Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes

Unick, Jessica L.; Pellegrini, Christine A.; Demos, Kathryn E.; Dorfman, Leah

doi:10.1007/s11892-017-0904-1

Cited by 44 publications

(62 citation statements)

References 35 publications

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“…In contrast, over 8 in 10 participants who did not respond early to treatment were unsuccessful in achieving 5% weight loss at 3 or 6 months. These findings illustrate the importance of early weight loss, which is consistent with past studies of behavioural interventions for weight loss (6)(7)(8). The GoalTracker trial is the first study to demonstrate this relation in the context of a standalone mHealth intervention, which holds promise as a less resource-intensive and more scalable initial intervention strategy in stepped-care approaches.…”

Section: Discussionsupporting

confidence: 85%

“…Consistent with previous behavioural weight loss research (6,12), participants were categorized into early responders (i.e. ≥2% weight loss at 1 month) and early nonresponders (i.e.…”

Section: Discussionmentioning

confidence: 99%

“…Because weight change did not differ between treatment arms at 1 or 3 months in the parent study , data were collapsed across arms in the current analysis. Consistent with previous behavioural weight loss research , participants were categorized into early responders (i.e. ≥2% weight loss at 1 month) and early non‐responders (i.e.…”

Section: Methodsmentioning

confidence: 99%

“…those without a counselling component) (3)(4)(5). Early weight loss is a robust predictor of clinically meaningful weight loss (6)(7)(8) and has been used as a trigger in stepped-care behavioural interventions to implement rescue efforts for individuals not responding early to obesity treatment (6,(9)(10)(11). A 12-week internet-based weight loss study found a strong positive relation of early weight loss at 1 month predicting weight loss at 3, 6 and 12 months (12).…”

Section: Introductionmentioning

confidence: 99%

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Early weight loss in a standalone mHealth intervention predicting treatment success

Patel

Hopkins

Bennett

2019

Obesity Science & Practice

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Summary Objective Early weight loss is a strong predictor of longer‐term and clinically meaningful weight loss but has not been studied in the context of mobile health (‘mHealth’) interventions. Methods GoalTracker was a randomized trial among adults (21–65 years) with overweight or obesity comparing three 12‐week standalone mHealth interventions for weight loss. All arms received a free commercial mobile app (MyFitnessPal) for daily self‐monitoring of diet and/or weight and a goal to lose 5% of weight by 3 months. Collapsing across arms, this analysis examined participants with a 1‐month weight ( n = 84), categorizing them as either early responders (≥2% weight loss at 1 month) or early non‐responders (<2% weight loss at 1 month). Results Early responders – 36% of participants – had greater per cent weight change at 3 months (−5.93% [95% confidence interval: −6.82%, −5.03%]) than early non‐responders (−1.45% [−2.15%, −0.75%]), which was sustained at 6 months (−5.91% [−7.33%, −4.48%] vs. −1.28% [−2.37%, −0.19%]; p s < 0.0001). Over half (57%) of early responders achieved ≥5% weight loss at 3 months vs. 11% of early non‐responders. At 4 weeks, self‐monitoring frequency (weight/diet) was significantly greater among early responders, which continued across 12 weeks. Conclusion Responding early to an mHealth treatment is associated with higher engagement and greater likelihood of achieving clinically meaningful weight loss.

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Section: Discussionsupporting

confidence: 85%

“…Consistent with previous behavioural weight loss research (6,12), participants were categorized into early responders (i.e. ≥2% weight loss at 1 month) and early nonresponders (i.e.…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Early weight loss in a standalone mHealth intervention predicting treatment success

Patel

Hopkins

Bennett

2019

Obesity Science & Practice

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“…Given that a previous study found that the provision of extra support to early non‐responders diminished the association between 4‐week and 12‐week weight loss, the provision of this extra support in Study 1 limits our ability to investigate the association between 4‐week and 12‐week weight losses. Nonetheless, prior work in this area indicates that 4‐week weight change consistently predicts weight change at 12 weeks and later time points when no extra support is provided . This design difference likely influenced the differences in 12‐week weight losses observed between studies and also prevented us from being able to examine the association between 4‐week survey questions and 12‐week weight loss across studies.…”

Section: Discussionmentioning

confidence: 98%

Factors associated with early non‐response within an Internet‐based behavioural weight loss program

Unick

Ross

Wing

2019

Obesity Science & Practice

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Summary Objective While behavioural weight loss interventions are effective overall, many individuals fail to achieve a clinically significant weight loss. Given that 4‐week weight loss has been shown to predict longer term outcomes, one potential strategy for improving rates of success is to provide additional support to early non‐responders. To inform these early rescue efforts, it is important to first identify how they may differ from their more successful peers. Methods At week 4 of a 12‐week Internet‐delivered weight loss program, 130 adults (age: 49.8 ± 9.8 years, body mass index: 31.2 ± 4.6 kg m −2 ) were asked to complete an 11‐item survey assessing mood and weight‐related cognitions and behaviours. Participants were then categorized as early non‐responders (4‐week weight loss <2%) or initial responders (4‐week weight loss ≥2%), and groups were compared on intervention adherence during weeks 1–4 and week 4 survey question responses. Results Early non‐responders and initial responders did not differ on any intervention adherence variables ( p s > 0.05). Compared to initial responders, early non‐responders reported less positive mood ( p = 0.011), greater boredom with weight loss efforts ( p = 0.036), greater temptation to eat foods not consistent with their goals ( p = 0.023), and that their eating choices were less consistent with their goals ( p < 0.001). Conclusions These findings identify important differences between early non‐responders and initial responders, offering potential intervention targets for rescuing early non‐responders (i.e. making it easier for individuals to choose healthier foods, reducing boredom in Internet‐delivered weight loss programs and providing strategies to limit exposure to dietary temptations).

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An Adaptive Behavioral Intervention for Weight Loss Management

Spring,

Pfammatter,

Scanlan

et al. 2024

JAMA

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ImportanceLifestyle interventions for weight loss are difficult to implement in clinical practice. Self-managed mobile health implementations without or with added support after unsuccessful weight loss attempts could offer effective population-level obesity management.ObjectiveTo test whether a wireless feedback system (WFS) yields noninferior weight loss vs WFS plus telephone coaching and whether participants who do not respond to initial treatment achieve greater weight loss with more vs less vigorous step-up interventions.Design, Setting, and ParticipantsIn this noninferiority randomized trial, 400 adults aged 18 to 60 years with a body mass index of 27 to 45 were randomized in a 1:1 ratio to undergo 3 months of treatment initially with WFS or WFS plus coaching at a US academic medical center between June 2017 and March 2021. Participants attaining suboptimal weight loss were rerandomized to undergo modest or vigorous step-up intervention.InterventionsThe WFS included a Wi-Fi activity tracker and scale transmitting data to a smartphone app to provide daily feedback on progress in lifestyle change and weight loss, and WFS plus coaching added 12 weekly 10- to 15-minute supportive coaching calls delivered by bachelor’s degree–level health promotionists viewing participants’ self-monitoring data on a dashboard; step-up interventions included supportive messaging via mobile device screen notifications (app-based screen alerts) without or with coaching or powdered meal replacement. Participants and staff were unblinded and outcome assessors were blinded to treatment randomization.Main Outcomes and MeasuresThe primary outcome was the between-group difference in 6-month weight change, with the noninferiority margin defined as a difference in weight change of −2.5 kg; secondary outcomes included between-group differences for all participants in weight change at 3 and 12 months and between-group 6-month weight change difference among nonresponders exposed to modest vs vigorous step-up interventions.ResultsAmong 400 participants (mean [SD] age, 40.5 [11.2] years; 305 [76.3%] women; 81 participants were Black and 266 were White; mean [SD] body mass index, 34.4 [4.3]) randomized to undergo WFS (n = 199) vs WFS plus coaching (n = 201), outcome data were available for 342 participants (85.5%) at 6 months. Six-month weight loss was −2.8 kg (95% CI, −3.5 to −2.0) for the WFS group and −4.8 kg (95% CI, −5.5 to −4.1) for participants in the WFS plus coaching group (difference in weight change, −2.0 kg [90% CI, −2.9 to –1.1]; P &lt; .001); the 90% CI included the noninferiority margin of −2.5 kg. Weight change differences were comparable at 3 and 12 months and, among nonresponders, at 6 months, with no difference by step-up therapy.Conclusions and RelevanceA wireless feedback system (Wi-Fi activity tracker and scale with smartphone app to provide daily feedback) was not noninferior to the same system with added coaching. Continued efforts are needed to identify strategies for weight loss management and to accurately select interventions for different individuals to achieve weight loss goals.Trial RegistrationClinicalTrials.gov Identifier: NCT02997943

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Initial Weight Loss Response as an Indicator for Providing Early Rescue Efforts to Improve Long-term Treatment Outcomes

Cited by 44 publications

References 35 publications

Early weight loss in a standalone mHealth intervention predicting treatment success

Early weight loss in a standalone mHealth intervention predicting treatment success

Factors associated with early non‐response within an Internet‐based behavioural weight loss program

An Adaptive Behavioral Intervention for Weight Loss Management

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