ABSTRACT
Adolescent overweight/obesity affects (AOB) 14 million adolescents in the United States, increasing their risk
of type 2 diabetes, cardiovascular disease, and cancer. Unfortunately, adolescents show suboptimal response
to behavioral pediatric obesity interventions, with a modal weight loss of less than one BMI point. One potential
explanation is that standard behavioral interventions do not target the key mechanisms of AOB. One such
mechanism of AOB not adequately targeted by existing interventions is sleep disturbance, which refers to too
little, poor quality, poorly timed, or inconsistent sleep, which affects over 80% of adolescents with obesity.
Recent models posit that sleep disturbance produces aberrations in decision-making that result in excess
energy intake. As per the candidate’s K23 award, these aberrations in decision-making drive engagement in
problematic eating behaviors that result in excess weight gain, and likely, poorer response to standard
behavioral obesity interventions. Integrating behavioral sleep interventions with AOB interventions is
compelling for three reasons: (1) the strong theoretical and empirical links of sleep disturbance with poor
weight outcomes, (2) the high rates of sleep disturbance in adolescents, and (3) the fact that behavioral sleep
interventions are amongst the most effective of any psychological treatment. Yet, few studies have attempted
to formally integrate behavioral sleep interventions in treatment for obesity in youth, and none have done so in
adolescents. An intervention that is a particularly good fit is the evidence-based Transdiagnostic Sleep and
Circadian Intervention (TSCI), which is designed specifically to address the sleep challenges faced by
adolescents (e.g., school schedules, screen time, social needs). In the current study, we will develop, refine
and test a 16-session group lifestyle modification (LM) intervention for AOB augmented with TSCI (i.e.,
LM+Sleep). In Phase I, we will develop the LM+Sleep manual and pilot the intervention in an initial set of
adolescents (n=10). We will collect feedback from adolescents, parents, and clinicians, which will inform
manual refinements. In Phase II, we will complete an open trial (n=40) of the refined LM+Sleep manual. We
will recruit adolescents (ages 14-18) with overweight or obesity who endorse at least 1 type of sleep
disturbance. Assessments of sleep (via sleep diaries and accelerometry), decision-making, problematic eating
behaviors, and weight will occur at baseline (week 0), mid-treatment (week 6), and post-treatment (week 12).
Our primary aims are to (1) Create and refine an LM+Sleep manual; (2) Estimate the effects of LM+Sleep on
weight loss, sleep, decision-making, and eating behaviors/dietary intake; and (3) Examine whether changes in
sleep and decision-making are associated with weight loss outcomes. This R03 award, in concert with Dr.
Manasse’s K23, will provide ideal pilot data for a fully-powered R01 trial testing the efficacy of LM+Sleep vs LM
alone and accelerate the candidate’s trajectory into her independent research career.
