Obesity is a pervasive public health problem, yet most effective weight loss treatments have been in-person Intensive Lifestyle Interventions (INLIs) that are too costly and burdensome to scale. Recently though, an important comparative effectiveness trial conducted by our consultant, Lawrence Appel demonstrated that a technology-supported weight loss INLI that delivered lessons via the web and coaching via telephone could be as effective as in-person treatment. Those findings suggest that it may be feasible to develop more resource- efficient obesity treatment than was previously believed possible. We propose to apply an innovative methodological framework, the Multiphase Optimization Strategy (MOST) 14, to improve a remotely delivered, technology-supported intensive lifestyle intervention for obesity. Unlike nearly all previous research which treats INLI as a bundled """"""""treatment package,"""""""" MOST implements efficient experimentation on individual intervention components to determine which could be reduced, eliminated, or replaced to improve efficiency. This information then guides assembly of an optimal, comprehensive treatment package that, when combined with a core intervention (CORE), achieves target outcomes with least resource consumption and participant burden. The proposed experiment quantifies the effects of five experimental treatment components on 6 month weight loss among 560 adults. The components are: 1. Number of coaching calls [24 or 12];2. Text Message support [yes or no];3. Primary Care Provider (PCP) contact [yes or no];4. Buddy training [yes or no];5. Meal replacements recommended [yes or no]). The five components were selected to foster adherence to obesity treatment by acting upon social cognitive mediators of behavior change that are posited by social-cognitive theory (self-efficacy, self-regulation, supportive accountability, facilitation). Findings will be applied to build a new Opt-IN intervention made up of only active components and implementable for $500 or less. Because such an intervention will be both effective and scalable, it will enjoy greatly increased reach and make significant progress in the fight against obesity.

Public Health Relevance

Recent findings suggest that it may be possible to make obesity treatment more efficient and less burdensome by using technology and coaching people remotely. The Opt-IN study applies a new research method to test which treatment components can be reduced, eliminated, or replaced to minimize consumer burden and resource utilization, while still achieving weight loss. .

National Institute of Health (NIH)
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Research Project (R01)
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Psychosocial Risk and Disease Prevention Study Section (PRDP)
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Hunter, Christine
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Northwestern University at Chicago
Public Health & Prev Medicine
Schools of Medicine
United States
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Nahum-Shani, Inbal; Smith, Shawna N; Spring, Bonnie J et al. (2018) Just-in-Time Adaptive Interventions (JITAIs) in Mobile Health: Key Components and Design Principles for Ongoing Health Behavior Support. Ann Behav Med 52:446-462
Nahum-Shani, Inbal; Dziak, John J; Collins, Linda M (2018) Multilevel factorial designs with experiment-induced clustering. Psychol Methods 23:458-479
Pellegrini, Christine A; Conroy, David E; Phillips, Siobhan M et al. (2018) Daily and Seasonal Influences on Dietary Self-monitoring Using a Smartphone Application. J Nutr Educ Behav 50:56-61.e1
Welch, Whitney A; Spring, Bonnie; Phillips, Siobhan M et al. (2018) Moderating Effects of Weather-Related Factors on a Physical Activity Intervention. Am J Prev Med 54:e83-e89
Piper, Megan E; Cook, Jessica W; Schlam, Tanya R et al. (2018) A Randomized Controlled Trial of an Optimized Smoking Treatment Delivered in Primary Care. Ann Behav Med 52:854-864
Baker, Timothy B; Smith, Stevens S; Bolt, Daniel M et al. (2017) Implementing Clinical Research Using Factorial Designs: A Primer. Behav Ther 48:567-580
Spring, Bonnie; Pellegrini, Christine A; Pfammatter, Angela et al. (2017) Effects of an abbreviated obesity intervention supported by mobile technology: The ENGAGED randomized clinical trial. Obesity (Silver Spring) 25:1191-1198
Spring, Bonnie; Pfammatter, Angela; Alshurafa, Nabil (2017) First Steps Into the Brave New Transdiscipline of Mobile Health. JAMA Cardiol 2:76-78
Piper, Megan E; Cook, Jessica W; Schlam, Tanya R et al. (2017) Toward precision smoking cessation treatment II: Proximal effects of smoking cessation intervention components on putative mechanisms of action. Drug Alcohol Depend 171:50-58
Piper, Megan E; Schlam, Tanya R; Cook, Jessica W et al. (2017) Toward precision smoking cessation treatment I: Moderator results from a factorial experiment. Drug Alcohol Depend 171:59-65

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