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Battling Adolescent Obesity with Behavioral Therapy


Now that we’re well into September, many families are settling into the swing of school schedules, band practices, dance lessons and packed daily agendas. With so much running around going on from September to June, it can be easy to lose sight of keeping up a healthy diet and active lifestyle – particularly for adolescents whose obesity rates have more than doubled since the 1980s.

The prevalence, severity and long-term risks of obesity have become a regular topic of discussion between parents, their children and their primary care physicians, but more and more, the media has been shining a very big spotlight on this epidemic. A Huffington Post piece from earlier this summer cited research from the American Academy of Pediatrics and stated, “in order to prevent obesity and eating disorders, parents should focus less on diets and the scale and emphasize family togetherness and exercise for fitness, not weight loss.” Quality family time, much like healthy eating, can also fall by the wayside when juggling busy schedules sets in.

In an ongoing effort to combat this epidemic, Penn Medicine is approaching adolescent obesity from all sides. A team of researchers from Center for Health Incentives and Behavioral Economics published a report just last week which found that teens are less likely to purchase soda or sugar-filled drinks if they see a health warning label on the bottle. Another team from Penn’s Center for Weight and Eating Disorders is approaching adolescent obesity by leaning on both teens and their parents and caregivers. They’re conducting a clinical trial that will implement and evaluate a treatment program to help obese adolescents lose weight by combining behavioral and cognitive strategies to promote lifestyle change.

“Our program combines standard behavioral treatment with acceptance and commitment therapy (ACT), which is a psychological treatment that helps individuals separate their behavior from their internal experiences, such as their thoughts and emotions, in order to behave in a way that is consistent with their long-term goals,” said Jena Shaw, PhD , an assistant professor of Psychology. “This method has proven effective for treating a variety of other physiological and behavioral health problems in adults, so we believe it may be effective for adolescents struggling with obesity.”

There have only been a few case studies and trials investigating the efficacy of ACT treatments in adolescent populations, but the benefits of ACT for weight loss have not yet been tested.

“Past research indicates that the ACT approach may be well-suited to address adolescents' vulnerability to impulsive decision-making, but that has yet to be directly proven,” Shaw said. “We suspect that this approach will improve participants’ ability to regulate their eating habits in accordance with their long-term weight loss goals.”

Several studies have shown that the addition of ACT strategies may improve the efficacy of weight loss treatments in adults. Standard teen behavioral treatments employ many of the same methods as adult programs, often with an added parent component. Therefore, it’s possible that researchers will see the same added benefit of ACT in teens they have in adults.

Shaw and her colleagues at Penn Medicine and the Children’s Hospital of Philadelphia are specifically testing whether a behavioral weight loss program combining lifestyle change with ACT is effective for adolescent weight loss. Shaw said the team is evaluating the approach in teens between the ages of 12 and 17 who are overweight by at least 25 pounds – those above the 98th percentile based on height and weight.

“One of the things we are really focused on is identifying ways to improve current behavioral treatments for adolescent weight loss,” said Tom Wadden, PhD, director of the Center for Weight and Eating Disorders. “If this approach proves to be effective with this initial group, we hope to evaluate the efficacy of combining ACT with standard behavioral treatment in a broader population of teens.”

In the study, half of the participating teens have been randomly assigned to attend weekly ACT healthy groups, designed to teach teens to develop healthier eating and physical activity habits, over the course of a four month period. At the same time, the parents or caregivers of these teens attend a separate group session that focuses on ways to support their teens' efforts – such as assisting with meal plan and physical activity adherence, modeling their own healthy choices, and providing encouragement and praise for healthy changes. The other half of the participants does not receive any additional treatment during the 16-week study period. Instead, this group will be offered the opportunity to attend the ACT healthy program after the study period has ended.

“For teens, weight loss is the product of a collaborative effort between the teen and the parent or caregiver, not something that rests solely on their shoulders,” Shaw said. “We are hopeful that ACT strategies will make it easier for both teenagers and their caregivers to implement the lifestyle changes that have been shown to promote a healthy weight.”

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