title: Imagine HEALTH: results from a randomized pilot lifestyle intervention for obese Latino adolescents using Interactive Guided ImagerySM.
abstract: BACKGROUND
  There is an urgent need for innovative and developmentally appropriate lifestyle interventions to promote healthy lifestyle behaviors and to prevent the early onset of type 2 diabetes and cardiovascular disease risk in obese Latino adolescents. Guided imagery offers promise to reduce stress and promote lifestyle behavior change to reduce disease risk in obese adolescents. Our objectives were: 1) To pilot test a new 12-wk lifestyle intervention using a randomized trial design in obese Latino adolescents, in order to determine the effects of the mind-body modality of Interactive Guided ImagerySM (IGI), over and above those of a didactic lifestyle education, on insulin resistance, eating and physical activity behaviors, stress and stress biomarkers; and 2) To explore the role of intervention-related changes in stress and stress biomarkers on changes in metabolic outcomes, particularly insulin resistance.
  
  
  METHODS
  Obese (BMI > 95th percentile), Latino adolescents (n = 35, age 14-17) were randomized to receive either 12 weekly sessions of a lifestyle education plus guided imagery program (GI), or lifestyle education plus a digital storytelling computer program (DS). Between-group differences in behavioral, biological, and psychological outcomes were assessed using unpaired T-tests and ANCOVA in the 29 subjects who completed the intervention.
  
  
  RESULTS
  The GI group demonstrated significant reductions in leisure sedentary behavior (p < .05) and increases in moderate physical activity (p < .05) compared to DS group, and a trend toward reduced caloric intake in GI vs DS (p = .09). Salivary cortisol was acutely reduced by stress-reduction guided imagery (p < .01). There were no group differences in adiposity, insulin resistance, perceived stress, or stress biomarkers across the 12-week intervention, though decrease in serum cortisol over the course of the intervention was associated with improved insulin sensitivity (p = .03) independent of intervention group and other relevant co-variates.
  
  
  CONCLUSIONS
  The improvements in physical activity and stress biomarkers following this pilot intervention support the role of guided imagery in promoting healthy lifestyle behavior change and reducing metabolic disease risk in obese Latino adolescent populations. Future investigations will be needed to determine the full effects of the Imagine HEALTH intervention on insulin resistance, stress, and stress biomarkers.
  
  
  BACKGROUND
  Clinicaltrials.gov Registry #: NCT01895595.
authors.affiliation: Department of Pediatrics, University of Southern California Keck School of Medicine, 2250 Alcazar St, Ste 211, Los Angeles 90089, CA, USA. weigensb@usc.edu.
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Weigensberg
authors.forename: Christianne J
authors.initials: CJ
authors.lastname: Lane
authors.forename: Quintilia
authors.initials: Q
authors.lastname: Ávila
authors.forename: Kati
authors.initials: K
authors.lastname: Konersman
authors.forename: Emily
authors.initials: E
authors.lastname: Ventura
authors.forename: Tanja
authors.initials: T
authors.lastname: Adam
authors.forename: Zohreh
authors.initials: Z
authors.lastname: Shoar
authors.forename: Michael I
authors.initials: MI
authors.lastname: Goran
authors.forename: Donna
authors.initials: D
authors.lastname: Spruijt-Metz
mesh_terms: D050154:Adiposity; D000293:Adolescent; D000294:Adolescent Behavior; D000704:Analysis of Variance; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control; D003924:Diabetes Mellitus, Type 2 / Q000209:etiology / Q000517:prevention & control; D002149:Energy Intake; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006630:Hispanic or Latino; D006801:Humans; D007333:Insulin Resistance; D008019:Life Style; D008297:Male; D026441:Mind-Body Therapies; D009765:Obesity / Q000150:complications / Q000628:therapy*; D010865:Pilot Projects; D040242:Risk Reduction Behavior; D057185:Sedentary Behavior; D013315:Stress, Psychological / Q000150:complications / Q000628:therapy*