Testing a Healthy Weight Intervention in Adolescents

Obesity is associated with increased risk of mortality, atherosclerotic cerebrovascular disease, coronary heart disease, colorectal cancer and death from all causes (Flegal et al., 2005), is credited with over 111,000 deaths annually in the US (Flegal et al., 2005), shortens the lifespan by 5-20 years (Fontaine et al., 2003) and results in $150 billion in annual health-related expenditures (Finkelstein et al., 2009). Despite alarming increases in both adult and childhood obesity in recent decades, obesity rates in adolescents have grown at an even faster rate (Ogden et al., 2012; NCHS, 2012). Adolescent obesity has more than tripled in the past 30 years and continues to rise (Ogden et al., 2012; NCHS, 2012). Obese adolescents are more likely to have high cholesterol and high blood pressure, prediabetes, bone/joint problems, sleep apnea, and social and psychological problems such as stigmatization and poor self-esteem (DHHS, 2010; CDC, 2011). Unfortunately, virtually all obesity treatments result in only transient weight loss (Turk et al., 2009). Evidence suggests that it is nearly impossible for individuals to maintain behavioral weight losses once they have been obese for an extended period of time (Ochner et al., 2013). Although bariatric surgery can result in more persistent weight loss, this invasive procedure is contraindicated for numerous individuals, particularly children (Martin et al., 2010). Thus, a pressing public health priority is to develop simple and effective obesity prevention programs.

In 2010, the U.S. Preventive Services Task Force (USPSTF) issued recommendations for screening and treating childhood and adolescent obesity. They endorsed comprehensive moderate-to high intensity programs including counseling for weight loss, healthy diet, and physical activity as well as instruction and support for the use of behavioral management techniques including self-monitoring, stimulus control, eating management, contingency management, and cognitive behavioral therapy techniques. The USPSTF further defined moderate- to high-intensity programs as > 25 hr of contact and states that "such interventions would not be feasible for implementation in a primary care setting." (USPSTF, 2010, p. 365). Further, they assert that less intensive (< 25 contact hours) programs do not produce significant improvements. "Low-intensity interventions, defined as < 25 contact hours over a 6-month period, did not result in significant improvement in weight status" (USPSTF, 2010, p. 364). The implication is that, since most centers cannot provide this level of service, it is not worthwhile for adolescent health centers to provide any kind of obesity intervention at all. According to the USPSTF's website, "its recommendations are considered the gold standard for clinical preventive services." Such recommendations could discourage the testing and implementation of brief interventions designed to prevent obesity. Thus, to refute USPSTF statement, we propose to show that a 6-hr intervention led by graduate students can produce significant reductions in risk for both obesity and eating disorders, suggesting that this brief and inexpensive intervention could and should be rolled out nationwide.