The prevalence of overweight and obesity in youth is emerging as a global health concern, necessitating clinical interventions to treat obesity through promotion of lifestyle modification. Interventions in adolescents have demonstrated improvements in healthy eating and physical activity, with only modest weight loss outcomes. As a result, there is growing interest in developing strategies to enhance effectiveness of clinical interventions, especially those targeting adolescents who have the highest rates of obesity and dropout from treatment. Targeting family members to treat obesity in youth can be an effective approach, but adherence to family treatment can be sub-optimal despite research suggesting that parent-child interventions can be more effective than treatment programs that focus primarily on the child. We propose to develop a coordinated care model and assess the feasibility, acceptability, and effectiveness relative to standard care. The proposed study will leverage two successful weight loss programs administered at the Wake Forest Baptist Medical Center: Brenner Families in Training (Brenner FIT) and By Design. Brenner FIT is a family-based pediatric weight management clinic for youth 2-18 years old referred by a physician for overweight or obesity.11-14 By Design is an adult (>18yrs) weight loss clinic that includes tailored dietary and physical activity behavioral counseling. Our preliminary data suggest that most adolescent youth who enroll in Brenner FIT have at least one adult caregiver who is eligible and would benefit from enrollment in By Design. Therefore, we propose the development of a coordinated program (Dyad Plus) that would be a theoretically- based, coordinated approach designed to facilitate self-monitoring, positive communication, joint problem solving, and social support to increase physical activity, healthy eating, and weight loss relative to a non-coordinated approach or Brenner FIT alone. We will randomize 45 parent/adolescent Dyads to one of three conditions (n=15 for each); Brenner FIT only, Dyad where the child and parent both enrolled simultaneously in the age appropriate program, or Dyad Plus where the child and parent both enrolled simultaneously, but with the coordinated component. The study will achieve the following aims:
Specific Aim 1 : Develop a coordinated intervention for adolescents and adults with obesity co-enrolled in the Brenner FIT and By Design weight loss clinics.
Specific Aim 2 : Pilot the coordinated intervention in adolescent/caregiver dyads to establish the feasibility of the intervention in terms of accrual, retention, and adherence.
17 Specific Aim 3 : Establish costs associated with the implementation of Dyad Plus relative to delivering By Design and Brenner FIT without the coordination component. The proposal is significant, as it addresses a pressing chronic disease (obesity) in an underserved population (adolescents) and would be the first to develop a coordinated adolescent/adult weight loss intervention.

Public Health Relevance

This project has great potential public health value in that it addresses the significant need of clinicians for tools to augment current obesity treatment efforts. This project will lead to the development of a new strategy to enhance weight loss programs for adolescents and their caregivers, which is relevant since current clinical treatments for adolescents and adults with obesity have been only marginally successful. If proven effective, our novel approach would provide a new strategy to enhance the effectiveness of currently existing youth and adult obesity treatment programs.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Exploratory/Developmental Grants (R21)
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Clinical and Integrative Diabetes and Obesity Study Section (CIDO)
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Esposito, Layla E
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Wake Forest University Health Sciences
Family Medicine
Schools of Medicine
United States
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