Peer-Based Skills Training to Enhance Teen Weight Loss

BACKGROUND:

The prevalence of obesity in children, adolescents, and adults has increased significantly over the last two decades. Adolescents who are obese are at great risk for remaining obese into adulthood. Given the difficulty of treating adult obesity, intervening with adolescents before they reach adulthood is critical. Decreasing obesity during adolescence provides an opportunity to prevent the continuance of pediatric onset obesity into adulthood. There are well-established weight control interventions for children between 8 and 12 years of age. However, treatment findings with overweight adolescents are not as robust and are difficult to replicate. One potential limitation of existing weight control interventions for adolescents is the minimal attention given to the peer group as an active component of treatment.

The study was in response to an initiative issued by the National Institute of Diabetes and Digestive and Kidney Diseases and entitled "Innovative Approaches to the Prevention of Obesity". The resulting grant was later reassigned to the National Heart, Lung, and Blood Institute.

DESIGN NARRATIVE:

A total of 119 adolescents between the ages of 13 and 16 years and between 20 and 80% overweight were randomized to one of three treatment conditions: (1) cognitive-behavioral treatment (CBT); (2) cognitive-behavioral treatment with the addition of peer-based skills training (CBT + PBST); or 3) standard care (SC). The cognitive-behavioral intervention consisted of 16 weekly sessions followed by four monthly maintenance sessions. Adolescents randomized to CBT + PBST received the cognitive-behavioral treatment as well as an intensive 32 session peer-based intervention. The peer-based intervention combined problem-solving therapy with principles from Outward Bound to address self-reliance, social competence and physical self-worth. One way analyses of variance was conducted at the end of treatment and at 6-months after the end of treatment to compare the three groups on initial reduction in percent overweight and maintenance of decreases in percent overweight at follow-up. Analysis of variance was also used to compare the three groups on measures of social functioning, self-esteem, physical activity level, and physical self-worth.