title: Outcomes of a 1-year randomized controlled trial to evaluate a behavioral 'stepped-down' weight loss intervention for adolescent patients with obesity.
abstract: BACKGROUND
  Stepped-care approaches to weight loss have shown some success among adults. A 'stepped-down' version of the stepped-care approach to adolescent weight loss has never been evaluated.
  
  
  OBJECTIVE
  We conducted a one-year randomized controlled trial to compare a stepped-down weight loss intervention versus enhanced usual care (EUC).
  
  
  METHODS
  Study participants were obese adolescents age 11-13 (N = 106, 51% girls, and 82% Hispanic) recruited from primary care clinics in San Diego, California. The stepped-down intervention was delivered through clinician and health educator counseling (in-person and by phone) and mailed content. The intervention consisted of four-month 'steps' beginning with the most intensive contact followed by reduced contact if treatment goals were met. The EUC group received an initial physician visit, one session with a health counselor, and monthly mailed materials. Body mass index (BMI kg/m(2) ) was measured at baseline, 4, 8, and 12 months. Mixed-model regression analyses were stratified by sex.
  
  
  RESULTS
  Results indicated a clinically significant treatment effect for boys on BMI (p < 0.001) but not girls. No between group differences were found for adiposity and biometric outcomes. Only 13% of intervention participants succeeded in stepping down from step 1 to step 2 or step 3.
  
  
  CONCLUSIONS
  A stepped-down approach to weight loss showed some evidence of efficacy for weight loss in boys but not girls. The findings suggest the program as designed was not intensive enough to result in weight loss in this population segment.
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: G
authors.initials: G
authors.lastname: Norman
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Huang
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: E P
authors.initials: EP
authors.lastname: Davila
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: J K
authors.initials: JK
authors.lastname: Kolodziejczyk
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: J
authors.initials: J
authors.lastname: Carlson
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: J R
authors.initials: JR
authors.lastname: Covin
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Gootschalk
authors.affiliation: Department of Family and Preventive Medicine, University of California, San Diego, La Jolla, California, USA.
authors.forename: K
authors.initials: K
authors.lastname: Patrick
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000523:psychology*; D001521:Behavior Therapy; D015992:Body Mass Index; D002140:California / Q000453:epidemiology; D002648:Child; D037001:Directive Counseling / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D063766:Pediatric Obesity / Q000517:prevention & control* / Q000523:psychology / Q000628:therapy; D015397:Program Evaluation; D015431:Weight Loss; D061217:Weight Reduction Programs
keywords: Adolescents; obesity; primary-care intervention; stepped-down