Program

Jan 16, 2013

OVERVIEW

The Loozit
weight management intervention is an adolescent weight management intervention
designed for overweight or moderately obese adolescents. The intervention
consists of seven weekly group sessions for adolescents and parents (held
separately), followed by seven “booster” sessions for adolescents only. A
modification of the intervention, Loozit “plus additional therapeutic contact”
(Loozit+ATC), supplements the original Loozit curriculum with phone counseling
and email or text messages for the adolescents during the booster session
period. The primary goals of both versions are to reduce body mass index (BMI)
z-scores and to reduce waist circumference. BMI z-scores are measures of
a child’s weight-by-height, adjusted for the child’s age and sex and measured in
standard deviation scores. Additional goals are to improve metabolic profile
indicators and eating patterns; to increase physical activity and psychosocial
well-being; and to decrease sedentary behavior. The evaluation showed that both
the Loozit program and the Loozit+ATC program had significant impacts (when
compared with baseline measurements) on BMI z-score and waist-to-height ratio,
as well as on metabolic indicators (including levels of cholesterol and
triglycerides), psychosocial factors (including mental health, body
dissatisfaction, social acceptance with peers, global self-worth, and perceived
competences in various domains); and lifestyle behaviors (including dietary
intake and sedentary behaviors).

DESCRIPTION OF PROGRAM

Target
population:

Overweight
to moderately obese 13- to 16-year-olds.

Loozit
involves seven group sessions each for adolescents and parents, followed by
seven booster sessions for adolescents only. Sessions are held in community
health centers or local government community centers. The content of the first
seven adolescent sessions includes: 1) benefits of a healthy, active lifestyle;
2) increasing physical activity and reducing sedentary behavior; 3) healthy
eating for adolescents; 4) food labels, measuring fat and sugar in food and
drinks, and lunch box and snack ideas; 5) positive self esteem; 6) stress
management; and 7) review and maintenance (see
Shrewsbury, et al., 2009b).
The parent sessions cover: 1) an introduction to the Loozit program and an
overview of theimportance
of supporting their children and goal setting; 2) increasing physical activity
and reducing sedentary behavior; 3) healthy eating for your adolescent and your
family; 4) shopping, food labels, fat and sugar in foods and drinks, and
balanced meal ideas; 5) recipe modification, family food habits, and
parental/career role in building the self esteem of adolescents; 6) healthy
take-out options, eating out, and gatherings with family and friends; and 7)
review and maintenance.The initial seven weeks of the program are followed by seven additional
“booster” sessions for the adolescents only, held once a month for a period of
21 months after the initial sessions. The topics covered in the booster sessions
include: 1) healthy take-out food
options, eating out, and special occasions; 2)
increasing physical activity and overcoming the barriers to physical
activity; 3) portion sizes, eating cues, and overcoming non-hungry eating; 4)
the “ins and outs” of fad diets and reality TV
weight loss programs; and 5) time management and making the most of your day.
These additional sessions also include two measurement sessions (one at 12
months and one at 24 months).

Loozit+ATC
supplements the original Loozit program with telephone coaching and Short
Message Service (SMS or text messages) and/or emails. ATC is received once
every two weeks over the course of the 21 months of the booster sessions (for a
total of 32 emails or text messages and 14 telephone coaching sessions.

EVALUATION OF PROGRAM

Nguyen,
B., et al. (2012). Twelve-month outcomes of the Loozit randomized controlled
trial: A community-based healthy lifestyle program for overweight and obese
adolescents. Archives of Pediatrics and Adolescent Medicine, 166(2),
170-177.

Evaluated population:
Adolescents 13- to 16-years-old who were overweight or met the criteria for
being moderately obese (based on a BMI z-score of 1.0-2.5) living in Sydney,
Australia, were included in the evaluation. The sample had a mean age of 14.1
and was approximately balanced in gender (48 percent male). As described
elsewhere (see Shrewsbury, et al., 2009a), adolescents who were severely obese;
who had a secondary cause of obesity; who had an intellectual disability,
significant medical illness, or psychiatric disturbance who were taking
medications that affect weight status; who were unable to take part in physical
activity sessions; or who had low levels of spoken English (either the
adolescent or the parent/caregiver) were excluded.

Of the 474
youth who responded to invitations to participate in the study, 151 adolescents
were eligible; 78 were assigned to the Loozit group and 73 to the Loozit+ATC
group. Sixty of the original Loozit participants (77 percent) and 64 of the
Loozit+ATC participants (88 percent) remained after the first year of the
study. However, one-third of participants (44) did not provide height, weight,
waist circumference, and blood pressure measures at the 12-month mark.

Approach:
Participants were stratified by gender and age (13-14 and 15-16), then randomly
assigned to condition using computer-generated randomization sequences.
Assignment to treatment or control groups was revealed after consent was
obtained.

Baseline
measures included anthropometry (height, weight, waist circumference, and blood
pressure); metabolic profile (cholesterol, triglycerides, glucose, insulin, and
alanine aminotransferase (ALT)); psychosocial factors (quality of life, body
dissatisfaction, social acceptance with peers, global self-worth, and perceived
competence); and lifestyle behaviors (dietary intake, physical activity, and
sedentary behaviors). Follow-up collection of the same measures occurred at
two, 12, and 24 months after the baseline (though the focus of this evaluation
is on the 12-month follow-up only).

Results: At the 12-month follow up, participants who were in either the Loozit or the
Loozit+ATC treatment group showed significant increases in height and weight,
compared with their baseline measurements. They showed significant reductions
in their BMI z-scores, their waist-to-height ratio, their total cholesterol, and
their triglycerides. They also reported eating less high-fat meat, potato
chips, and lunch, and they reported spending less time in front of screens (such
as television) than they did at baseline. There were no improvements in BMI
(unadjusted for age and sex), waist circumference, systolic or diastolic blood
pressure, high-density or low-density cholesterol, glucose, insulin, ALT, or
other behaviors. Compared with the Loozit group, the Loozit+ATC group showed
significantly greater increases in their systolic blood pressure over the
12-month period. There were no differences in other anthropometric,
metabolic, or behavior measures.

Compared
with their baseline measurements, those in the Loozit or the Loozit+ATC groups
also showed improvements in self-reported measures of mental health, global
self-worth, social acceptance, romantic appeal, physical appearance, scholastic
competence, athletic competence, job competence, and subjective social status.
Further, their body dissatisfaction declined. There were no improvements in
behavior or close friendships. Compared with the Loozit group, the Loozit+ATC
group fared significantly worse in scholastic competence over the 12-month
period. There were no differences in other psychosocial factors.

At the
12-month follow-up, effect sizes (Cohen’s d‘s) indicate that the effect
of receiving either the Loozit or the Loozit+ATC treatment on the
anthropometric, metabolic, behavior, and psychosocial factors (compared with
their baseline measures) ranged from negligible (total cholesterol,
triglycerides, and athletic competence), to small (height, weight, BMI z-score,
waist-to-height ratio, global self-worth, physical appearance, scholastic
competence, and subjective social status), to medium (mental health,
dissatisfaction with body shape, romantic appeal, and social acceptance). The
negative effect of the Loozit+ATC treatment, compared with the Loozit treatment
alone, on systolic blood pressure was negligible, and the negative effect on
scholastic competence was small.

SOURCES
FOR MORE INFORMATION

References

Shrewsbury, V.A., et al. (2009a). A randomised controlled trial of a
community-based healthy lifestyle program for overweight and obese adolescents:
The Loozit study protocol. BMC Public Health9,119.

Shrewsbury, V.A., et al. (2009b).Phase 1 of
the Loozit

The
Loozit curriculum and other content can be found at:

Children’s Hospital at Westmead. (2012). Loozit: Healthy active living for young
people:
A community-based healthy lifestyle program for overweight and obese adolescents.Retrieved from

http://www.chw.edu.au/kids/loozit/
.

KEYWORDS: Adolescents, Co-ed, Urban, Community-Based, Clinic/Provider-Based, Skills Training, Parent Training/Education, Obesity, Self-Esteem/Self-Concept, Nutrition, Manual Is Available