Committed to Kids: An Integrated, 4-Level Team Approach to Weight Management in Adolescents

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Program Methods

Committed to Kids is a medical, psychosocial, nutrition, and exercise intervention for overweight adolescents along with their families and is conducted in a weekly outpatient clinical setting. The program is unique because of its integrated, 4-level approach that encourages short-term (12 weeks) goal setting, quarterly feedback, and motivational techniques to improve health behaviors. During the 1-year program, adolescents and their families attend weekly, 2-hour, comprehensive sessions (Fig. 1

Medical Supervision and Guidance

The medical therapy consists of a complete medical/family history, a physical exam, body composition by dual energy x-ray absorptiometry (DEXA), exercise tolerance (VO2 max using indirect calorimetry), and a baseline laboratory evaluation. Weight, weekly blood pressure and resting heart rate, symptoms, and complaints are monitored weekly. Quarterly evaluations include height; weight; BMI; %IBW; waist and hip circumference; bioelectrical impedance and skinfolds (triceps and subscapular) (12);

Medical Nutrition Therapy

The medical nutrition therapy consists of a diet history, intake visit and laboratory assessment of growth, and current weight status. During the intake visit, the dietitian establishes an initial 12-week weight-loss goal based on the participant's %IBW and BMI. Energy restriction is used if patients are unsuccessful initially in losing weight while on a diet of reduced-fat/healthful food choices. The diet prescription for overweight adolescents in the level 3 category includes a balanced,

Nutrition Education

Nutrition education is conducted in group sessions with patients, parents, siblings, extended family, and friends in attendance (Fig. 1). Patient participation is encouraged during cooking demonstrations and energy-counting and food-measuring activities. At the end of the 1-year program, families should be able to adequately identify, select, and prepare foods that are appropriate to continued weight maintenance and good health (Figure 3). Nutrition education sessions include identifying the

Exercise Protocol and Physical Activity Education

The physical activity education includes the Moderate Intensity Progressive Exercise Program, an educational, curriculum-based intervention designed using social cognitive theory (3), (14), (15). The approach includes not only guidelines for exercise frequency, duration, and intensity (FIG 4, FIG 5, FIG 6), but also a series of 52 weekly, dynamic, interactive group sessions that promote increased physical activity and improved body-movement awareness (3) (Fig. 3). The program also includes

Behavior-Modification Protocol

Weekly sessions begin with group discussion highlighting the patients’ accomplishments for the week (Fig. 1). Positive reinforcement is given for trying new vegetables, turning down high-energy snacks, or participating in physical activity. Behavior-modification skills are introduced using discussion, modeling, role-playing, and guided problem solving (18). Topics such as self-monitoring, commitment, setting limits, habit formation, goal setting and action plans, decision-making skills,

Outcome Data

For a 1-year period, 93 adolescents (aged 13.1 to 17.7 years) were enrolled in the program. At the end of the year, 56 patients (22 boys, 34 girls; 44 whites and 12 African-Americans) participated in evaluations (60.7%). Subjects reduced BMI from 32.3±1.3 at baseline to 29.35±1.9 at 10 weeks and further reduced BMI to 28.2±1.2 at 1-year; %IBW from 177±34.0 at baseline to 156.2±23.Tat 10 weeks and further reduced % IBW to 141.9±20.1 at 1 year (P<.001).

Summary

The integrated, 4-level approach of Committed to Kids is successful because of several factors:

■ The sessions are designed to entertain the adolescents and promote initial success;

■ The program features parent-training methods in short, interactive, educational sessions;

■ In severely obese adolescents, the diet intervention results in noticeable weight loss that motivates the patient to continue; also, the improved exercise tolerance resulting from the weight loss promotes increased physical

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