Table 2 DPP/GLB content by the socioecological model (SEM) and social cognitive theory (SCT) constructs, examples of adaptation for the TeenLYFT metabolic and bariatric surgery support intervention for adolescents

Observational learning

Intro to safe exercising; learning to read food labels; new nutrition intake

Share relatable stories & information about lifestyle change and challenges;

transformation weight loss stories

Community-based lifestyle programs; local events to prevent post-MBS weight regain; cooking classes: easy, affordable recipes

PCPs referrals to DPP; PCP involvement in pre-post MBS support

Reinforcement

Goal setting for sustained weight loss; healthy eating; exercise; create a healthy relationship with food

Supervised physical activity sessions; rewards for successful completion, and for adding more fruits and vegetables; incentives group session participation

Community-based DPPs; physical activity incentives (reduced gym fees); grocery discounts

Calorie and macro/micronutrient content skills; app to support exercise skills

Self-control

Self-monitoring of micro/macro nutrient content to prevent weight regain; regulating exercise habits

Active listening; life coach discussions; MBS team nutritionist; social support network; supporting exercise

Social/group DPP/GLB MBS support groups in community; weight wellness programs (WWP) and other networks

Food label mastery; restaurant menu calorie mastery; exercise mastery

Self-efficacy

Weekly goals

Family meal planning

Fitness classes

Restaurant menus

Knowledge

Evaluation of self-esteem/body image; motivation; weight & health goals; Health-related quality of life (HRQOL); Exercise goals

Communication; best practices; in diet, activity, sleep & tech (MyFitnessPal); benefits of support

Assessment of school, home, cyber, neighborhood resources for prolonged support

Crime/safety; food swamps; public transportation knowledge mastery

Skill building

Body acceptance; self-confidence, mindfulness; goal setting (to support weight loss retention);

Managing setbacks

Sleep hygiene tracking; food records; setting reminders; exercise tracking; social support strategies (group meetings)

Wellness resources at school & in the community; social support groups to overcome weight loss hurdles; use of social media support groups

Health/fitness trackers; walking maps; journaling; safety/healthy information use (e.g., Shopwell app)