Obesity is a risk factor for a number of serious medical comorbidities and is second only to
smoking as the leading cause of preventable death in the US. Further, estimates of the costs
associated with overweight and obesity have topped $200 billion annually. The numbers are
particularly alarming for adolescents, in whom the rate of obesity has risen at 2-3 times as
quickly as in adults. Despite the urgent need, very few clinical centers offer obesity
treatment due to the resource-intensive nature of most interventions and the fact that
behavioral obesity interventions have rarely been reimbursed by 3rd party payers. Following
the American Medical Association's recent decision to recognize obesity as a disease and
establish ICD-10-CM Diagnosis Codes (e.g., E66.0), however, there is increasing pressure for
3rd party payers to reimburse for effective obesity interventions. Thus, it is critical to
identify effective treatment options that can be implemented in medical centers. Prior
research has shown meal replacement-based diets to be more effective than typical
"lifestyle-change" diet programs, both in terms of weight loss and, more importantly, weight
loss maintenance. Evidence also suggests that solid meal replacements (e.g., bars) show
greater effectiveness than liquid meal replacements (e.g., shakes). Finally, greater
effectiveness is seen with meal replacements that are higher vs. lower in protein.
Importantly, these interventions show high rates of effectiveness even in the absence of
nutritional counseling, suggesting that a solid meal-replacement based diet program that is
relatively high in protein could be highly effective and easily implemented in clinical
settings. In this pilot study, 90 adolescents will be randomized to either a meal
replacement-based diet (experimental) group or an educational video (comparison) group.
All recruitment and study procedures will take place at the Mount Sinai Adolescent Health
Center (MSAHC). The MSAHC is the largest adolescent-specific, integrated, primary care
facility in the U.S., and is a unique model that integrates medical, sexual, reproductive,
mental health and health education services. MSAHC provides inner-city youth ages 10-24 who
are predominately youth of color high quality, comprehensive, easily accessed, free services.
Flyers will be posted in the clinic of the Mount Sinai Adolescent Health Center.
At the baseline assessment following recruitment, participants will provide informed consent
and complete a structured interview conducted by research staff to more formally assess
eating patterns and eating disorders symptomatology. Assessors will conduct interviews at the
MSAHC on an individual basis. If a patient meets criteria for an eating disorder, s/he will
be referred to treatment. Participants will be randomly assigned to one of two groups using
the coin flipper function available at www.random.org. All files will be password protected
to prevent unauthorized access of data.
