Theoretical foundations
weight loss
Both PAC and PWL are grounded in Social Cognitive Theory, which emphasizes interactions among environmental, personal and behavioral factors and capitalizes on social learning [Comparison of Parents as Coaches (PAC) with Parents Weight Loss (PWL) treatments• 16-weeks; 60 min group sessions• led by trained behavioral coaches• 8 behavioral parent skills training lessons & 8 nutrition education sessions (combined with teens)• 16-weeks; 60 min group sessions• led by trained behavioral coaches• 16 behavioral weight loss lessons (including 8 nutrition education sessions)• virtual grocery store teaches label-reading and healthy shopping on a budget• emphasizes realistic strategies for family and home environment change to support child’s efforts• taught how to help their adolescent meet dietary goals via meal planning, preparing meals at home, and home environment changes• problem-solving around challenges to adherence (e.g., schedules, food preferences, cost, and stress)• assigned diet goals based on predicted Resting Metabolic Rate (e.g., 1200-1800 kcal, 30% kcal from fat; adjusted as needed based on progress)• weekly weights obtained and adjustments made to address rapid, unsafe weight loss if needed• problem-solving around challenges to adherence (e.g., access, cost, stress, and social influences)• taught to make adjustments to dietary intake to maintain weight loss after the program• parents learn practical (free and low-cost) strategies to increase family PA• behavioral goals focus on increasing family PA and reducing / setting limits on screen time• psychoeducation provided / problem-solving conducted about overcoming family barriers to PA• parents instructed to increase PA until achieving ≥250 minutes/week of moderate intensity PA• multiple short bouts of PA encouraged (e.g., ≥10 min) to minimize potential barriers to activity• psychoeducation and problem-solving around challenges to PA (e.g., time, motivation, access)• parents keep logs of individualized parenting goals set in treatment and self-monitor progress• logs are reviewed, facilitating group-brainstorming of barriers encountered and possible solutions• parents review teen logs and assist as needed• parents meet briefly with coach individually before meeting facilitating personalized feedback• parents keep personal logs including detailed food records and minutes / type of PA• coaches review logs & provide weekly feedback• parents taught to self-weigh at least weekly (≥4 days / week recommended)• parents weigh in before each meeting, facilitating personalized feedback / brainstorming of barriers