Obesity in adolescents has reached epidemic proportions in the United States. As a chronic condition, adolescent obesity increases risk for type 2 diabetes, hypertension, hyperlipidemia, low self-esteem, and depression. Obese adolescents are at increased risk for poor health outcomes as they become adults.[27-29] One way to address adolescent obesity is with interventions that target their parents’ behaviors and attitudes. Weight loss in parents is positively associated with weight changes in their obese children and it is known that adolescents’ behaviors are strongly influenced by parental behaviors. There have been a few clinical interventions that addressed childhood obesity by targeting health behaviors of parents, and their results showed that interventions that target parents only are as effective as those that target parents and children together. However, to date, no interventions directed at reducing adolescent obesity by targeting parents have been implemented in real-world, community-based settings. Moreover, there has not been a thorough assessment of the underlying mechanisms of how changes in parental behaviors influence adolescents’ weight-related behaviors and health outcomes. Preexisting, ongoing community programs that address obesity in parents offer a rich environment for understanding the real world implications of clinical findings on the relationships among parental behaviors, family dynamics, and adolescent health. The long term goal of PP2 is to develop effective interventions that reduce adolescent obesity through community-based programs. Blue Care Network of Michigan (BCN) (the largest health maintenance organization in Michigan), through its “Healthy Blue Living (HBL)” program, has incentivized, community-based weight-management programs. Weight Watchers, a popular traditional obesity management program, is one of the HBL weight-management programs for obese adults. We believe that Weight Watchers provides a valuable opportunity for assessing whether, or to what degree, parent participation and success in weight-management programs also affects the health of adolescent children living in the same household. A previous study of HBL showed that participation of obese adults lowered their cardiovascular risk factors, and lowered the rate of increase in their direct medical costs. However, no studies have examined the indirect effects on children of the adult participants within the context of the family. Approximately 84 obese parents and their adolescent children (aged 11 to 17 years) will be recruited from parents who are primary caregivers and who have decided to participate in Weight Watchers but have not yet started to participate. The specific aims of this study are to:

• Aim 1: Assess family functioning, parental behaviors, adolescent children behaviors, and body mass index (BMI)/waist circumference-to-height ratio (WCHt) of obese parents participating in Weight Watchers and their adolescent children at baseline; and compare the baselines with measures taken 3 months after enrollment.
• Hypothesis: There will be positive changes (e.g., improved physical activity and diet) between baseline and post-3 months in Weight Watchers participants.
• Aim 2: Assess whether changes in family dynamics mediate the effect of changes in parental behaviors on changes in adolescent behaviors and BMI/WCHt.
• Hypothesis: Parental behaviors are positively associated with changes in family dynamics which are in turn accompanied by positive changes in adolescent behaviors and BMI/WCHt.
• Aim 3: Assess the parents’ perception of the utility and influence of Weight Watchers intervention on family dynamics and parental behaviors by conducting structured qualitative interviews with parents at post-3 months.

We expect that results from this, mixed-methods study will contribute to our understanding whether existing parent-oriented weight management programs can improve the BMI/WCHt and behavior of adolescent children living in the family. Ultimately, we expect that successful completion of this research will (a) increase our understanding of how parental behaviors and family dynamics influence adolescent health and (b) provide data to guide a larger study of preexisting, high reach, and relatively low-cost programs to target adolescent obesity.