Department of Behavioral Sciences and Social Medicine, Florida State University, Tallahassee, FL.
Department of Family Medicine and Public Health Sciences, Wayne State University, Detroit, MI.
Ann Behav Med. 2019 Aug 29;53(10):928-938. doi: 10.1093/abm/kaz003.
Minority adolescents are at highest risk for obesity and extreme obesity; yet, there are few clinical trials targeting African American adolescents with obesity.
The purpose of the study was to develop an adaptive family-based behavioral obesity treatment for African American adolescents using a sequential multiple assignment randomized trial (SMART) design.
Fit Families was a SMART where 181 African American adolescents (67% female) aged 12-17 were first randomized to office-based versus home-based behavioral skills treatment delivered from a Motivational Interviewing foundation. After 3 months, nonresponders to first phase treatment were rerandomized to continued home-based behavioral skills treatment or contingency management with voucher-based reinforcement for adolescent weight loss and for caregiver adherence to the program. All interventions were delivered by community health workers. The primary outcome was treatment retention and percent overweight.
All adolescents reduced percent overweight by -3.20%; there were no significant differences in percent overweight based on treatment sequence. Adolescents receiving home-based delivery in Phase 1 and contingency management in Phase 2 completed significantly more sessions than those receiving office-based treatment and continued skills without CM (M = 8.03, SD = 3.24 and M = 6.62, SD = 2.95, respectively). The effect of contingency management was strongest among older and those with lower baseline confidence. Younger adolescents experienced greater weight reductions when receiving continued skills (-4.90% compared with -.02%).
Behavioral skills training can be successfully delivered to African American adolescents with obesity and their caregivers by community health workers when using a home-based service model with incentives. More potent interventions are needed to increase reductions in percent overweight and may need to be developmentally tailored for younger and older adolescents.
少数族裔青少年面临肥胖和极度肥胖的风险最高；然而，针对肥胖的非裔美国青少年的临床试验很少。
本研究旨在使用序贯多重分配随机试验（SMART）设计，为非裔美国青少年开发一种适应性家庭为基础的行为肥胖治疗方法。
Fit Families 是一项 SMART 研究，其中 181 名非裔美国青少年（67%为女性）年龄在 12-17 岁之间，首先随机分配到基于办公室的或基于家庭的行为技能治疗，这些治疗都是从动机访谈的基础上进行的。3 个月后，对第一阶段治疗无反应的患者重新随机分配到继续进行家庭行为技能治疗或与凭证强化相关的行为矫正治疗，以促进青少年减肥和照顾者对项目的依从性。所有干预措施均由社区卫生工作者提供。主要结局是治疗保留率和超重百分比。
所有青少年的超重百分比都减少了-3.20%；根据治疗顺序，超重百分比没有显著差异。在第 1 阶段接受家庭治疗，在第 2 阶段接受行为矫正治疗的青少年完成的治疗次数明显多于接受办公室治疗和继续不进行 CM 的技能治疗的青少年（M=8.03，SD=3.24 和 M=6.62，SD=2.95）。行为矫正治疗的效果在年龄较大和基线信心较低的患者中最强。接受继续技能治疗的青少年（-4.90%）比接受 CM 的青少年（-0.02%）体重减轻幅度更大。
当使用基于家庭的服务模式和激励措施时，社区卫生工作者可以成功地为肥胖的非裔美国青少年及其照顾者提供行为技能培训。需要更有效的干预措施来增加超重百分比的减少，并且可能需要根据青少年的年龄进行个性化调整。
