of parent weight-related behaviors and feeding practices in the context of adolescent BWC.
    Journal of Pediatric Psychology 11/2010; 36(4):451-60. DOI:10.1093/jpepsy/jsq105 · 2.91 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: This scientific statement addresses parents and adult caregivers (PACs) as "agents of change" for obese children, evaluating the strength of evidence that particular parenting strategies can leverage behavior change and reduce positive energy balance in obese youth. The statement has 3 specific aims. The first is to review core behavior change strategies for PACs as used in family-based treatment programs and to provide a resource list. The second is to evaluate the strength of evidence that greater parental "involvement" in treatment is associated with better reductions in child overweight. The third is to identify research gaps and new opportunities for the field. This review yielded limited and inconsistent evidence from randomized controlled clinical trials that greater PAC involvement necessarily is associated with better child outcomes. For example, only 17% of the intervention studies reported differential improvements in child overweight as a function of parental involvement in treatment. On the other hand, greater parental adherence with core behavior change strategies predicted better child weight outcomes after 2 and 5 years in some studies. Thus, the literature lacks conclusive evidence that one particular parenting strategy or approach causally is superior to others in which children have a greater focus in treatment. A number of research gaps were identified, including the assessment of refined parenting phenotypes, cultural tailoring of interventions, examination of family relationships, and incorporation of new technologies. A conceptual model is proposed to stimulate research identifying the determinants of PAC feeding and physical activity parenting practices, the results of which may inform new treatments. The statement addresses the need for innovative research to advance the scope and potency of PAC treatments for childhood obesity.
    Circulation 03/2012; 125(9):1186-207. DOI:10.1161/CIR.0b013e31824607ee · 14.43 Impact Factor
Show more