A low-burden, self-weighing intervention to prevent weight gain in adults with obesity who do not enroll in comprehensive treatment.

Background: For individuals who are eligible but unlikely to join comprehensive weight loss programs, a low burden self-weighing intervention may be a more acceptable approach to weight management. Methods: This was a single-arm feasibility trial of a 12-month self-weighing intervention. Participants were healthcare patients with a BMI ≥25 kg/m2 with a weight-related comorbidity or a BMI >30 kg/m2 who reported lack of interest in joining a comprehensive weight loss program, or did not enroll in a comprehensive program after being provided program information. In the self-weighing intervention, participants were asked to weigh themselves daily on a cellular connected scale and were sent text messages every other week with tailored weight change feedback, including messages encouraging use of comprehensive programs if weight gain occurred. Results: Of 86 eligible patients, 39 enrolled (45.3%) in the self-weighing intervention. Self-weighing occurred on average 4.6 days/week (SD = 1.4). At 12 months, 12 participants (30.8%) lost ≥3% baseline weight, 11 (28.2%) experienced weight stability (±3% baseline), 6 (15.4%) gained ≥3% of baseline weight, and 10 (25.6%) did not have available weight data to evaluate. Three participants reported joining a weight loss program during the intervention (7.7%). Participants reported high intervention satisfaction in quantitative ratings (4.1 of 5), and qualitative interviews identified areas of satisfaction (e.g., timing and content of text messages) and areas for improvement (e.g., increasing personalization of text messages). Conclusion: A low-burden self-weighing intervention can reach adults with overweight/obesity who would be unlikely to engage in comprehensive weight loss programs; the efficacy of this intervention for preventing weight gain should be further evaluated in a randomized trial.

Exploring potential reach and representativeness of a self-weighing weight gain prevention intervention in adults with overweight and obesity.

Most adults with obesity do not enrol in comprehensive weight loss interventions when offered. For these individuals, lower burden self-weighing interventions may offer an acceptable alternative, though data is lacking on the potential for reach and representativeness of such interventions. Health system patients with BMI ≥30 kg/m2 (or 25-30 kg/m2 with an obesity comorbidity) completed a general health survey. During the survey, patients were given information about comprehensive weight loss interventions. If they denied interest or did not enrol in a comprehensive intervention, they were offered enrolment in a low-burden weight gain prevention intervention focused on daily self-weighing using a cellular network-connected in-home scale without any dietary or physical activity prescriptions. Enrolment in this program was documented. Among patients offered the self-weighing intervention (n = 85; 55.3% men; 58.8% White; BMI = 34.2 kg/m2), 44.2% enrolled. Compared to those who did not enrol, enrollers had higher educational attainment (57.1% vs. 42.9% with bachelor's degree p = .02), social anxiety (5.8 vs. 2.8, p < .001), and perceptions of the effectiveness of the self-weighing intervention (25.8 vs. 20.9 on 35, p = .007). The most highly endorsed reason for not enrolling in the self-weighing intervention was that it would make individuals overly focused on weight. A low-intensity weight gain prevention intervention may serve as a viable alternative to comprehensive weight loss interventions for the substantial portion of patients who are at risk for continued weight gain but would otherwise not enrol in a comprehensive intervention. Differential enrolment by education, however, suggests potential for inequitable uptake.

Parental Factors Associated With Intentions to Initiate a Family-Based Pediatric Weight Management Program.

Background: Childhood obesity can be addressed through family-based pediatric weight management; however, treatment enrollment in the United States is low. This study aimed to identify parental factors associated with intentions to initiate a family-based pediatric weight management program. Methods: Cross-sectional survey data were collected from an online panel of US parents with at least one 5- to 11-year-old child identified as likely to have overweight or obesity. Participants viewed a video about a hypothetical family-based pediatric weight management program, rated their 30-day initiation intentions for that program, and answered additional related questionnaires. Results: Participants (n = 158) identified as White/Caucasian (53%) or Black/African American (47%), were primarily female (61.4%) and married/cohabitating (81.6%) with children who were predominantly girls (53.2%) and, on average, 9-year-olds. Higher parents' perception of program effectiveness predicted initiation intentions (p < 0.001), while concern for their child's weight and parent depression and anxiety levels did not. Higher initiation intentions and perceived program effectiveness were reported by Black/African American participants (p < 0.01) and those with at least a bachelor's degree (p < 0.01) compared to White/Caucasian participants and those without a bachelor's degree, respectively. Initiation intentions were higher for those with greater financial security (p = 0.020) and fewer than three children in the home (p = 0.026). Participants endorsed initiation barriers of time constraints (25%), possible lack of enjoyment for the child (16.9%), and lack of family support (15%). Conclusions: Future program enrollment efforts may need to focus on strategies to increase perceived program effectiveness, although further research is needed that measures actual enrollment in real-world contexts.

The Determinants of Food Insecurity Among Hispanic/Latinx Households With Young Children: A Narrative Review.

Food insecurity has disproportionately impacted Hispanic/Latinx households in the United States, specifically those with young children. Although the literature provides evidence of an association between food insecurity and adverse health outcomes in young children, minimal research has addressed the social determinants and related risk factors associated with food insecurity among Hispanic/Latinx households with children under three, a highly vulnerable population. Using the Socio-Ecological Model (SEM) as a framework, this narrative review identified factors associated with food insecurity among Hispanic/Latinx households with children under three. A literature search was conducted using PubMed and four additional search engines. Inclusion criteria consisted of articles published in English from November 1996 to May 2022 that examined food insecurity among Hispanic/Latinx households with children under three. Articles were excluded if conducted in settings other than the US and/or focused on refugees and temporary migrant workers. Data were extracted (i.e., objective, setting, population, study design, measures of food insecurity, results) from the final articles (n = 27). The strength of each article's evidence was also evaluated. Results identified individual factors (i.e., intergenerational poverty, education, acculturation, language, etc.), interpersonal factors (i.e., household composition, social support, cultural customs), organizational factors (i.e., interagency collaboration, organizational rules), community factors (i.e., food environment, stigma, etc.), and public policy/societal factors (i.e., nutrition assistance programs, benefit cliffs, etc.) associated with a food security status of this population. Overall, most articles were classified as "medium" or higher quality for the strength of evidence, and more frequently focused on individual or policy factors. Findings indicate the need for more research to include a focus on public policy/society factors, as well as on multiple levels of the SEM with considerations of how individual and policy levels intersect and to create or adapt nutrition-related and culturally appropriate interventions to improve food security of Hispanic/Latinx households with young children.

Pre-Enrollment Steps and Run-Ins in Weight Loss Trials: A Meta-Regression.

INTRODUCTION: The generalizability of study findings may be influenced by pre-enrollment trial procedures, including the use of behavioral run-in periods. The study goals were to determine whether behavioral run-in periods and other pre-enrollment processes affect outcomes in randomized trials of behavioral weight loss interventions that have contributed to clinical guidelines. METHODS: The sample was behavioral weight loss intervention trials included in the 2018 U.S. Preventive Services Task Force systematic review. Information on pre-enrollment processes (total steps, in-person steps, behavioral run-in) was abstracted, and meta-regressions were conducted in 2022 to test whether pre-enrollment processes were associated with weight loss at 6 or 12 months and trial retention at 12 months. RESULTS: Across 80 trials, the median number of total pre-enrollment steps was 2 (range=1-5), and that of in-person pre-enrollment steps was 1 (range=0-4). Almost one-third of the trials (k=24; 30%) used a behavioral run-in. The most common run-in tasks were self-monitoring physical activity (k=9) or both physical activity and diet (k=6). Greater weight loss was observed in trials with behavioral run-ins at 6 months (-2.33 kg; 95% CI= -3.72, -0.93) and, to an attenuated extent, at 12 months (-0.86 kg; 95% CI= -1.72, 0.01) compared to those without run-ins. The total number of pre-enrollment steps was also associated with greater 6-month weight loss (-0.85 kg; 95% CI= -1.59, -0.11). Higher retention was associated with total number of pre-enrollment steps and in-person steps and marginally with the presence of run-ins. DISCUSSION: The use of more pre-enrollment processes is associated with greater weight loss in behavioral weight loss trials and may impact the generalizability of outcomes.

Behavior change techniques in digital physical activity interventions for breast cancer survivors: a systematic review.

Given the broad benefits of physical activity (PA) but low PA levels among breast cancer survivors (i.e., women who have received a breast cancer diagnosis), innovative and evidence-based techniques are needed to motivate and support exercise. This study systematically reviews the use of behavior change techniques (BCTs) in digital PA interventions for breast cancer survivors. Studies were retrieved from five electronic databases and were included if they (i) sampled exclusively female breast cancer survivors aged >18 years, (ii) involved a digital intervention with the primary purpose of increasing PA, (iii) included a BCT component, (iv) used a randomized or quasi-randomized design, and (v) were published from January 2000 to May 2022. Two coders independently extracted data. Twenty primary studies met the inclusion criteria and were included in this review. All interventions used at least one BCT (mean 4 ± 1, range 2-13); self-monitoring (85%) and goal setting (79%) were the most common BCTs. Twelve of 20 (60%) studies reported improvements in PA behavior in the intervention vs. control group, and self-monitoring and goal setting were the most commonly used BCTs in these studies. Of the 93 total BCTs, 66 were not used in any interventions in the review, including critical constructs for PA behavior change (e.g., biofeedback). BCTs, important facilitators of PA behavior change, are being underutilized in digital PA interventions for breast cancer survivors. Future research should incorporate more diverse BCTs to explore if they can add to the effectiveness of digital interventions for this population.

Physical activity (PA) has many benefits, yet PA levels are low among breast cancer survivors (i.e., women who have received a breast cancer diagnosis). This study reviews the use of behavior change techniques (BCTs) in digital PA interventions for breast cancer survivors. BCTs are evidence-based and are important for encouraging changes in health behaviors, such as PA. Twenty studies were included in this review. All interventions used at least one BCT (mean 4 ± 1, range 2­13); self-monitoring (85%) and goal setting (79%) were the most common BCTs. Twelve of 20 (60%) studies reported improvements in PA, and self-monitoring and goal setting were the most commonly used BCTs in these studies. Of the 93 total BCTs, 66 were not used in any interventions in the review. This finding reveals that many BCTs, which are important influencers of behavior change, are often not being used in digital PA interventions for breast cancer survivors. BCTs such as biofeedback (e.g., providing information on heart rate during exercise) and practical social support (e.g., virtual exercise coaching), could be helpful. Future research should include more diverse BCTs to explore if they can add to the usefulness of digital interventions for this population.

Nudges and choice architecture to promote healthy food purchases in adults: A systematized review.

OBJECTIVE: Consistent with behavioral economic models that emphasize the context-dependance of behavioral choice, choice architecture strategies change the environmental context to promote or nudge healthier choices including the healthfulness of food purchases that may help reduce disease and premature death. This review summarizes research that investigated nudging interventions to promote healthful food purchase choices among adults. METHOD: A comprehensive systematized search strategy identified research published since 2009 that investigated the role of nudges and choice architecture interventions on adult food purchasing decisions with behavioral outcomes. Study data were extracted and summarized regarding nudge characteristics, design features, study quality, and food purchasing outcomes. RESULTS: The search identified 1,129 articles, 33 of which met inclusion criteria. Twelve studies were rated as high quality, 21 as neutral, and none as low quality. Some evidence of effectiveness was found for priming nudges that manipulated physical, verbal, or sensational cues to promote healthy choices (8 of 11 studies); salience and affect nudges that used novel or personally relevant cues to direct attention to healthy choices (3/3); messenger nudges that presented information on socially normative food choices (2/2), and default nudges that made healthy options the preset choice (1/2). In studies that combined nudge types, combining priming and salience and affect nudges was at least partially effective in 5 of 5 studies. CONCLUSIONS: Nudge applications in food purchasing settings, particularly priming, offers a promising public health strategy to encourage healthier food choices among adults. More research is needed to determine optimal nudge combinations and contexts. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Privacy Concerns in Group Format Lifestyle Interventions for Obesity.

BACKGROUND: Group format weight loss interventions have benefits over individual format, but privacy concerns may limit their uptake. METHOD: In this study, adults with obesity and interest in losing weight were recruited nationally online and randomly assigned to view one of eight videos describing a hypothetical, group behavioral weight loss intervention. Based on three fully crossed factors, the videos varied on privacy features of intervention (present or not); matching participants to group based on weight loss barriers (matched or not); and intervention format (online or in-person). Participants rated their willingness to join, privacy concerns, and perceived effectiveness of these interventions. They further reported preference for individual or group format interventions and reason for preferences. RESULTS: Description of privacy features, matching of participants, and format did not affect willingness to join, privacy concerns, or perceived effectiveness of the intervention. Privacy concerns were associated with lower willingness to join and lower perceived intervention effectiveness, and greater social anxiety and weight stigma. More participants preferred individual over group format (40.1% vs 33.9%; 26% selected neither) and preference for individual format was associated with greater privacy concerns. CONCLUSION: Strategies to address privacy concerns in group-based interventions warrant further attention.

Engaging primary care patients with existing online tools for weight loss: A pilot trial.

Objective: Free online tools show potential for promoting weight loss at a low cost, but there is limited evidence about how to effectively engage patients with them. To address this, a low-dose, flexible intervention was developed that aims to enhance weight-related discussions with primary care providers (PCPs) and engage patients with an organic (i.e., not researcher-created) weight loss-focused social media community and online self-monitoring tool. Feasibility and acceptability of the intervention was evaluated in a single-arm, 12-week pilot. Methods: PCPs were recruited at two clinics, then PCP's patients with upcoming appointments were identified and recruited. Patients received an interactive online kickoff before their scheduled primary care appointment, then 8 follow-up messages over 12 weeks via email or their electronic health record patient portal. Patients completed assessments at baseline, post-appointment, and week 12. Primary care providers and patients completed semi-structured interviews. Results: All PCPs approached enrolled (n = 6); patient recruitment was on track to meet the study goal prior to COVID-19 restrictions, and n = 27 patients enrolled. Patient satisfaction with the pre-appointment kickoff was high. Twenty-four patients reported discussing weight-related topics at their primary care appointment and all were satisfied with the discussion. Twenty-two patients completed 12-week assessments. Of these, 15 reported engaging with the self-monitoring tool and 9 with the social media community. Patient interviews revealed reasons for low social media community engagement, including perceived lack of fit. On average, patients with available data (n = 21) lost 2.4 ± 4.1% of baseline weight, and 28.6% of these patients lost ≥3% of baseline weight. Primary care providers reported high intervention satisfaction. Conclusions: The intervention and trial design show potential, although additional strategies are needed to promote tool engagement.

Engaging adults with obesity in organic online communities to support weight loss: a mixed methods pilot study.

OBJECTIVES: Organic online communities have shown potential for aiding weight loss, but few adults use them. We sought to test strategies to encourage adults to select and engage in online communities for weight loss. DESIGN: 4-week single-arm, mixed-methods pilot. MAIN OUTCOME MEASURES: Quantitative and qualitative data on selection of online community, engagement with community, and engagement and satisfaction with tasks. RESULTS: On average, participants (n = 25) were female (80.0%) and white (68.0%), 45.2 ± 18.1 years old, with a BMI of 36.2 ± 6.5 kg/m2. Selection of online community varied across participants (13 MyFitnessPal, 5 Facebook, 5 Reddit). In qualitative analyses, reasons for selection included experience with community, privacy considerations, and seeking people similar to them. Most tasks were fully or partially completed by a majority of participants (>80.0%). For most tasks, ∼50% of participants felt the task helped them with weight loss support. Variability in response was observed, especially between tasks that requested reading compared to posting/commenting in the community. Frequent reading of community content throughout the study was reported by >70.0% of participants, though posting/commenting was less frequent. Barriers to further engagement included concerns about privacy, judgement, and misinformation. CONCLUSIONS: This study provides insights about strategies for engaging individuals in online health communities.

Volunteer-Based Social Support Structures and Program Exposure Outcomes in an Adolescent Young Adult Palliative Care Peer Support Program.

Objective: To conduct a social network analysis (SNA) of patient-volunteer networks and assess the impact of patient characteristics on network measures. Background: Volunteers play a critical role in providing peer support to adolescent and young adult (AYA) palliative care patients. Streetlight at UF Health is a peer support palliative care program for hospitalized AYAs that aims at forming positive peer relationships through volunteer visits, events, and a virtual online health community. Methods: Data were collected on patient characteristics, hospitalizations, average length of stays (LOS), and volunteer visitation records. Egocentric SNAs were conducted on each patient to calculate network outcomes. Study participants were AYA patients (N = 69), enrolled in the US-based Streetlight program at UF Health Shands Hospital. Results: The LOS was significantly associated with network size (B = 0.583; 95% confidence interval; CI [0.463 to 0.702]). Autoimmune patients had smaller network sizes when controlling for LOS. Total hospital admissions predicted - 0.172 ([- 0.263 to - 0.080]) lower average repeat visits. Higher average repeat visits were predicted for patients who had cancer (B = 0.246 [0.046 to 0.447]) and awaiting organ transplantation (B = 0.370 [0.082 to 0.658]). Although cystic fibrosis patients received more visits (B = 0.364 [0.003 to 0.724]) compared with other illness populations, the network density was lower (B = - 0.580 [1.01 to - 0.155]). Cancer patients had networks with a higher diversity in volunteer repeat visits (B = 0.714 [0.312 to 0.920]). Conclusions: Significant relationships between patient characteristics and network outcomes highlight the differences in social support service delivery among diverse populations. These analyses can be utilized in practice to guide program delivery for high-need patients.

Transparent reporting of hypotheses and analyses in behavioral medicine research: An audit of publications in 2018 and 2008.

OBJECTIVE: We aimed to document the use of transparent reporting of hypotheses and analyses in behavioral medicine journals in 2018 and 2008. DESIGN: We examined a randomly selected portion of articles published in 2018 and 2008 by behavioral medicine journals with the highest impact factor, excluding manuscripts that were reviews or purely descriptive. MAIN OUTCOME MEASURES: We coded whether articles explicitly stated if the hypotheses/outcomes/analyses were primary or secondary; if study was registered/pre-registered; if "exploratory" or a related term was used to describe analyses/aims; and if power analyses were reported. RESULTS: We coded 162 manuscripts published in 2018 (87% observational and 12% experimental). Sixteen percent were explicit in describing hypotheses/outcomes/analyses as primary or secondary, 51% appeared to report secondary hypotheses/outcomes/analyses but did not use term "secondary," and 33% were unclear. Registration occurred in 14% of studies, but 91% did not report which analyses were registered. "Exploratory" or related term was used in 31% of studies. Power analyses were reported in 8% of studies. Compared to 2008 (n=120), studies published in 2018 were more likely to be registered and less likely to have explicitly stated if outcomes were primary or secondary. CONCLUSIONS: Behavioral medicine stakeholders should consider strategies to increase clarity of reporting, and particularly details that will inform readers if analyses were pre-planned or post-hoc.

A web-based intervention to increase weight loss treatment initiation: results of a cluster randomized feasibility and acceptability trial.

Evidence-based behavioral weight loss treatment is under-utilized. To increase initiation of treatment, we developed a single-session, online, primary care-based intervention ("mobilization tool"). We evaluated the mobilization tool's acceptability for primary care patients with obesity, trial design feasibility, and signal of an effect of the tool on treatment initiation. In this cluster randomized feasibility trial, primary care providers (PCPs) were randomized to a mobilization tool or comparator tool arm. Patients with obesity and a scheduled appointment with a randomized PCP were assigned to complete the mobilization or comparator tool prior to their appointment. The online mobilization tool asks patients to answer questions about a variety of weight-related topics and then provides automated, tailored feedback that addresses psychosocial determinants of weight loss treatment initiation. The comparator tool provided a nontailored description of treatments. All participants were offered free enrollment in behavioral weight loss treatments. Six PCPs were randomized. Sixty patients (57% female; 66% white; aged 55 ± 13 years) participated in this study of 296 contacted for eligibility evaluation (20.2%). Six-month follow-up assessments were completed by 65% (22/34) of the mobilization and 73% (19/26) of comparator tool participants. Participants completing the acceptability survey reported that the mobilization tool was usable, enjoyable, informative, and useful. Weight loss treatment was initiated by 59% (n = 19) of mobilization and 33% (n = 8) of comparator tool participants. The mobilization tool shows promise for increasing treatment initiation among primary care patients, which may increase population weight loss. Trial Registration: Clinicaltrials.gov identifier: NCT02708121.

A randomized feasibility pilot trial of a financial incentives intervention for dietary self-monitoring and weight loss in adults with obesity.

Financial incentives could be used to improve adherence to behavioral weight loss interventions, increasing their effectiveness. This Phase IIb randomized pilot study evaluated the feasibility and acceptability of a study protocol for providing financial incentives for dietary self-monitoring and/or weight loss. Community-dwelling adults with obesity were enrolled in a 24 week, group-based weight loss program. Participants were randomized in a 2 × 2 factorial design to receive financial incentives for both dietary self-monitoring and weekly weight loss, just one, or neither. Participants could earn up to $300, evolving from fixed weekly payments to intermittent, variable payments. The notice of reward was provided by text message. The study was conducted in three successive cohorts to evaluate study procedure changes, including dietary approach, recruitment and retention strategies, text messaging, and incentives. Descriptive statistics calculated separately for each cohort described study performance relative to predefined targets for recruitment, including minority representation; retention; adherence; and weight loss. Acceptability was assessed via postintervention qualitative interviews. In Cohort 1 (n = 34), a low-carbohydrate diet was used. Recruitment, retention, adherence, and weight loss were adequate, but minority representation was not. For Cohort 2 (n = 31), employing an additional recruitment method and switching to a reduced-calorie diet yielded adequate recruitment, minority representation, retention, and adherence but less weight loss. Returning to a low-carbohydrate diet in Cohort 3 (n = 28) yielded recruitment, minority representation, retention, adherence, and weight loss similar to Cohort 2. Participant feedback informed changes to text message timing and content and incentive amount. Through successive cohorts, we optimized recruitment and retention strategies and text messaging. An adequately powered trial is warranted to evaluate the efficacy of these incentive structures for reducing weight. The trial registration number is NCT02691260.

Using the Design Sprint process to enhance and accelerate behavioral medicine progress: a case study and guidance.

While challenges in the translation of behavioral medicine knowledge from academic settings to real-world use are well documented, they could potentially be reduced through the use of the Design Sprint process, a roadmap that facilitates progression from an idea to a product in 5 days via agile design and user-centered design principles. The Design Sprint is well aligned with several priorities of and methods common in behavioral medicine, including obtaining end-user feedback and thinking about implementation during intervention development. The Design Sprint could be used by behavioral medicine researchers for the development of research tools, implementation strategies, and behavior change interventions. The process may encourage creative and focused thinking, speed product development, and facilitate early user input. However, translating the Design Sprint to behavioral medicine research may present challenges, such as difficulty getting buy-in from team members, inconsistencies between the Design Sprint timeline, the need to obtain institutional review board approval for user testing, and the lack of traditional research processes (e.g., incorporating scientific research into intervention design). Several solutions and adaptations are possible to overcome these challenges while still maintaining the core features of the Design Sprint process. To demonstrate the use of the Design Sprint and potential adaptations, we present a case study of the development of a patient-facing digital tool for weight management and an accompanying implementation strategy. In conclusion, the Design Sprint offers behavioral medicine researchers an approach to developing new products with numerous potential benefits to researchers and to the individuals and communities we seek to impact.

Effects of Intervention Characteristics on Willingness to Initiate a Weight Gain Prevention Program.

PURPOSE: To determine characteristics of weight gain prevention programs that facilitate engagement. DESIGN: Randomized factorial experiment (5 × 2). SETTING: Recruited nationally online. PARTICIPANTS: Adults aged 18 to 75 with body mass index ≥25 who decline a behavioral weight loss intervention (n = 498). MEASURES: Participants were randomly presented with one of 10 possible descriptions of hypothetical, free weight gain prevention programs that were all low dose and technology-based but differed in regard to 5 behavior change targets (self-weighing only; diet only; physical activity only; combined diet, physical activity, and self-weighing; or choice between diet, physical activity, and self-weighing targets) crossed with 2 financial incentive conditions (presence or absence of incentives for self-monitoring). Participants reported willingness to join the programs, perceived program effectiveness, and reasons for declining enrollment. ANALYSIS: Logistic regression and linear regression to test effects of program characteristics offered on willingness to initiate programs and programs' perceived effectiveness, respectively. Content analyses for open-ended text responses. RESULTS: Participants offered the self-weighing-only programs were more willing to initiate than those offered the programs targeting all 3 behaviors combined (50% vs 36%; odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.01-3.13). Participants offered the programs with financial incentives were more willing to initiate (50% vs 33%; OR = 2.08; 95% CI, 1.44-2.99) and anticipated greater intervention effectiveness (ß = .34, P = .02) than those offered no financial incentives. Reasons for declining to initiate included specific program features, behavior targets, social aspects, and benefits. CONCLUSION: Targeting self-weighing and providing financial incentives for self-monitoring may result in greater uptake of weight gain prevention programs. STUDY PREREGISTRATION: https://osf.io/b9zfh, June 19, 2018.

Early-phase study of a telephone-based intervention to reduce weight regain among bariatric surgery patients.

OBJECTIVE: This study describes early-phase development of a behavioral intervention to reduce weight regain following bariatric surgery. We utilized the Obesity-Related Behavioral Intervention Trials model to guide intervention development and evaluation. We sought to establish recruitment, retention, and fidelity monitoring procedures; evaluate feasibility of utilizing weight from the electronic medical record (EMR) as an outcome; observe improvement in behavioral risk factors; and evaluate treatment acceptability. METHOD: The intervention comprised 4 weekly telephone calls addressing behavior change strategies for diet, physical activity, and nutrition supplement adherence and 5 biweekly calls addressing weight loss maintenance constructs. Veterans (N = 33) who received bariatric surgery 9-15 months prior consented to a 16-week, pre-post study. Self-reported outcomes were obtained by telephone at baseline and 16 weeks. Clinic weights were obtained from the EMR 6 months pre- and postconsent. Qualitative interviews were conducted at 16 weeks to evaluate treatment acceptability. We aimed to achieve a recruitment rate of ≥ 25% and retention rate of ≥ 80%, and have ≥ 50% of participants regain < 3% of their baseline weight. RESULTS: Results supported the feasibility of recruiting (48%) and retaining participants (93% provided survey data; 100% had EMR weight). Pre-post changes in weight (73% with < 3% weight regain) and physical activity (Cohen's ds 0.38 to 0.52) supported the potential for the intervention to yield clinically significant results. Intervention adherence (mean 7.8 calls of 9 received) and positive feedback from interviews supported treatment acceptability. CONCLUSIONS: The intervention should be evaluated in an adequately powered randomized controlled trial. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Dose-response research in digital health interventions: Concepts, considerations, and challenges.

To optimize digital health interventions, intervention creators must determine what intervention dose will produce the most substantial health behavior change-the dose-response relationship-while minimizing harms or burden. In this article we present important concepts, considerations, and challenges in studying dose-response relationships in digital health interventions. We propose that interventions make three types of prescriptions: (1) intervention action prescriptions, prescriptions to receive content from the intervention, such as to read text or listen to audio; (2) participant action prescriptions, prescriptions to produce and provide content to the intervention, such as to send text messages or post intervention-requested photos on social media; and (3) behavioral target action prescriptions, prescriptions to engage in behaviors outside the intervention, such as changing food intake or meditating. Each type of prescription has both an intended dose (i.e., what the intervention actually prescribes) and an enacted dose (i.e., what portion of the intended dose is actually completed by the participant). Dose parameters of duration, frequency, and amount can be applied to each prescription type. We consider adaptive interventions and interventions with ad libitum prescriptions as examples of tailored doses. Researchers can experimentally manipulate the intended dose to determine the dose-response relationship. The enacted dose cannot be directly manipulated; however, we consider the applicability of "controlled concentration" research design to the study of enacted dose. We consider challenges in dose-response research in digital health interventions, including characterizing amount with self-paced activities and combining doses across modality. The presented concepts and considerations may help contribute to the optimization of digital health interventions. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Provider Counseling and Weight Loss Outcomes in a Primary Care-Based Digital Obesity Treatment.

BACKGROUND: Primary care-based digital health weight loss interventions offer promise for addressing obesity in underserved populations. OBJECTIVES: To determine if primary care providers' weight counseling is associated with weight change during a weight loss intervention. DESIGN: This is a secondary analysis of a randomized clinical trial testing a 12-month primary care-based digital health weight loss intervention. PARTICIPANTS: Participants were community health center patients with body mass indexes of 30-44.9 kg/m2. INTERVENTIONS: The weight loss intervention included tailored behavioral goal setting; weekly goal monitoring via text messaging or interactive voice response calls; counseling calls; skills training material; and participant-tailored recommendations for provider counseling. MAIN MEASURES: At 6 and 12 months, participants' weight was measured and they reported if their provider delivered weight counseling (general or intervention-specific) at their most recent visit and their perception of providers' empathy. Providers' documentation of weight counseling was extracted from health records. KEY RESULTS: Participants (n = 134-141) were predominantly female (70%) and African American (55%) with a mean age of 51 years and BMI of 36 kg/m2. Participant-reported provider weight counseling was not associated with weight change. However, participants whose providers documented intervention-specific counseling at any point during the intervention (n = 35) lost 3.1 kg (95% CI 0.4 to 5.7 kg) more than those whose providers documented only general weight counseling (n = 82) and 4.0 kg (95% CI 0.1 to 7.9 kg) more than those whose providers did not document weight counseling (n = 17). Perceptions of provider empathy were associated with greater weight loss from 6 to 12 months (0.8 kg per measure unit, 95% CI 0.07 to 1.5 kg, p = .03). CONCLUSIONS: Provider counseling that focuses specifically on engagement in a weight loss intervention may enhance weight loss outcomes relative to more general weight loss advice. Counseling that enhances patients' perceptions of empathy may be most beneficial for patients' weight loss. TRIAL REGISTRATION: NCT01827800.