Interventionist Procedures for Adherence to Weight Loss Recommendations in Black Adolescents

To date, attempts to construct effective weight loss interventions for African American
adolescents with obesity (AAAO) have largely failed. While effective weight loss strategies
and skills have been identified, lifestyle changes require youth and their families to learn
new dietary and exercise behavior with repeated skills practice in natural ecology of the
family. A major barrier is motivation of both parents and adolescents to engage in treatment
and to adhere to behavior change recommendations. Advances in the science of increasing
human motivation (both intrinsic and extrinsic) that could inform intervention development
for minority youth with obesity have been insufficiently applied to date to the process of
intervention development. The study brings together a multidisciplinary research group
comprised of obesity intervention researchers with extensive experience in adolescent health
behavior change research, basic behavioral scientists with experience in motivation and
learning research and communication scientists with experience in provider-family
interactions within urban populations. Basic science obesity researchers will inform
intervention development by contributing a strong background in the physiological correlates
of obesity. Finally experts in the area of community interventions for African American
adolescents will contribute to the effective transport of these interventions to real-world
settings. The overarching aims of the study are: To refine intervention protocols from our
preliminary studies that maximize adolescent and parent skills, informed by learning theory,
through the use of home and community-based interventions in which in-vivo opportunities are
used to promote practice in making changes in dietary, exercise and sedentary behaviors in
AAAO and their families (PHASE I); To develop intervention protocols that utilize findings
from basic science regarding intrinsic and extrinsic motivation to maximize adolescent and
family adherence to recommendations for obesity-related behavior change in AAAO and their
families (PHASE I); To develop an adaptive intervention using a sequential multiple
randomized assignment trial (SMART design) (PHASE II); To refine the intervention including
qualitative analysis of interviews from participant families and to develop further
community participation in preparation for a confirmatory randomized clinical trial (PHASE
III).

There are two proposed hypotheses for this study:

1. Families initially receiving home/community delivery of Motivational Interviewing
(MI)/skills training will show greater weight loss over the course of the study than
families receiving initial office-based delivery of MI/skills training.

2. Non-responders receiving home/community delivery of MI/skills training with Contingency
Management (CM) will show greater weight loss than non-responders receiving MI/skills
training alone.