Enhancing Emotion Regulation to Support Weight Control Efforts in Adolescents With Overweight and Obesity

Participants will be assigned to one of two treatment conditions (HealthTRAC or Standard Behavioral Weight Control) using urn randomization procedure. Participants assigned to either condition will receive a 12-month weight control intervention that includes 12 weekly sessions and 2 bi-weekly sessions (14 primary sessions delivered over 4-months), followed by 8 months of maintenance sessions. Both conditions will also include parents at sessions 1, 7, and 14, and maintenance sessions at 6-8-,10-, and 12 months.

Both interventions will be delivered using a group-based treatment model. We selected a control condition that offers a more rigorous test of the program than a treatment as usual condition, commonly included in efficacy trials. Few studies have examined the combined impact of targeting emotion regulation skills and standard behavioral weight control strategies. Given the literature documenting the relationship between emotion regulation and weight-related behaviors, and the evidence from adult weight management studies, targeting this construct in adolescent populations may facilitate improved weight management outcomes via a reduction in emotional eating and sedentary time and improvement in overall diet quality.

The timing of study assessments immediately following intervention and at 12 months are justified by improvements in primary weight status outcomes observed in the treatment development study that was the immediate precursor of the proposed trial. Our previous work delivering adolescents weight control interventions supports our ability to retain participants through this study period. We have included an 18-month follow-up to examine sustainability of intervention effects. Few weight control interventions with adolescents include outcomes out to 18 months, and those that do, often have low rates of retention. Following established protocols, we anticipate approximately 80% retention at 18-month follow-up.

Participants will be enrolled into the efficacy trial continuously between Year 1, Month 6 and Year 4, Month 37. Consistent with the HealthTRAC pilot trial, we will recruit participants from primary care clinics and subspecialty clinics affiliated with children's hospitals, as well as through community advertisements. The majority of adolescent referrals to the treatment development study came from pediatric health care clinics at Hasbro Children's Hospital in Providence, RI (90%), with local advertisements accounting for the remainder. We anticipate that health care clinics will serve as a primary source for recruitment for the current trial. We will use parallel procedures to enroll participants in Providence, RI and Portland, OR. The PIs will work with representative staff from Hasbro Children's Hospital (RI) and Doernbecher Children's Hospital (OR) to distribute Consent to Contact forms, which can be completed by interested families. Families recruited in these settings will receive follow-up calls, emails, or texts (based on preference) to further determine initial eligibility and schedule consent/assents. Study brochures and advertisements will also be sent to adolescents who receive care within these various settings via direct home mailings. In addition to these successful approaches from the HealthTRAC pilot trial, we will also advertise through Facebook ads directed at parents. This strategy has been very effective in recent enrollment of adolescents to a behavioral weight control trial.

Initial evaluations will be conducted at the Weight Control and Diabetes Research Center or the University of Oregon Portland campus. Parents will undergo a brief interview and parents and adolescents will complete questionnaire measures. Adolescents will also complete computerized emotion regulation tasks. Parent questionnaires will focus on socio-demographic variables, the teen's dieting and medical history, any psychiatric history and treatment and emotion regulation abilities. Adolescent questionnaires will focus on emotion regulation abilities, mental health symptoms, and emotional eating. The first of the 24-hour dietary recalls will also be conducted during this visit, and adolescents will be provided instruction regarding completing 7-day accelerometry. Adolescent height and weight will be obtained at the end of the evaluation. Participants will be asked to return accelerometers after one week of wear or at the first intervention session, depending on the timing. Adolescents and parents will be informed of randomization condition at the first intervention session.