Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jan:100:106217.
doi: 10.1016/j.cct.2020.106217. Epub 2020 Nov 14.

Evaluation of intervention components to maximize outcomes of behavioral obesity treatment delivered online: A factorial experiment following the multiphase optimization strategy framework

J Graham Thomas  1 , Carly M Goldstein  2 , Dale S Bond  2 , Jason Lillis  2 , Eric B Hekler  3 , Jessica A Emerson  2 , Hallie M Espel-Huynh  2 , Stephanie P Goldstein  2 , Shira I Dunsiger  4 , E Whitney Evans  2 , Meghan L Butryn  5 , Jeff Huang  6 , Rena R Wing  2
Affiliations

Evaluation of intervention components to maximize outcomes of behavioral obesity treatment delivered online: A factorial experiment following the multiphase optimization strategy framework

J Graham Thomas et al. Contemp Clin Trials. 2021 Jan.

Abstract

Background: Behavioral lifestyle intervention (BLI) is recommended as a first-line treatment for obesity. While BLI has been adapted for online delivery to improve potential for dissemination while reducing costs and barriers to access, weight losses are typically inferior to gold standard treatment delivered in-person. It is therefore important to refine and optimize online BLI in order to improve the proportion of individuals who achieve a minimum clinically significant weight loss and mean weight loss.

Study design: Five experimental intervention components will be tested as adjuncts to an established 12-month online BLI: virtual reality for BLI skills training, interactive video feedback, tailored intervention to promote physical activity, skills for dysregulated eating, and social support combined with friendly competition. Following the Multiphase Optimization Strategy (MOST) framework, the components will first be refined and finalized during Preparation Phase pilot testing and then evaluated in a factorial experiment with 384 adults with overweight or obesity. A priori optimization criteria that balance efficacy and efficiency will be used to create a finalized treatment package that produces the best weight loss outcomes with the fewest intervention components. Mediation analysis will be conducted to test hypothesized mechanisms of action and a moderator analysis will be conducted to understand for whom and under what circumstances the interventions are effective.

Conclusion: This study will provide important information about intervention strategies that are useful for improving outcomes of online BLI. The finalized treatment package will be suitable for testing in a future randomized trial in the MOST Evaluation Phase.

Keywords: Multiphase optimization strategy; Obesity; Weight loss.

PubMed Disclaimer

Conflict of interest statement

Competing Interests Statement

The authors have no competing or conflicts of interest to disclose.

Figures

Figure 1.
Figure 1.
The experimental intervention components to be tested in this trial and their purported behavioral and psychosocial mechanisms to be tested in mediators analysis. MVPA = moderate to vigorous intensity physical activity
Figure 2.
Figure 2.
Schedule of key intervention activities for the core program and experimental intervention components. Note. Gray shading indicates that the component is active and available. A = Self-assessment, F = Feedback delivered, G = Goal setting with tailored plan, Gray shading indicates that the component is active and available. A = Self-assessment, F = Feedback delivered, G = Goal setting with tailored plan, L = Online lesson, M = Selection of lesson module and first lesson, S = Self-monitoring, VR = New virtual reality module becomes available.
See this image and copyright information in PMC

References

    1. Jensen MD, Ryan DH, Apovian CM, et al. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. Circulation. 2014;129(25 Suppl 2):S102–138. - PMC - PubMed
    1. LeBlanc ES, Patnode CD, Webber EM, Redmond N, Rushkin M, O’Connor EA. Behavioral and pharmacotherapy weight loss interventions to prevent obesity-related morbidity and mortality in adults: Updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018;320(11): 1172–1191. - PubMed
    1. Wadden TA, Tronieri JS, Butryn ML. Lifestyle modification approaches for the treatment of obesity in adults. Am Psychol. 2020;75(2):235–251. - PMC - PubMed
    1. Tate DF, Finkelstein EA, Khavjou O, Gustafson A. Cost effectiveness of internet interventions: review and recommendations. Ann Behav Med. 2009;38(1):40–45. - PMC - PubMed
    1. Sorgente A, Pietrabissa G, Manzoni GM, et al. Web-Based interventions for weight loss or weight loss maintenance in overweight and obese people: A systematic review of systematic reviews. J Med Internet Res. 2017;19(6):e229. - PMC - PubMed

Publication types