While the prevalence of overweight and obesity among children and adolescents has plateaued, national data indicate that approximately 35% of children and adolescents continue to struggle with overweight/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 and limited impact of adolescent weight control interventions which may be attributable to the failure of these interventions to explicitly address emotion regulation abilities that are necessary for weight loss. Notably, adolescents with poorer general emotion regulation have been found to consume more snack/junk food and report greater amounts of sedentary behavior. Poor emotion regulation among adolescents has also been associated with more rapid weight gain and greater BMI. We propose to adapt a previously validated Emotion Regulation intervention (TRAC) for at-risk adolescents, targeting sexual risk reduction, to focus on weight loss among a sample of overweight and obese adolescents (ages 13 to 17). Although we recognize that sexual risk and weight management are distinct health behaviors, we believe this same model of emotion regulation can be applied to overweight/obese adolescents attempting to lose weight. In fact, data from overweight/obese adolescents attending our outpatient weight management program (N=124) indicate that 82% of these youth report emotion regulation scores that are comparable to youth with significant mental health problems. Furthermore, higher levels of emotional dysregulation was associated with greater BMI within this same sample. These data suggest that emotion regulation is related to health decision making and will be relevant to the majority of overweight/obese adolescents seeking to lose weight. The current study will be carried out across Phase 1a and 1b. During Phase 1a, a youth advisory board and the investigator team will modify the intervention and we will evaluate the initial acceptability and feasibility of the adapted intervention (HEALTH TRAC) with sixteen adolescents in an open pilot trial. During Phase 1b, we will randomize 48 adolescents between the ages of 13-17 years to receive either the HEALTH TRAC or standard behavioral weight control intervention (SBWC) and examine the impact on emotion regulation abilities and BMI status over an eight-month period. The information gained in this project will improve our understanding of strategies to improve weight loss outcomes among overweight/obsess adolescents and how improving emotion regulation abilities can enhance these interventions.
Thirty-five percent of children and adolescents have a BMI > 85th% and most adolescent weight control studies demonstrate limited impact on adolescent weight outcomes. One potential reason for this limited effect may be that emotional dysregulation impairs an adolescent's ability to make healthy lifestyle changes necessary for weight loss and therefore may be less likely to benefit from standard behavioral weight control interventions that do not address emotional dysregulation. This project seeks to improve adolescent response to weight control interventions, by adapting and testing a previously validated emotion regulation intervention to decrease emotional dysregulation among a sample of overweight and obese adolescents attempting to lose weight.