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

Sylvie Naar; Deborah Ellis; April Idalski Carcone; Angela J Jacques-Tiura; Phillippe Cunningham; Thomas Templin; Kathryn Brogan Hartlieb; K-L Cathy Jen

doi:10.1093/abm/kaz003

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

Ann Behav Med. 2019 Aug 29;53(10):928-938. doi: 10.1093/abm/kaz003.

Authors

Sylvie Naar¹, Deborah Ellis², April Idalski Carcone², Angela J Jacques-Tiura², Phillippe Cunningham³, Thomas Templin⁴, Kathryn Brogan Hartlieb⁵, K-L Cathy Jen⁶

Affiliations

¹ Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL.
² Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI.
³ Department of Psychiatry, Medical University of South Carolina, Charleston, SC.
⁴ School of Nursing, Wayne State University, Detroit, MI.
⁵ Stempel College of Public Health and Social Work, Florida International University, Miami, FL.
⁶ Department of Nutrition and Food Science, Wayne State University, Detroit, MI.

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.

Keywords: Adolescent; Minority; Motivational interviewing; Obesity; SMART; Skills.

Publication types

Randomized Controlled Trial
Research Support, N.I.H., Extramural

MeSH terms

Adolescent
Behavior Therapy*
Black or African American*
Child
Female
Humans
Male
Motivational Interviewing*
Outcome Assessment, Health Care*
Pediatric Obesity / therapy*
Weight Loss*
Weight Reduction Programs*

Grants and funding

U01 HL097889/HL/NHLBI NIH HHS/United States