African-American Adolescents' Weight Loss Skills Utilization: Effects on Weight Change in a Sequential Multiple Assignment Randomized Trial

Abstract

Objective: Successful weight loss interventions for African-Americans adolescents are lacking. Cognitive-behavioral interventions seek to develop weight loss skills (e.g., counting calories, goal setting, managing one's environment). Little is known about how well adolescents implement such skills in their daily lives. Study aims were to (1) examine weight loss skills utilization at midpoint and end of a 6-month cognitive-behavioral/motivational interviewing weight loss sequential multiple assignment randomized trial (SMART), and (2) determine if greater skill utilization predicted weight loss at treatment end and 3 months post-treatment.

Method: One hundred and eighty six African-Americans adolescents with obesity and their caregiver were first randomly assigned to complete 3 months of cognitive-behavioral and motivational interviewing family-based weight loss treatment in their home or in the research office (Phase 1). Nonresponders (i.e., those who lost < 3% of initial weight, n = 161) were rerandomized to 3 months of continued skills training (n = 83) or contingency management (n = 78) for Phase 2; responders were allocated to 3 months of relapse prevention (n = 20). Adolescents' frequency of weight loss skills utilization was assessed via questionnaire at treatment midpoint and end.

Results: Higher treatment attendance was associated with better skill utilization. Higher skill utilization was associated with more weight loss at treatment end, whereas higher baseline confidence was associated with more weight loss at follow-up.

Conclusions: This study indicates the importance of attending weight loss intervention sessions to develop and strengthen weight loss skills in African-American adolescents with obesity, and strengthening confidence to use such skills for continued weight loss.

Trial registration: ClinicalTrials.gov NCT01350531.

Keywords: Adolescents; African-Americans; Intervention; Obesity; Weight loss skills.

Conflict of interest statement

Conflict of interest: The authors do not have any potential, perceived, or real conflict of interest. A.J. Jacques-Tiura wrote the first draft of the manuscript; all authors contributed to study conception and manuscript editing, and all authors approve of the final draft. S. Naar is now at Florida State University.

Copyright © 2018. Published by Elsevier Inc.

Figures

Figure 1.

Participant flow following Consolidated Standards of Reporting Trials (CONSORT) guidelines. Notes. CM= contingency management; CS= continued skills; DC= data collection; HB= home-based; LTF= lost to follow-up; MIS= motivational interviewing and skills; OB= office-based; RP= relapse prevention.