Recruiting African American girls and parents for a secondary weight gain prevention study.

This research report describes the process and results of recruiting African American adolescent girls and parents for a secondary weight gain prevention study. We sought to recruit 60 girls with equal representation of at-risk for overweight (BMI percentile 85-95) and overweight (BMI > 95th percentile), and at least one obese (BMI > 30 kg/m2) parent. A personal and individual recruitment approach was the sole method utilized for recruitment of participants into this two-year Internet-based study targeting weight gain prevention. Participants were randomized to either an interactive behavioral condition or a health-based education (control) condition. Fifty-seven African American adolescent girls and their parents were enrolled in the study conducted at a university-based nutrition research center. One hundred eight adolescent girls volunteered and met the study criteria on the first contact, 95 interviewed in the clinic, 64 were randomized, and 57 (89%) of those randomized began the study. Seven percent of the study sample was comprised of African American girls at-risk for overweight, while the majority (93%) of those enrolled were overweight (BMI > 95th percentile). Our study sample comprised an imbalanced number of overweight versus at-risk for overweight African American girls suggesting that perhaps a clinic-based secondary weight gain prevention study may be an inefficient and ineffective setting for recruiting this population. Although we were successful in recruiting a majority of overweight girls, we conclude that the imbalance in the number of participants recruited is likely related to the sociocultural environment that predisposes African American girls to obesity and a lack of awareness by the parents' of the consequences of being overweight.

Two-year internet-based randomized controlled trial for weight loss in African-American girls.

OBJECTIVE: A randomized controlled trial tested the efficacy of an internet-based lifestyle behavior modification program for African-American girls over a 2-year period of intervention. RESEARCH METHODS AND PROCEDURES: Fifty-seven overweight (mean BMI percentile, 98.3) African-American girls (mean age, 13.2 years) were randomly assigned to an interactive behavioral internet program or an internet health education program, the control condition. Overweight parents were also participants in the study. Forty adolescent-parent dyads (70%) completed the 2-year trial. Outcome data including BMI, body weight, body composition, and weight loss behaviors were collected at baseline and at 6-month intervals. A computer server tracked use of the web sites. RESULTS: An intention-to-treat statistical approach was used, with the last observation carried forward. In comparison with the control condition, adolescents in the behavioral program lost more mean body fat (BF) (-1.12 +/- 0.47% vs. 0.43 +/- 0.47% BF, p < 0.05), and parents in the behavioral program lost significantly more mean body weight (-2.43 +/- 0.66 vs. -0.35 +/- 0.64 kg, p < 0.05) during the first 6 months. This weight loss was regained over the next 18 months. After 2 years, differences in fat for adolescents (-0.08 +/- 0.71% vs. 0.84 +/- 0.72% BF) and weight for parents (-1.1 +/- 0.91 vs. -0.60 +/- 0.89 kg) did not differ between the behavioral and control programs. DISCUSSION: An internet-based weight management program for African-American adolescent girls and their parents resulted in weight loss during the first 6 months but did not yield long-term loss due to reduced use of the web site over time.

A new dental approach for reducing food intake.

OBJECTIVE: A behavioral recommendation for weight loss is reduction of size of bites of food. This "proof of concept" study tested the efficacy of a new, patented, dental approach, the DDS System, for reducing food intake. This removable tool is inserted into the upper palate of the mouth, reducing the size of the oral cavity, thereby potentially reducing bite size. RESEARCH METHODS AND PROCEDURES: Thirty-two adults (18 to 65 years) with BMI between 27 and 40 were randomly assigned to the control or experimental conditions. Participants ate all meals and stayed between meals at a research center. Day 1 served as baseline for both groups. On Day 2, experimental participants utilized the tool during meals. Changes in subjective ratings of hunger and satiety were measured using visual analog scales before and after each meal. RESULTS: Food intake difference scores were calculated for each participant (Day 2 - Day 1). Analysis of covariance on difference scores, using baseline as a covariate, showed that the experimental group ate significantly less (p < 0.05) on the second day (M = -659.2 kcal/d) compared with the control group (M = -125.9 kcal/d). Analysis of covariance, with ratings on Day 1 as a covariate, revealed that the experimental and control group did not differ on visual analog scale difference scores (premeal - postmeal) from Day 1 to Day 2. DISCUSSION: These findings suggest that use of this tool during meals significantly reduced food intake. This reduction of food intake was not associated with changes in ratings of hunger or satiety.

Mediators of weight loss in a family-based intervention presented over the internet.

OBJECTIVE: To assess the process variables involved in a weight loss program for African-American adolescent girls. Several process variables have been identified as affecting success in in vivo weight loss programs for adults and children, including program adherence, self-efficacy, and social support. The current study sought to broaden the understanding of these process variables as they pertain to an intervention program that is presented using the Internet. It was hypothesized that variables such as program adherence, dietary self-efficacy, psychological factors, and family environment factors would mediate the effect of the experimental condition on weight loss. RESEARCH METHODS AND PROCEDURES: Participants were 57 adolescent African-American girls who joined the program with one obese parent; family pairs were randomized to either a behavioral or control condition in an Internet-based weight loss program. Outcome data (weight loss) are reported for the first 6 months of the intervention. RESULTS: Results partially supported the hypotheses. For weight loss among adolescents, parent variables pertaining to life and family satisfaction were the strongest mediating variables. For parental weight loss, changes in dietary practices over the course of 6 months were the strongest mediators. DISCUSSION: The identification of factors that enhance or impede weight loss for adolescents is an important step in improving weight loss programs for this group. The current findings suggest that family/parental variables exert a strong influence on weight loss efforts for adolescents and should be considered in developing future programs.