PORTLAND, Ore., Feb. 13, 2012 /PRNewswire/ -- Teenage girls gained less weight, improved their body image, ate less fast food, and had more family meals after participating in a 6- month program that involved weekly peer meetings, consultations with primary care providers and separate meetings for parents. Those results from a study published online today in the journal Pediatrics.

Funded by the National Institutes of Health, the study is the first to report long-term results from a weight management program designed specifically for teenage girls. Most other programs have included younger children and interventions focused on the entire family. This program included separate meetings for parents with the rationale that teens are motivated more by peer acceptance than parental influence. Unlike previous programs, this one was conducted in a primary-care setting, rather than an academic or specialty-care environment.

"Nearly one-third of teenage girls are overweight or obese, and many of them are likely to become obese adults," said Lynn DeBar, PhD, MPH, lead author and senior investigator with the Kaiser Permanente Center for Health Research. "Our study shows that intervention programs can help these girls achieve long-term success managing their weight and also learning new habits that will hopefully carry over into their adult life." 

"Many teenage girls are still growing taller, so for them, maintaining weight or slowing weight gain is an acceptable goal," said Phil Wu, MD, a pediatrician who leads Kaiser Permanente's effort to prevent and treat childhood obesity and is also a co-author of the study. "Girls in the program gained less weight than those who weren't in the program, and they reduced their overall body mass index, improved their self-image and developed healthy lifestyle habits, so all of these are successes."

The study included 208 girls, ages 12–17, in Oregon and Washington during 2005–2009. All of the girls were classified as overweight or obese, according to standards set by the Centers for Disease Control and Prevention standards. Half of the girls were assigned to the intervention group and half to usual care.

Girls in the intervention group met weekly with their peers and a behavioral counselor during the first three months, and then every other week during months four and six. The girls were weighed and asked to keep a food and activity diary, which they discussed during each meeting. The program focused on decreasing portion size, limiting consumption of energy-rich foods, establishing regular meal patterns, substituting water for sugar-sweetened beverages, reducing fast food, increasing fruit and vegetable consumption, and having more family meals.

The girls were encouraged to exercise at least 5 days a week for 30-60 minutes, and to limit screen time to 2 hours a day.  They also received yoga instruction, and a physical-activity video game to use at home.  Discussion topics included ways to avoid disordered eating, coping with family and peer teasing and developing strategies to combat negative self-talk.

Parents attended separate weekly meetings to learn how to support their daughters. The girls' health care providers received summaries of the girls' current health habits, including meal and physical activity patterns. After receiving training in motivational techniques, the providers met with the girls at the beginning of the study to help them choose one or two behaviors to work on. The providers had a second visit with the girls at the end of the six-month intervention to check their progress.

Girls assigned to the usual-care group received a packet of materials that included a list of online reading about lifestyle changes. They also met with their primary care provider at the beginning of the study, but the providers were not given health habit summaries for these girls.

Both groups had health assessments and lab tests at the beginning of the study, at six months, and then again at 12 months. The girls started out with an average weight in the 190 lb. range, and an average body mass index in the 97th percentile, which by CDC standards is considered to be obese. At the end of the study, girls who participated in the program were in the 95th percentile, while girls in the usual-care group were in the 96th percentile.

Authors say the weight changes were statistically significant but modest compared to some other weight loss interventions. They point out that the girls were severely obese to begin with and possibly treatment-resistant due to previous involvement in other weight loss programs. The program purposely de-emphasized calorie counting, focusing instead on lifestyle changes, and the authors acknowledge that this approach may have produced more modest weight changes than they had expected.

This study is part of ongoing Kaiser Permanente research into weight loss. Previous studies include:

A Kaiser Permanente Center for Health Research study published in the International Journal of Obesity last year found that people trying to lose at least 10 pounds were more likely to reach that goal if they had lower stress levels and slept more than six hours, but not more than eight hours, a night. Another Kaiser Permanente Center for Health Research study published in 2010 found that the more people logged on to an interactive weight management website, the more weight they kept off. Researchers at the Kaiser Permanente Center for Health Research also reported in a 2008 study that keeping a food diary can double a person's weight loss and that both personal contact and Web-based support can help with long-term weight management.

Authors include Lynn L. DeBar, PhD, MPH; Victor J. Stevens, PhD; Nancy Perrin, PhD; John Pearson, MD; Bobbi Jo Yarborough, PsyD; John Dickerson, MS; and Frances Lynch, PhD, from the Kaiser Permanente Center for Health Research in Portland, Ore.,; and Philip Wu, MD, from Northwest Permanente in Portland, Ore.

About the Kaiser Permanente Center for Health Research (http://www.kpchr.org)

Kaiser Permanente's Center for Health Research, founded in 1964, is a nonprofit research institution dedicated to advancing knowledge to improve health. It has research sites in Portland, Ore., Honolulu, and Atlanta.

About Kaiser Permanente

Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America's leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: http://www.kp.org/newscenter.  

For more information
Mary Sawyers, mary.a.sawyers@kpchr.org, 503 335 6602
Danielle Cass, danielle.x.cass@kp.org, 510-267-5354

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Primary Care Intervention Helps Obese Teen Girls Manage Weight, Improve Body Image, and Change Behavior

A new weight-loss study focusing on teenage girls finds that they may be more likely to eat healthy and exercise if they're given the freedom to do it on their own.

Gary S Chapman / Getty Images

It’s hard to convince teens to do anything they don’t want to, but new research shows that when it comes to losing weight, a program that leaves parents out of the picture may help.

The study, published in the journal Pediatrics, involved 208 overweight or obese teen girls aged 12 to 17, who were living in Oregon and Washington in 2005-09. The girls were assigned either to receive usual weight-loss advice or to participate in a moderately intensive behavioral program that stressed healthy eating and exercise habits. The twist? The teens’ parents were given separate sessions about how to support their daughters in their weight-loss efforts. In contrast, most previous youth weight loss studies have offered treatment to families all together.

After six months, all of the girls were evaluated for weight and height to calculate their body mass index, or BMI; six months later, they were measured again. By the end of the yearlong interval, the teens in the behavioral program showed only slightly lower BMIs than the control group on average, but they reported having significantly better body image and had adopted healthier eating habits. Specifically, the teens in the behavior-modification program ate more meals together with their families, which previous studies have shown promotes healthier eating, ate less fast-food and consumed more fruits and vegetables.

“We purposefully set up the study not expecting people to have very dramatic and quick weight losses, but emphasizing different tools in terms of dietary changes and physical activity that we thought would be easy to include in every life, and which could be sustained over time,” says Lynn DeBar, senior investigator at Kaiser Permanente Center for Health Research and the study’s lead author. “We suspected these would have more staying power than a more calorically focused weight management regimen.”

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Indeed, while the girls on the program didn’t lose a remarkable amount of weight, especially compared with other weight-loss regimens, DeBar says the results are still significant because they are the first to show that a teen-centered approach to weight loss can be effective. What’s more, because it did not focus on calorie-counting, the adolescent girls may have been more likely to embrace the behavior changes.

The behavioral program involved 90-min. group sessions that occurred 16 times over the study’s five-month period, during which teens met with specially trained counselors to discuss how to change their eating patterns and become more physically active by using exergames and incorporating 15 minutes of yoga daily. The girls also spoke with counselors about body image and eating disorders.

To change their eating habits, the counselors emphasized decreasing portion sizes and advised the teens on eating fewer high-calorie foods and more lower-calorie options such as fruits and vegetables. They also talked to the adolescents about substituting water for sugared sodas, and the importance of eating regular meals, especially breakfast.

To encourage the teens to exercise more, the program provided yoga equipment as well as exergames such as Dance Dance Revolution, which the girls could use on their own or with friends and which researchers figured they would enjoy more than regimented sessions at a gym. The researchers advised the teens to incorporate 30 to 60 minutes of physical activity a day, five days a week.

At the start of the study and again six months later, the teens also visited their pediatricians to discuss concerns about weight. The pediatricians were trained to be more attentive to weight issues and to work collaboratively with the girls to find the best way to adopt a healthier lifestyle.

MORE: Want Your Kids to Exercise? Let Them Play Video Games!

The control group was given a packet of information on weight-loss strategies, books and online materials, as well as contacts to local resources for weight management. They also met with primary care physicians at the beginning of the study to discuss healthy lifestyle changes, but these doctors were not provided with the specialized training to address teens’ weight issues.

Overall, the behavioral program seemed to be effective in giving teens the right tools with which to maintain healthy weight over the long term. After six months, the girls in the program had reduced their sedentary TV and computer time by 5 hours and consumed 240 fewer calories per day on average, compared with the control group.

Part of the program’s success may be due to the fact that unlike specialized or clinic-based weight management programs, which are more structured and conducted over limited periods of time, this program involved the teens’ pediatricians, with whom the girls have ongoing relationships. “The idea was to see if we could have a weight loss program that involved primary care providers, since formal weight management programs are time limited, meaning people do well during the program but then lose their improvements over time,” says DeBar. “We thought that since the girls have an ongoing relationship with their pediatrician, that would allow what they are doing to be reinforced and sustained over a longer period of time.”

It did, and giving the adolescent girls more autonomy over their weight loss options, without directly involving Mom and Dad, also helped. Still, there is a limit to how much control teens should be allowed to have over their diets, since studies also show that when parents are more involved in helping children decide what to eat — particularly by adopting the same diet and exercise changes that their children do — youngsters are more likely to learn and maintain healthier eating habits.

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME’s Facebook page and on Twitter at @TIME.

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Do Teen Weight Loss Programs Work Better Without Mom or Dad?

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