Preventing Obesity in Military Communities-Adolescents

The prevalence of overweight among military personnel and their dependents is at a rate
similar to that of the civilian population. Nearly 30% of adolescent dependents are
overweight, including approximately 15-17% who are obese, placing them at high risk for
impairments in metabolic functioning, type 2 diabetes, and adult obesity. Youth who are
overweight (body mass index, kg/m2, BMI ≥ 85th percentile) are at high risk for excess weight
gain as they grow. Since effective weight loss and maintenance treatments are rare,
prevention may be the most important approach to reducing the high prevalence of obesity. To
date, most pediatric obesity prevention programs have been met with limited success. To
address those at greatest risk for obesity, more targeted approaches may be required. There
is a need to reduce prospectively identified risk factors in order to prevent excess weight
gain in youth at high risk for adult obesity. The most common disordered eating behavior
among overweight adolescents is loss of control (LOC) eating, during which the feeling of
being unable to stop eating is experienced. LOC eating predisposes youth to gain excessive
weight and fat. Thus, LOC eating is likely to be an important contributor to obesity in
susceptible individuals. Decreasing LOC in adolescents may prevent excess weight gain.
Investigators at the Uniformed Services University of the Health Sciences (USUHS) is in
partnership with Ft. Belvoir Community Hospital (FBCH) and Walter Reed National Military
Medical Center (WRNMMC) to test the effectiveness of IPT-WG to slow the trajectory of weight
gain in overweight adolescent boys and girls who report LOC and prevent worsening disordered
eating and metabolic functioning. The unique stress burdening the children of military
personnel while the country is at war suggests that obesity prevention programs targeting
interpersonal stress and promoting positive social functioning may be especially timely in
this population. It is hypothesized that IPT-WG will decrease LOC eating and related eating
behaviors and, in turn, prevent excess weight gain and the development of exacerbated
disordered eating in adolescent children of military personnel. Secondary to the prevention
of excess weight gain, youth will experience improvements in metabolic functioning.

Adolescent Inclusion Criteria:

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

2. BMI at or above the 85th percentile for age and sex

3. English-speaking

4. Ability to complete study procedures, including the ability to participate in a group

5. > 1 episode of LOC eating during the 3 months prior to assessment

6. Must have a parent(s) enrolled in TRICARE at the time of study initiation

Parent Inclusion Criteria:

1.The consenting parent or caregiver must be able to comprehend English.

Adolescent Exclusion Criteria:

1. 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).

2. 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.

3. Self-reported current pregnancy, current breast-feeding, or recently pregnant girls
(within 1 year of delivery).

4. 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. For girls, 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.

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

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

7. 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 (BED) will be permitted, although adolescents will be informed that they have
an eating disorder and have the option to participate in the study or seek outside
treatment (and not participate in the study).

8. 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 DSM-5, or any other DSM psychiatric disorder that, in the
opinion of the investigators, would impede competence or compliance or possibly hinder
completion of the study.

Parent Exclusion Criteria:

1. None