The prevalence of adolescents struggling with excess weight is remarkably high, with 38.7% of 12-15 year-olds and 41.5% of 16-19 year-olds meeting criteria for overweight or obesity. While considerable attention has been given to comprehensive behavioral interventions to address obesity in children, there is less empirical evidence demonstrating efficacy of interventions with adolescents. Additionally, there is great variability in outcomes. Limited impact of adolescent weight control treatment may be attributable to the failure of these interventions to explicitly address key mechanisms that are necessary for successful weight loss. Notably, adolescents with poorer emotion regulation have been found to consume foods of lower diet quality and report greater time spent in sedentary behavior than their peers. Poor emotion regulation among adolescents has also been associated with more rapid weight gain and higher BMI. Data from adolescents with overweight/obesity from an outpatient weight management program at Hasbro Children's Hospital (N=124) indicate that 82% of these youth report emotion regulation scores that are comparable to youth with significant mental health problems; furthermore, there is a positive association between emotional dysregulation and BMI within this same treatment-seeking sample. Despite these established relationships, interventions targeting emotion regulation in adolescents with obesity are lacking. To fill this gap, our laboratory developed and piloted an adolescent weight control intervention (HealthTRAC) that combines two efficacious interventions, one targeting emotion regulation skill building, the other focused on behavioral weight control. Preliminary findings from the small pilot trial are promising and indicate that the developed HealthTRAC intervention is acceptable, feasible to deliver, and results in significant reduction in BMI (d=.58) and improvement in emotion regulation skills (d=.20-.35) relative to a standard behavioral weight control (SBWC) condition. The proposed multi-site trial builds on these previous findings and will evaluate the efficacy of the developed HealthTRAC intervention on improving emotion regulation skills and reducing adolescent BMI. We propose to enroll 200 adolescents (100 per site) between the ages of 13-17 years of age to receive either HealthTRAC or SBWC. Adolescents will be randomly assigned to treatment condition within site. Intervention components will be delivered in 27.5 hours of direct contact time across 12 months. All adolescents will be assessed prior to randomization (baseline), immediately following the intervention (4 months), upon completion of maintenance sessions (12 months) and 18 months after the start of intervention. The information gained in this project will extend our understanding of how improving emotion regulation abilities can enhance adolescent weight control interventions.
