Preventing Obesity in Military Communities, Adolescents
Preventing Obesity in Military Communities, Adolescents
This research study is aimed at the prevention of excessive weight gain in female military
 dependents at high risk for adult obesity. The purpose of this study is to determine whether
 reducing Loss of Control (LOC) eating and associated indicators through use of interpersonal
 psychotherapy (IPT) will be feasible and acceptable to female adolescent dependents who
 report such behaviors. Moreover, patterns in the data will be examined to assess whether IPT
 influences body weight gain trajectories and prevent worsening disordered eating and
 metabolic functioning among female military dependents at heightened risk for unhealthy
 weight gain.
The increased prevalence of obesity among the children of military personnel has paralleled
 that observed in the civilian population. Disordered eating, especially binge or loss of
 control (LOC) eating, is common among adolescents and is a salient risk factor for obesity
 and the development of exacerbated disordered eating and depressive symptoms. The goal of
 this study is to test the effectiveness of interpersonal psychotherapy (IPT) to slow the
 trajectory of weight gain in adolescent girls at high-risk for adult obesity by virtue of
 elevated body mass index (BMI) percentile and LOC eating. IPT targets the difficult social
 functioning and stressful events that are associated with LOC and highly relevant to the
 adolescent youth from military families. Adolescent military dependents will be randomized to
 receive either the IPT weight gain prevention program or a health education (HE) control
 condition, for 12 weekly group sessions. Adolescents' weight status, eating behaviors, and
 mood will be assessed at baseline, immediately following the prevention program (12-weeks),
 and at 1-year follow-up. At 2-year and 3-year follow-up time points, participants' BMI and
 physiologic data will be collected via the Military Health System's electronic medical record
 system. It is hypothesized that adolescents who receive the IPT group program will show
 significantly less weight gain (or more weight loss) relative to those randomized to HE at
 3-year follow-up. Additionally, it is hypothesized that adolescents receiving IPT (as
 compared to HE) will demonstrate improvements on secondary outcomes of interest, including
 the presence and frequency of classic binge eating episodes, as well as obesity-related
 physiological measures of health (e.g., fasting insulin). The overall goal of the study is to
 prevent excess weight gain and adult obesity, and to prevent worsening disordered eating and
 metabolic functioning among overweight military dependents at risk for adult obesity and
 binge eating disorders.
Inclusion Criteria:

 -  Female

 -  Age between 12 and 17 years (at the start of the study)

 -  English-speaking

 -  Ability to complete study procedures, including ability to participate in a group

 -  Endorsement of at least one LOC criteria, as assessed by Eating Disorder Examination
 (EDE) semi structured interview

 Exclusion Criteria:

 -  Presence of a chronic major medical illness: : renal, hepatic, gastrointestinal,
 endocrinologic (e.g., Cushing syndrome, hyper- or hypothyroidism), hematological
 problems or pulmonary disorders (other than asthma not requiring continuous
 medication). Non-serious medical illnesses, such as seasonal allergies, will be
 reviewed on a case-by-case basis.

 -  Presence of a documented, obesity-related medical complication that would require a
 more aggressive weight loss intervention approach: type 2 diabetes, hyperlipidemia,
 hypertension, fasting hyperglycemia, or nonalcoholic steatohepatitis

 -  Documented or self-reported current pregnancy, current breast-feeding, or recently
 pregnant girls (within 1 year of delivery). Because pregnancy is a state in which
 weight gain is expected and appropriate, pregnant individuals would not be suitable
 for this study. Sexually active females must be using an effective form of birth
 control. These methods include total abstinence (no sex), oral contraceptives ("the
 pill"), an intrauterine device (IUD), levonogestrol implants (Norplant), or
 medroxyprogesterone acetate injections (Depo-provera shots). If one of these cannot be
 used, contraceptive foam with a condom is recommended. Should a participant in the
 IPT-WG group become pregnant during the ~12 weeks of the group program, she will be
 excluded from the group sessions. The study team will closely assist in obtaining an
 appropriate referral to a community mental healthcare provider, as indicated, and will
 request a release of information so that they may facilitate a smooth transition for
 the girl.

 -  Current, regular use of prescription medications that affect appetite, mood, or body
 weight: currently prescribed SSRI's, neuroleptics, tricyclics, stimulants, or any
 other medication known to affect appetite, mood, or body weight. Oral contraceptive
 use will be permitted, provided the contraceptive has been used for at least two
 months before starting the prevention groups. Medication use for non-serious
 conditions (e.g., acne) will be considered on a case-by-case basis.

 -  Current involvement in psychotherapy or a structured weight loss program.

 -  Weight loss during the past two months for any reason exceeding 3% of body weight.

 -  Current anorexia nervosa or bulimia nervosa as determined by documented medical
 history or if uncovered during K-SADS semi-structured interview. Current binge eating
 disorder will be permitted. Girls with anorexia or bulimia nervosa will be referred to
 mental health specialists for further evaluation and treatment. Individuals who need
 further behavioral health or medical services will be accommodated through their
 primary care medical home in accordance with normal clinical standard of care. This
 will be accomplished by direct communication with the patients' primary care
 physician.

 -  Individuals who have major depressive disorder, psychoses, current substance or
 alcohol abuse, conduct disorder, as determined by Kiddie Schedule for Affective
 Disorders and Schizophrenia (K-SADS) semi-structured interview and as defined by
 criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders
 (DSM-IV-TR) or any other DSM-IV-TR psychiatric disorder that, in the opinion of the
 investigators, would impede competence or compliance or possibly hinder completion of
 the study.