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
Randomized Controlled Trial
. 2022 Sep 1;5(9):e2231903.
doi: 10.1001/jamanetworkopen.2022.31903.

Effect of a Lifestyle Intervention on Cardiometabolic Health Among Emerging Adults: A Randomized Clinical Trial

Jessica Gokee LaRose  1 , Tricia M Leahey  2 , Autumn Lanoye  1   3 , Melanie K Bean  4   5 , Joseph L Fava  6 , Deborah F Tate  7   8 , Ronald K Evans  9 , Edmond P Wickham 3rd  4   5   10 , Megan M Henderson  1
Affiliations
Randomized Controlled Trial

Effect of a Lifestyle Intervention on Cardiometabolic Health Among Emerging Adults: A Randomized Clinical Trial

Jessica Gokee LaRose et al. JAMA Netw Open. .

Abstract

Importance: The prevalence of obesity has increased substantially among emerging adults, yet no previous large-scale behavioral weight loss trials have been conducted among this age group.

Objective: To test the effect of 2 theory-based motivational enhancements on weight loss within a primarily digital lifestyle intervention designed for emerging adults.

Design, setting, and participants: In this randomized clinical trial conducted at an academic medical research center, 382 participants aged 18 to 25 years with a body mass index (BMI; calculated as weight in kilograms divided by height in meters squared) of 25 to 45 were enrolled between February 2, 2016, and February 6, 2019. Data collection was completed February 8, 2020. Analysis was performed on an intention-to-treat basis.

Interventions: Participants were randomized to 1 of 3 groups: developmentally adapted behavioral weight loss (aBWL), aBWL plus behavioral economics (aBWL + BE), or aBWL plus self-determination theory (aBWL + SDT). All groups received a 6-month intervention with 1 group session, 1 individual session, and a digital platform (digital tools for self-monitoring, weekly lessons, tailored feedback, text messages, and optional social media). The aBWL + BE group received modest financial incentives for self-monitoring and weight loss; the aBWL + SDT group received optional experiential classes. Coaching and message framing varied by group.

Main outcomes and measures: The primary outcome was mean (SE) weight change (in kilograms) at 6 months. Secondary outcomes included proportion of participants achieving weight loss of 5% or more, percentage weight change, waist circumference, body composition, and blood pressure.

Results: Among the 382 participants (mean [SD] age, 21.9 [2.2] years), 316 (82.7%) were female, mean (SD) BMI was 33.5 (4.9), 222 (58.1%) were of underrepresented race and/or ethnicity, and 320 (83.8%) were retained at the primary end point. There was a significant time effect for mean (SE) weight loss (-3.22 [0.55] kg in the aBWL group; -3.47 [0.55] kg in the aBWL + BE group; and -3.40 [0.53] kg in the aBWL + SDT group; all P < .001), but no between-group differences were observed (aBWL vs aBWL + BE: difference, -0.25 kg [95% CI, -1.79 to 1.29 kg]; P = .75; aBWL vs aBWL + SDT: difference, -0.18 kg [95% CI, -1.67 to 1.31 kg]; P = .81; and aBWL + SDT vs aBWL + BE: difference, 0.07 kg [95% CI, -1.45 to 1.59 kg]; P = .93). The proportion of participants achieving a weight loss of 5% or more was 40.0% in the aBWL group (50 of 125), 39.8% in the aBWL + BE group (51 of 128), and 44.2% in the aBWL + SDT group (57 of 129), which was not statistically different across groups (aBWL vs aBWL + BE, P = .89; aBWL vs aBWL + SDT, P = .45; aBWL + SDT vs aBWL + BE, P = .54). Parallel findings were observed for all secondary outcomes-clinically and statistically significant improvements with no differences between groups.

Conclusions and relevance: In this randomized clinical trial, all interventions produced clinically significant benefit, but neither of the motivational enhancements promoted greater reductions in adiposity compared with the developmentally adapted standard group. Continued efforts are needed to optimize lifestyle interventions for this high-risk population and determine which intervention works best for specific individuals based on sociodemographic and/or psychosocial characteristics.

Trial registration: ClinicalTrials.gov Identifier: NCT02736981.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosures: Dr LaRose reported receiving grant funding from and serving as a consultant for WW International outside the submitted work. Dr Lanoye reported serving as a consultant for WW International outside the submitted work. Dr Fava reported receiving grants from Lifespan/The Miriam Hospital during the conduct of the study. Dr Tate reported serving on the Scientific Advisory Board for WW International and Wondr Health outside the submitted work. Dr Wickham reported receiving grants from WW International outside the submitted work. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. CONSORT Flow Diagram
aBWL indicates developmentally adapted behavioral weight loss; BE, behavioral economics; BMI, body mass index (calculated as weight in kilograms divided by height in meters squared); and SDT, self-determination theory.
Figure 2.
Figure 2.. Proportion of Participants Achieving a Weight Loss of 5% or More by Intervention Group
aBWL indicates developmentally adapted behavioral weight loss; BE, behavioral economics; and SDT, self-determination theory.
See this image and copyright information in PMC

References

    1. Jensen MD, Ryan DH, Apovian CM, et al. ; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society . 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-S138. Published correction appears in Circulation. 2014;129(25)(suppl 2):S139-S140. doi:10.1161/01.cir.0000437739.71477.ee - DOI - PMC - PubMed
    1. Arnett JJ. Emerging Adulthood: The Winding Road From the Late Teens Through the Twenties. Oxford University Press; 2004.
    1. Ellison-Barnes A, Johnson S, Gudzune K. Trends in obesity prevalence among adults aged 18 through 25 years, 1976-2018. JAMA. 2021;326(20):2073-2074. doi:10.1001/jama.2021.16685 - DOI - PMC - PubMed
    1. Loria CM, Signore C, Arteaga SS. The need for targeted weight-control approaches in young women and men. Am J Prev Med. 2010;38(2):233-235. doi:10.1016/j.amepre.2009.11.001 - DOI - PMC - PubMed
    1. Gooding HC, Gidding SS, Moran AE, et al. . Challenges and opportunities for the prevention and treatment of cardiovascular disease among young adults: report from a National Heart, Lung, and Blood Institute working group. J Am Heart Assoc. 2020;9(19):e016115. doi:10.1161/JAHA.120.016115 - DOI - PMC - PubMed

Publication types

Associated data