Optimizing a school-based obesity prevention intervention for adolescent girls

ABSTRACT In Kenya, like most low- and middle-income countries (LMICs), rapid urbanization and changing food environments are leading to increased access to energy-dense nutrient-poor foods that are contributing to rising rates of obesity and the burden of nutrition-related noncommunicable diseases. Adolescence is a critical lifecycle period for the prevention of obesity, and an opportunity to establish lifelong habits for healthy eating. Adolescent girls are particularly at risk for overweight and obesity, and women in urban Kenya have more than double the rates of obesity compared to men. Although there is widespread agreement on the need to improve adolescent girls’ dietary practices in LMICs, effective obesity prevention interventions are lacking, particularly in sub-Saharan Africa. With the mentorship and training proposed in this K01 application, I will pilot test theory- based adolescent obesity prevention intervention components for girls in an urban informal settlement in Kenya. In Aim 1, I will follow a community-engaged process to refine school-based adolescent obesity prevention intervention components that were designed based on our previous formative research. In Aim 2, I will conduct a pilot multiphase optimization strategy (MOST) study to determine the feasibility of recruitment, randomization, intervention delivery, retention, and data collection procedures, and the acceptability of intervention components in preparation for a future fully-powered factorial trial. In the pilot MOST study, 8 secondary schools will be randomized to one of eight combinations of intervention components, and data will be collected from students at baseline; after the 3-month intervention; and after a subsequent 3-month follow-up period. My aims are linked to training objectives that will advance my conceptual knowledge and skills in obesity research, the design of adolescent obesity prevention interventions, and MOST. This research will provide preliminary results to inform a future trial testing a multicomponent adolescent obesity prevention intervention for girls in urban Kenya. My mentoring team has expertise in the design of adolescent obesity prevention interventions, global obesity research, and the design and analysis of MOST and factorial trials, as well as extensive experience mentoring early career investigators. This research will generate novel insights into the design of school-based adolescent obesity prevention interventions in urban LMIC settings. The K01 will help me achieve my long-term career goal of becoming a leader in adolescent obesity prevention intervention research. With the support from this award, I will transition from conducting intervention research focused on undernutrition to creating an independent research program that is building the evidence base for effective obesity prevention interventions. The proposed mentorship, training, and research activities will generate data needed to develop a competitive R01 application to identify effective obesity prevention interventions for adolescent girls in urban areas.