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

• Published in: Annals of behavioral medicine Vol. 53; no. 10; pp. 928 - 938
• Main Authors: Naar, Sylvie, Ellis, Deborah, Idalski Carcone, April, Jacques-Tiura, Angela J, Cunningham, Phillippe, Templin, Thomas, Hartlieb, Kathryn Brogan, Jen, K-L Cathy
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 29-08-2019
• Subjects: Adolescent; African Americans; Behavior Therapy; Black or African American; Child; Child & adolescent psychiatry; Female; Health psychology; Humans; Male; Motivational Interviewing; Obesity; Outcome Assessment, Health Care; Pediatric Obesity - therapy; Regular; Teenagers; Weight control; Weight Loss; Weight Reduction Programs; Motivational interviewing; Obesity; SMART; Skills; Minority; Adolescent
• ISSN: 0883-6612; 1532-4796; 1532-4796
• DOI: 10.1093/abm/kaz003

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.
Contingency management and home-based delivery helps retain African American adolescents in family-based behavioral obesity treatment.