Behavioral interventions for adolescent weight control are often difficult to access because they are rarely provided in primary health care. This study was designed to assess the feasibility, acceptability, and preliminary effectiveness of a motivational interviewing plus adaptive text messaging intervention for adolescent weight control delivered in primary care. Methods: Forty-seven overweight adolescents (aged 13-18 years) participated in a single, hour-long, in-person motivational interviewing session in their primary care pediatrician's office with a clinical psychology doctoral student. All participants monitored diet, physical activity, and weight over 6 months and reported this information nightly via text message. Participants were selected randomly to receive computer-tailored adaptive text messages 3 times per day at mealtimes as an additional intervention component. Results: Participants found the intervention to be acceptable and beneficial for promoting weight-related behavior change. Adherence to self-monitoring was significantly higher in the adaptive text messaging group. Although body mass index z-score (zBMI) change was not significantly different across treatment groups, participants receiving the adaptive text message intervention demonstrated a reduction of .32 zBMI standard deviation units from before to after intervention, t(28) ϭ Ϫ2.84, p Ͻ .01, d ϭ .54, whereas zBMI did not change for individuals receiving the control intervention. Several domains of weight-related quality of life improved during the intervention period irrespective of treatment assignment. Conclusions: Study findings suggest that a behavioral weight control intervention delivered in a primary care is acceptable/feasible and may produce reductions in zBMI. Fully powered studies to further evaluate this intervention approach are warranted. Implications for Impact StatementThis pilot trial demonstrates that adaptive text messaging is a feasible, acceptable method for delivering weight control intervention content as an addition to inperson treatment for overweight adolescents. Furthermore, our findings suggest that interventions including adaptive text messages may improve self-monitoring adherence and produce superior weight loss outcomes.

Results from this study highlight considerations for future adolescent weight control treatment development.

Poor sleep is related to increased obesity risk in adolescents, though the mechanisms of this relationship are unclear. This paper presents a conceptual framework of the various pathways that have been proposed to drive this relationship. In this framework, increased food reward, emotional reactivity, decreased inhibitory control, metabolic disturbances, poorer dietary quality, and disrupted meal timings may increase the likelihood of increasing overall energy intake. This paper further notes how poor sleep increases sedentary behavior and screen time, which likely limits overall energy expenditure. The model posits that these mechanisms result in an imbalance of energy intake and expenditure following poor sleep, intensifying the overall risk for obesity. Increases in food reward processes, decreases in insulin sensitivity, disrupted meal timing, and increases in sedentary behavior seem to be the most compelling mechanisms linking poor sleep with increased obesity risk in adolescents. Future directions and clinical implications of this framework are discussed.

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BackgroundThe efficacy of adolescent weight control treatments is modest, and effective treatments are costly and are not widely available. Smartphones may be an effective method for delivering critical components of behavioral weight control treatment including behavioral self-monitoring.ObjectiveTo examine the efficacy and acceptability of a smartphone assisted adolescent behavioral weight control intervention.MethodsA total of 16 overweight or obese adolescents (mean age=14.29 years, standard deviation=1.12) received 12 weeks of combined treatment that consisted of weekly in-person group behavioral weight control treatment sessions plus smartphone self-monitoring and daily text messaging. Subsequently they received 12 weeks of electronic-only intervention, totaling 24 weeks of intervention.ResultsOn average, participants attained modest but significant reductions in body mass index standard score (zBMI: 0.08 standard deviation units, t (13)=2.22, P=.04, d=0.63) over the in-person plus electronic-only intervention period but did not maintain treatment gains over the electronic-only intervention period. Participants self-monitored on approximately half of combined intervention days but less than 20% of electronic-only intervention days.ConclusionsSmartphones likely hold promise as a component of adolescent weight control interventions but they may be less effective in helping adolescents maintain treatment gains after intensive interventions.