Improving sleep as a method for enhancing decision-making and reducing problematic eating behaviors in adolescents with obesity

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.