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Obesity is a pervasive chronic disease that disproportionately affects low income, ethnic minority populations. Individual response to adolescent obesity treatment is well documented. This project identified characteristics of low income, Hispanic middle school students that distinguished between being responsive or unresponsive to a school-based obesity intervention. Response to the intervention was defined according to American Academy of Pediatrics (AAP) guidelines. Overall, the Classification Regression Tree (CRT) models developed in Aim One illustrated the complex relationship between baseline factors and intervention response. Individuals who were unresponsive in the first three months were unlikely to become responsive by six months. This indicates the importance of providing alternative intervention to individuals initially unresponsive. Aim Two adapted clinical pediatric obesity treatment guidelines to the school setting to provide an escalated treatment option to low income, ethnic minority adolescents unresponsive to initial school-based intervention. Specifically, a stepped randomized control trial evaluated differences in BMI represented as a percentage of the 95th BMI percentile (%BMIp95) between an escalated treatment (Take CHARGE) and a maintenance program (PE Planners) following an established intensive lifestyle intervention (ILI). While there were no differences in %BMIp95 over the second semester between conditions (F(1,168.16)=0.28, p=0.60), there were statistically significant differences between treatment arms when response to ILI in the first semester was considered (F(3,166.14)=5.00, p<0.01). Specifically, among those unresponsive to ILI, those in Take CHARGE! had a significantly greater decrease in %BMIp95 than those in PE Planners (β = -0.01, t=-2.52, p<0.01). Conversely, among those responsive to ILI in the first semester, those in Take CHARGE! had significantly smaller decreases in %BMIp95 than those in PE Planners (β= 0.02, t=2.31, p<0.05). Of those unresponsive to intervention, 29% in Take CHARGE became responsive compared to 26% in PE Planners.

Taken together, these results indicate the importance of considering response to initial intervention when determining treatment plans. While escalated treatment improved outcomes for some initially unresponsive participants, many remained unresponsive. Future research is needed to refine the framework established in this project. Although schools can play an important role in staged obesity treatment, further treatment escalation may require community and clinical partnerships.



Obesity, Pediatrics, School-based