SHAPEDOWN

Adolescent obesity is an epidemic in the United States.  There is increasing medical concern about the problem, as its risk of persistence into adulthood is high and obesity in adults is relatively intractable.  Moreover, overweight adolescents face social discrimination leading to poor self-esteem, depression, and sub-par school performance.  Effective programs for dealing with adolescent obesity remain relatively rare, and most programs reporting some success fail to maintain weight loss in the long-term.  Multi-component programs that are transferable to a wide range of clinical and geographic sites, and that produce significant long-term outcomes are needed.

SHAPEDOWN is a family-based adolescent obesity intervention that aims to normalize adolescents' weight within his or her genetic potential.  The program uses individual comprehensive assessments to identify and treat psychosocial and biological contributors to the weight problem.  Obesity is addressed within the context of the overall development of the adolescent and in relation to family and social systems.  Very low calorie or restrictive diets are avoided in this program.  Adolescents meet weekly for 10 group meetings that include voluntary weigh-in, leader facilitated group interaction, and an exercise period.  Because SHAPEDOWN uses an individualized treatment model, sessions may also be delivered individually.  Two parent sessions instruct parents on strategies for supporting their adolescents' weight-loss efforts.  SHAPEDOWN stresses overall fitness, including endurance, flexibility and strength. Children and parents develop a more active lifestyle and replace television viewing and other inactive pursuits with chores, hobbies, sports and projects.

The standard SHAPEDOWN program is delivered in 10 weekly sessions plus two parent sessions.  Each session is approximately 2.5 hours in length.  Different levels of care, however, will require different lengths of program intervention.  Training includes an introductory 6-hour video tape; three advanced SHAPEDOWN video courses are also available; each course requires 13-14 hours.

Participants who tested this program were obese adolescent boys and girls aged 12 to 18 years old in northern California.  Of the participants, 88% were White; 7% were Hispanic; 3% were Black; and 2% were Asian.  Weight ranged from 128 to 297 pounds for all populations represented in the study.

The intervention is suitable for implementation in medical settings.

The SHAPEDOWN instructors guide for adolescents, the parent and adolescent workbook, and the introductory training tape are required.  The assessment instrument (Y.E.S.) is optional.  The SHAPEDOWN start-up package is $475, plus $100 annual license fee (first full calendar year is included in start-up package.)  On going costs are approximately $28 per family for the parent and adolescent workbook.

Adolescents (N = 66) from four intervention sites in northern California were randomized to the SHAPEDOWN program or a control group.  Sites included a rural health department, a rural nutrition private practice, a suburban medical clinic, and an urban medical center.  Nutritionists volunteered as SHAPEDOWN group leaders and conducted 14 weekly sessions (now offered in 10 sessions) for adolescents and two sessions for parents.  Each 90-minute session included voluntary weigh-in, leader facilitated group interactions, and an exercise period.  Assessments were conducted at baseline, 3-, 6- and 15-month follow-up. 

Results indicated:

• At 3- and 15- month follow-up, SHAPEDOWN adolescents improved their relative weight (percent of mean weight for height, age, and sex), weight-related behavior, self-esteem, weight management knowledge, and demonstrated less depression; whereas the control group only improved on self-esteem.