Guided Imagery Lifestyle Intervention to Promote Health and Prevent Diabetes in Youth

The childhood obesity epidemic represents a major health threat to the current generation of
youth, and falls disproportionately on urban, Latino adolescents. Data suggests modern
inner-city minority youth suffer from high levels of psychosocial stress, and that such
chronic stress contributes to obesity and insulin resistance, increasing risk of type 2
diabetes, cardiovascular disease, fatty liver disease, and other obesity-related disorders.
Guided imagery is a mind-body complementary/alternative medicine (CAM) modality that offers
promise as a therapeutic intervention to reduce psychosocial stress, and also to promote
healthy lifestyle behaviors. In a pilot 12-week lifestyle intervention, Interactive Guided
ImagerySM significantly reduced salivary cortisol, reduced sedentary behavior, and increased
moderate physical activity in overweight Latino adolescents. The overall aim of this proposal
is to determine the separate contributions of stress reduction guided imagery and health
behavior guided imagery, when delivered in the context of a health-promoting, lifestyle
intervention, on short-term and long-term stress-reduction and behavioral outcomes in
predominantly Latino high school students. The study consists of a high school-based, 12-week
lifestyle intervention delivered in an after school program to urban, predominantly Latino
adolescents. The intervention features a health-promoting, lifestyle education class,
combined with a group guided imagery intervention that is theoretically grounded in
Self-Determination Theory (SDT). High school students are randomized to one of 4 intervention
arms 1) Non-intervention control; 2) lifestyle education alone (LS); 3) LS + Stress Reduction
guided imagery alone; 4) LS + Physical Activity/Healthy Eating guided imagery. Outcomes will
be measured upon completion of the 12-wk intervention, after an additional 6-month
maintenance program, and after a further 6-month period of no program contact. Primary
outcomes will be change in salivary cortisol patterns and changes in physical activity and
dietary intake. Secondary outcomes are insulin resistance, body fat, carotid intima media
thickness, metabolic syndrome, perceived stress, well-being (self-esteem, health related
quality of life), and measures of mediation by SDT constructs. Results will demonstrate the
isolated effects of the lifestyle education and the two different forms of guided imagery,
and could shift the paradigm of obesity prevention and treatment in urban minority youth to
include attention to social stress and promotion of well-being.

Inclusion Criteria:

- Male and female enrolled in second year (i.e. sophomore year) of high school at time
of consent into study, junior year at time of intervention

- Self-stated intent to complete high school

- Predominantly minority ethnicity (self-reported)

- Overweight/ obese and normal weight

- Agreement to attend up to 3 after school classes per week for the 12 weeks of the
program

Exclusion Criteria:

- Serious chronic illness or physical, cognitive, or behavioral disability that would
prevent ability to fully receive intervention

- Prior diagnosis of clinical eating disorder, psychiatric disorder, or significant
cognitive disability

- Lack of English fluency

- Participation in previous "Council" programs offered through the school

- Participation in formal weight-loss programs in 3 months preceding entry to study

- Pregnancy

- Sibling or other household member enrolling for the intervention