Preventing Obesity in Military Communities, Adolescents

The increased prevalence of obesity among the children of military personnel has paralleled
that observed in the civilian population. Disordered eating, especially binge or loss of
control (LOC) eating, is common among adolescents and is a salient risk factor for obesity
and the development of exacerbated disordered eating and depressive symptoms. The goal of
this study is to test the effectiveness of interpersonal psychotherapy (IPT) to slow the
trajectory of weight gain in adolescent girls at high-risk for adult obesity by virtue of
elevated body mass index (BMI) percentile and LOC eating. IPT targets the difficult social
functioning and stressful events that are associated with LOC and highly relevant to the
adolescent youth from military families. Adolescent military dependents will be randomized to
receive either the IPT weight gain prevention program or a health education (HE) control
condition, for 12 weekly group sessions. Adolescents' weight status, eating behaviors, and
mood will be assessed at baseline, immediately following the prevention program (12-weeks),
and at 1-year follow-up. At 2-year and 3-year follow-up time points, participants' BMI and
physiologic data will be collected via the Military Health System's electronic medical record
system. It is hypothesized that adolescents who receive the IPT group program will show
significantly less weight gain (or more weight loss) relative to those randomized to HE at
3-year follow-up. Additionally, it is hypothesized that adolescents receiving IPT (as
compared to HE) will demonstrate improvements on secondary outcomes of interest, including
the presence and frequency of classic binge eating episodes, as well as obesity-related
physiological measures of health (e.g., fasting insulin). The overall goal of the study is to
prevent excess weight gain and adult obesity, and to prevent worsening disordered eating and
metabolic functioning among overweight military dependents at risk for adult obesity and
binge eating disorders.

Inclusion Criteria:

- Female

- Age between 12 and 17 years (at the start of the study)

- English-speaking

- Ability to complete study procedures, including ability to participate in a group

- Endorsement of at least one LOC criteria, as assessed by Eating Disorder Examination
(EDE) semi structured interview

Exclusion Criteria:

- Presence of a chronic major medical illness: : renal, hepatic, gastrointestinal,
endocrinologic (e.g., Cushing syndrome, hyper- or hypothyroidism), hematological
problems or pulmonary disorders (other than asthma not requiring continuous
medication). Non-serious medical illnesses, such as seasonal allergies, will be
reviewed on a case-by-case basis.

- Presence of a documented, obesity-related medical complication that would require a
more aggressive weight loss intervention approach: type 2 diabetes, hyperlipidemia,
hypertension, fasting hyperglycemia, or nonalcoholic steatohepatitis

- Documented or self-reported current pregnancy, current breast-feeding, or recently
pregnant girls (within 1 year of delivery). Because pregnancy is a state in which
weight gain is expected and appropriate, pregnant individuals would not be suitable
for this study. Sexually active females must be using an effective form of birth
control. These methods include total abstinence (no sex), oral contraceptives ("the
pill"), an intrauterine device (IUD), levonogestrol implants (Norplant), or
medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be
used, contraceptive foam with a condom is recommended. Should a participant in the
IPT-WG group become pregnant during the ~12 weeks of the group program, she will be
excluded from the group sessions. The study team will closely assist in obtaining an
appropriate referral to a community mental healthcare provider, as indicated, and will
request a release of information so that they may facilitate a smooth transition for
the girl.

- Current, regular use of prescription medications that affect appetite, mood, or body
weight: currently prescribed SSRI's, neuroleptics, tricyclics, stimulants, or any
other medication known to affect appetite, mood, or body weight. Oral contraceptive
use will be permitted, provided the contraceptive has been used for at least two
months before starting the prevention groups. Medication use for non-serious
conditions (e.g., acne) will be considered on a case-by-case basis.

- Current involvement in psychotherapy or a structured weight loss program.

- Weight loss during the past two months for any reason exceeding 3% of body weight.

- Current anorexia nervosa or bulimia nervosa as determined by documented medical
history or if uncovered during K-SADS semi-structured interview. Current binge eating
disorder will be permitted. Girls with anorexia or bulimia nervosa will be referred to
mental health specialists for further evaluation and treatment. Individuals who need
further behavioral health or medical services will be accommodated through their
primary care medical home in accordance with normal clinical standard of care. This
will be accomplished by direct communication with the patients' primary care
physician.

- Individuals who have major depressive disorder, psychoses, current substance or
alcohol abuse, conduct disorder, as determined by Kiddie Schedule for Affective
Disorders and Schizophrenia (K-SADS) semi-structured interview and as defined by
criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders
(DSM-IV-TR) or any other DSM-IV-TR psychiatric disorder that, in the opinion of the
investigators, would impede competence or compliance or possibly hinder completion of
the study.