Improving Cardiometabolic Health in Adolescent Girls With Elevated Anxiety: Web-Based Multisite, Pilot, and Feasibility Randomized Controlled Trial.

چکیده اصلی

BACKGROUND: Anxiety is common in adolescents with elevated BMI (kg/m2), affecting 33%-43% of adolescents with overweight or obesity (age- and sex-specific BMI ≥85th percentile ). Anxiety has been associated with poorer cardiometabolic health, and disinhibited eating in response to anxiety may be a key explanatory mechanism. Therefore, reducing anxiety in adolescents may improve disinhibited eating patterns and prevent worsening cardiometabolic health. OBJECTIVE: This pilot study primarily aimed to assess the feasibility and acceptability of 2 virtual group psychological interventions, interpersonal psychotherapy (IPT) and cognitive behavioral therapy (CBT), in adolescent girls with elevated anxiety and above-average weight. Secondary aims were to describe changes in anxiety, eating behavior, and cardiometabolic health indices. METHODS: This 2-site, 2-year, pilot and feasibility randomized controlled trial enrolled 12- to 17-year-old girls with elevated anxiety symptoms (State-Trait Anxiety Inventory for Children total score ≥32) and above-average weight (BMI ≥75th percentile for age and sex), who were in good general health and not concurrently receiving therapy or medication treatment. Girls were randomly assigned to 1 of 2 web-based arms: 12-week, psychologist-led, group IPT or CBT. In both arms, groups of 5-7 adolescents met for 90 minutes on secure Zoom (Zoom Communications, Inc) once per week. Anxiety, disinhibited eating, BMI indices, blood pressure, lipids, hemoglobin A1c (HbA1c), and fasting glucose were measured at baseline, 12-week follow-up, and 1-year follow-up. Feasibility of recruitment, retention, and study protocol, and acceptability and fidelity of IPT and CBT were evaluated. RESULTS: Of 47 eligible adolescents, 40 (85%) enrolled. Enrollment of the total sample (n=40) was completed in 7 months. Retention was 85% (n=17) in IPT and 100% (n=20) in CBT at 12-week follow-up. Protocol adherence exceeded 96% for all intervals. Missing data varied, with higher rates for phlebotomy (up to 30%). Acceptability ratings were above-average for likability (mean 3.03, SD 1.14) and credibility (mean 3.26, SD 0.75; 0-4 scale with 4=Highest) across arms. Most adolescents received ≥80% intervention dosage (IPT: 90%, CBT: 95%). Expert fidelity ratings of IPT were 78% (SD 11%) and CBT were 94% (SD 9%). From baseline to 1-year, IPT demonstrated improvements in general anxiety (95% CI -8.95 to -1.40), social anxiety (95% CI -12.37 to -1.88), and HbA1c (95% CI -0.48 to -0.23); CBT demonstrated improvement in emotional eating (95% CI -1.18 to -0.18), and both arms demonstrated improvements in BMI percentile (effect sizes=-0.82 and -0.63, IPT and CBT, respectively). CONCLUSIONS: This pilot and feasibility trial provided initial support for the feasibility of recruitment and retention and acceptability of web-based group IPT and CBT, as well as yielded areas for optimizing protocol feasibility and intervention fidelity. These preliminary results inform the planning of larger-scale efficacy trials with powered samples to assess effects on BMI and cardiometabolic health indicators among adolescents with elevated anxiety and above-average weight.

ترجمه فارسی چکیده

اضطراب در نوجوانان با شاخص توده بدنی بالا (kg/m2) شایع است و با سلامت قلبی-متابولیک ضعیف‌تر مرتبط است. این مطالعه هدف اصلی آن ارزیابی پذیرش‌پذیری و پذیرش دو مداخله روانشناختی گروهی مجازی، رواندرمانی بین‌فردی (IPT) و درمان شناختی-رفتاری (CBT) در دختران نوجوان با اضطراب بالا و وزن بالاتر از میانگین بود. تغییرات اضطراب، رفتار خوردن و شاخص‌های سلامت قلبی-متابولیک نیز مورد بررسی قرار گرفت. این مطالعه تصادفی‌شده و پیکربندی‌شده به صورت وب، ۱۲ تا ۱۷ ساله‌های دختر با علائم اضطراب بالا و وزن بالاتر از میانگین را در دو سایت ثبت کرد. شرکت‌کنندگان به طور تصادفی به یکی از دو گروه ۱۲ هفته‌ای، رهبری شده توسط روانشناس، اختصاص یافتند. اضطراب، خوردن بدون محدودیت، BMI، فشار خون، چربی‌ها، هموگلوبین A1c و قند ناشتا در زمان پایه و پیگیری‌های ۱۲ هفته‌ای و ۱ ساله اندازه‌گیری شدند. پذیرش‌پذیری جذب، حفظ participant و پذیرش و وفاداری مداخلات ارزیابی شد. نتایج نشان داد که ۴۰ از ۴۷ شرکت‌کننده (۸۵٪) ثبت‌نام شدند. حفظ participant در پیگیری ۱۲ هفته‌ای ۸۵٪ (IPT) و ۱۰۰٪ (CBT) بود. اطلاعاتی که در متن اصلی گزارش نشده است.

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