Primary Care Intervention Helps Overweight Adolescents

Overweight adolescents enrolled in a behavioral weight-control program begun in a primary care setting and continued through telephone and mail contact have better outcomes than those receiving single-session physician counseling. Researchers from the Children’s Hospital Medical Center in Cincinnati, Ohio based this conclusion on a recent study of 44 overweight adolescents randomly assigned to either a 4-month multi-component Healthy Habits (HH) intervention or single-session Typical Care (TC).

Participants were between 12 and 16 years old and had a body mass index (BMI) above the 89th percentile for their age and gender. The researchers measured weight, height, dietary intake, physical activity, sedentary behavior, and problematic weight-related eating behaviors and beliefs at the beginning of the study, after the 4-month intervention, and 3 months later at follow-up.

HH adolescents started with a computer program adapted for overweight adolescents from PACE+ (Patient-Centered Assessment and Counseling for Exercise plus Nutrition) software. The program helped participants generate individualized plans to increase physical activity and improve eating habits, as well as identify barriers to weight loss and develop strategies to overcome these barriers. HH adolescents met with a pediatrician to discuss the computer program results and create a final action plan for reaching their goals.

Counselors called HH adolescents once a week for the first 8 weeks and biweekly for the last 6 weeks. Telephone counseling addressed the link between weight change and eating and physical activity behaviors, instruction and feedback on self-monitoring, eating and physical activity goals, and the use of behavioral skills to achieve goals.

Participants also received a manual, mailed to them in sections throughout the intervention, to help them learn specific behavioral skills for weight control. Skills included self monitoring, goal setting, problem solving, self reward, and planning for high-risk situations such as parties. HH participants were also encouraged to complete weekly self-monitoring booklets and mail them to their telephone counselors.

Adolescents in the TC group met with a pediatrician to discuss motivation for weight-related behavior changes, health risks associated with overweight, benefits of maintaining a healthy weight, healthful eating habits consistent with the Food Guide Pyramid, recommendations for physical activity, and the importance of consistency in making healthy behavior changes. Physicians encouraged TC adolescents to make these changes on their own and with the help of their parents.

At the end of 4 months, HH adolescents lost a modest amount of weight, with an average decrease in BMI of 0.2 units, whereas the TC group showed an average 1.1 BMI unit increase. Both HH adolescents and their parents reported greater use of behavioral skills among this group than did TC adolescents. Even so, physical activity and eating behaviors were not much different between the two groups. The researchers speculate that their measures of weight-related behaviors may not have been sensitive enough to detect actual behavior change.

The multi-component approach shows promise in treating the increasing population of overweight adolescents. An intervention beginning in the primary care setting and continuing through phone and mail contact may decrease provider and participant cost while improving on the effectiveness of a single counseling session between pediatrician and patient.

This study, funded in part by the North American Association for the Study of Obesity, appears in the January 1, 2002 issue of Obesity Research. s