TEENS+ adolescent intervention
obesity, caloric deficit, TEENS+PWL
OBESITY
To reduce potential contamination, adolescents are assigned to groups according to their parents’ treatment. Adolescent groups are single-gender (self-identified), to facilitate interaction at this critical developmental stage, led by two trained, supervised lifestyle coaches masked to study hypotheses. Over 16 weeks, adolescents meet weekly for 1-hour groups. Content in TEENS+PAC and TEENS+PWL is identical; however, in PAC, adolescents alternate weekly between concurrent, separate group visits and conjoint (parent and child) group nutrition education visits. In PWL, all core adolescent groups occur separately from their parents. TEENS+ considers the adolescent developmental tasks of individuation and autonomy development, and includes strategies to navigate peer influences, while also eliciting adolescent-driven reasons for change. TEENS+ recognizes that responsibility for eating choices shifts from parents to adolescents, yet acknowledges that parent influence remains strong (e.g., ~50% of adolescents eat ≥5 meals/week with their family) [Manualized sessions follow a behavior therapy approach, including guided goal-setting, self-monitoring, identifying barriers and solutions, contingency management, stimulus control, dealing with setbacks, maintenance and relapse prevention. Weight is assessed weekly by coaches, and adolescents maintain food and physical activity logs. These logs are reviewed weekly by coaches, with personalized, written feedback provided. This feedback is contextualized within a self-regulation framework [Adolescents also complete four 30-min individual visits. In month 1, adolescents meet with their behavior coach for an MI-informed values exploration exercise to explore the consistency of TEENS+ with adolescents’ goals and values. The purpose of this meeting is to increase adolescent’s internal motivation for change and treatment engagement. Use of MI Is consistent with prior research demonstrating its value in increasing obesity treatment engagement [The TEENS+ dietary intervention was designed to yield a caloric deficit via adding low calorie, nutrient-dense foods (“Go Foods”) while remaining within a prescribed calorie range. Individual calorie and Go Food goals are provided and adjusted as needed throughout treatment [The TEENS+ exercise intervention includes identifying strategies to achieve ≥1hr/day of moderate to vigorous physical activity (PA) [