Early intervention of eating- and weight-related problems via the Internet in overweight adolescents: A randomized controlled trial 

Denise Wilfley, Ph.D.,
Professor of Psychiatry, Medicine, Pediatrics, and Psychology
 


Project Overview:
More than one out of seven adolescents are currently overweight or obese, and the majority of these adolescents are expected to experience compromised mental and physical health over their lifetimes. In particular, the literature suggests that overweight adolescents are often dissatisfied with their weight and frequently turn to unhealthy methods in their pursuit of weight loss, ultimately putting them at even higher risk for increased adiposity and eating disorders. Body dissatisfaction and the elevated rates of eating disordered behaviors in this population have rarely been addressed in obesity treatment programs. Few randomized controlled trials of behavioral weight loss programs for adolescents have been reported in the literature and there are no known integrated interventions for weight management and eating disorder prevention reported in the literature. The present study aims to test the efficacy of an integrated, Internet-delivered, early intervention approach targeting weight loss, body dissatisfaction, and reduction of eating disordered behaviors in an overweight adolescent sample. Potential implications of the proposed research include the prevention of adult obesity and eating disorders using a novel method of early intervention. 

Obesity and overweight among youth has been described as a health problem of epidemic proportions. In 1999-2000, 15.3% of children aged 6-11 years and 15.5% of adolescents aged 12-19 years were defined as overweight.i The consequences of this rapid increase in pediatric obesity are far-reaching and extend to medical, psychological, and psychosocial domains. In particular, body dissatisfaction is found at higher rates among overweight youth compared with normal-weight peers ii,iii,ivand weight concerns have been linked to the development of eating disorders in female adolescentsv and adults.vi,vii,viii In addition, up to 75% of overweight adolescents turn to unhealthy weight control methods (e.g., fasting, diet pills, self-induced vomiting)11 rather than healthy behaviors, such as increased physical activity or healthier eating.ix,xxi Of particular concern, overweight adolescents use unhealthy and harmful weight loss techniques at a higher rate than normal-weight adolescents who are equally dissatisfied with their bodies, possibly in an attempt to find a quick solution to their weight problem.xii This will be the first Internet-delivered early intervention program to concurrently target weight loss, body dissatisfaction, and eating disordered attitudes and behaviors in adolescent boys and girls. The current standard of care for overweight adolescents consists of physician advice in the primary care setting, most frequently in the form of recommendations on how to modify activity and eating behaviors.xiii However, many barriers exist to this approach, including lack of physician time to provide appropriate education to patients, the need for long-term and intensive assistance in behavior modification, physician frustration,13,xiv and lack of specialized training in obesity treatment.14,xv Interventions beyond the current standard of care are needed. The Internet is a promising approach for the delivery of eating- and weight-related interventions among youth.xvi In the U.S., the majority of homes with children have computers (70.1%) and Internet connections (62.2%),xvii and a significant increase in Internet access can be seen across all major ethnic groups, as well.17 The Internet provides the opportunity to disseminate standardized, integrated, and empirically supported therapeutic techniques for obesity treatment beyond what would traditionally be feasible via specialized pediatric weight  loss clinics.

i Ogden, C. L., Flegal, K. M., Carroll, M. D., Johnson, C. L. (2002). Prevalence and trends in overweight among US children and adolescents, 1999-2000. Journal of the American Medical Association, 288, 1728-32.
ii Stice, E. & Whitenton, K. (2002). Risk factors for body dissatisfaction in adolescent girls: a longitudinal investigation. Developmental Psychology, 38(5), 669-678. 
iii Strauss, R. S. (2000). Childhood obesity and self-esteem. Pediatrics, 105, e15. 
iv Vander Wal, J. S. & Thelan, M. S. (2000). Eating and body image concerns among obese and average-weight children. Addictive Behaviors, 25, 775-778. 
v Killen, J. D., Taylor, C. B., Hayward, C., Haydel, K. F., Wilson, D. M., Hammer, L., Kraemer, H., Blair-Greiner, A., & Strachowski, D. (1996). Weight concerns influence the development of eating disorders: a 4-year prospective study. Journal of Consulting and Clinical Psychology, 64(5), 936-940. 
vi Gleaves, D. H., Williamson, D. A., & Barker, S. E. (1993). Confirmatory factor analysis of a multidimensional model of bulimia nervosa. Journal of Abnormal Psychology, 102, 173–176. 
vii Ricciardelli, L. A., Tate, D., & Williams, R. J. (1997). Body dissatisfaction as a mediator of the relationship between dietary restraint and bulimic eating patterns. Appetite, 29, 43–54. 
viii Graber, J. A., Brooks-Gunn, J., Paikoff, R. L., & Warren, M. P. (1994). Prediction of eating problems: An 8-year study of adolescent girls. Developmental Psychology, 30, 823-834. 
ix Stice, E., Mazotti, L., Krebs, M., & Martin, S. (1998). Predictors of adolescent dieting behaviors: A longitudinal study. Psychology of Addictive Behaviors, 12(3), 195-205. 
x Boutelle, K., Neumark- Sztainer, D., Story, M., & Resnick, M. (2002). Weight control behaviors among obese, overweight, and nonoverweight adolescents. Journal of Pediatric Psychology, 27, 531-540. 
xi Neumark-Sztainer, D. M., Story, M., Hannan, P. J., Perry, C. L., & Irving, L. M. (2002). Weight-related concerns and behaviors among overweight and nonoverweight adolescents: implications for preventing weight-related disorders. Archives of Pediatrics and Adolescent Medicine, 156(2), 171-178. 
xii Saelens, B. E., Jelalian, E., & Kukene, D. M. (2002). Physician weight counseling for adolescents. Clinical Pediatrics, 41, 575-585. 
xiii Barlow, S. E., Trowbridge, F. L., Klish, W. J., & Dietz W. H. (2002). Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110(1 Pt 2), 229-35. 
xiv Jelalian, E., Boergers, J., Alday, S., & Frank, R. (2003). Survey of physician attitudes and practices related to pediatric obesity. Clinical Pediatrics, 42, 235-245. 
xv Story, M. T., Neumark-Sztainer, D. R., Sherwood, N. E., Holt, K., Sofka, D., Trowbridge, F. L., & Barlow, S. E. (2002). Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals. Pediatrics, 110, 210-214. 
xvi Zabinski, M. F., Celio, A. A., Wilfley, D. E., & Taylor, C. B. (in press). Prevention of eating disorders and obesity via the Internet. Cognitive Behaviour Therapy. Special issue on CBT and the Internet. 
xvii U.S. Department of Commerce. A Nation Online: How Americans are Expanding Their Use of the Internet. Washington, DC: Government Printing Office, 2002.


Final Report:
More than one out of seven adolescents are currently overweight or obese, and the majority of these adolescents are expected to experience compromised mental and physical health over their lifetimes. In particular, the literature suggests that overweight adolescents are often dissatisfied with their weight and frequently turn to unhealthy methods in their pursuit of weight loss, ultimately putting them at even higher risk for increased adiposity and eating disorders. Body dissatisfaction and the elevated rates of eating disordered behaviors in this population have rarely been addressed in obesity treatment programs. Few randomized controlled trials of behavioral weight loss programs for adolescents have been reported in the literature and there are no known integrated interventions for weight management and eating disorder prevention reported in the literature. The present study aims to test the efficacy of an integrated, Internetdelivered, early intervention approach targeting weight loss, body dissatisfaction, and reduction of eating disordered behaviors in an overweight adolescent sample. Potential implications of the proposed research include the prevention of adult obesity and eating disorders using a novel method of early intervention. Read the full Final Report.