Sequential Multiple Assignment Randomized Trial (SMART) to Construct Weight Loss Interventions for African American...

Area of Science:

• Obesity research
• Adolescent health
• Behavioral science

Background:

• Childhood obesity, particularly among African American adolescents, is a significant public health concern.
• Existing behavioral treatments require adaptation to improve engagement and effectiveness in diverse populations.

Purpose of the Study:

• To develop and evaluate an adaptive behavioral treatment for African American adolescents with obesity.
• To investigate the efficacy of home-based versus office-based delivery and contingency management for improving treatment outcomes.

Main Methods:

• A sequential multiple assignment randomized trial involving 181 adolescents (ages 12-16) with obesity and their caregivers.
• Phase 1: Randomization to home-based or office-based motivational interviewing plus skills building for 3 months.
• Phase 2: Non-responders were rerandomized to continued home-based skills or contingency management.

Main Results:

• No significant differences in percent overweight reduction between home-based vs. office-based delivery or between continued skills vs. contingency management.
• Home-based treatment led to higher session attendance in both phases; contingency management increased attendance in phase 2.
• Overall, participants showed a 3% decrease in percent overweight, moderated by executive functioning (higher functioning associated with greater weight loss).

Conclusions:

• Adaptive behavioral treatments did not yield significant differences in weight outcomes for this population.
• Home-based delivery and contingency management show promise for increasing treatment engagement.
• Future interventions should consider targeting executive functioning and optimizing delivery methods for enhanced obesity treatment in adolescents.