SMART Weight Loss Management

Northwestern University

Status: Completed

Conditions: Weight Loss

Treatments: Behavioral: Step 1 Treatment: APP + Coaching; Behavioral: Step 2 Treatment Strategy: Vigorous Step-up; Behavioral: Step 2 Treatment Strategy: Modest Step-up; Behavioral: Step 1 Treatment: APP

Study type: Interventional

Funder types: Other; NIH

Identifiers

NCT02997943

R01DK108678 (U.S. NIH Grant/Contract)

NIH NIDDK R01DK108678

Details and patient eligibility

About

The overall objective of this study is to use an innovative experimental approach, the SMART (Sequential Multiple Assignment Randomized Trial), to determine the best way to sequence the delivery of mHealth tools and traditional treatment components in a stepped program of obesity treatments. The SMART approach is a highly efficient strategy for identifying and constructing efficacious adaptive interventions: it accommodates sequential decision-making based on the participant's response to early weight loss treatment components. The proposed treatment package begins with the least expensive components, and for participants identified as treatment non-responders, provides sequential step-up of additional treatment components. By sequentially delivering treatment components based on participant response, SMART permits achievement of the target outcome, weight loss, with least resource consumption and participant burden.

Full description

The proposed study seeks to develop an effective, resource-sensitive strategy to manage weight loss treatment for obesity. During the 12-week active intervention phase, participants will be randomized to one of two first-line treatments: 1) mobile app alone (APP) or 2) app plus weekly telephone coaching sessions (APP+C). Beginning at week 2, those who are identified as treatment non-responders (did not lose an average of 0.5 lbs/week) will be re-randomized to one of two augmentation tactics: 1) Modest Step-up, operationalized as the addition of an additional mHealth component, or 2) Vigorous Step-up, operationalized as the addition of an additional mHealth component plus a traditional weight loss intervention component. Treatment responders will continue with the same first-line treatment. Treatment response be re-assessed at weeks 4 and 8. Those identified as treatment non-responders will be re-randomized at that time.

Enrollment: 400 patients

Sex: All

Ages: 18 to 60 years old

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• 18 through 60 years old
• BMI between 27 - 45 kg/m2
• < 350 lbs
• Weight stable (no loss or gain >25 lbs. for the past 6 months)
• Interested in losing weight and not enrolled in a formal weight loss program or taking medications or supplements that may cause weight change
• Own a Smartphone and be willing to install the SMART App
• Reside in the Chicago area for the duration of their participation (12 months)

Exclusion criteria

• Unstable medical conditions (uncontrolled hypertension, diabetes - uncontrolled or treated with insulin, uncontrolled hypothyroidism, unstable angina pectoris, transient ischemic attack, cancer undergoing active treatment, cerebrovascular accident or myocardial infarction within the past six months, or Crohn's disease)
• Pregnancy, lactation, or intended pregnancy
• Active suicidal ideation, anorexia, bulimia, binge eating disorder, current substance abuse or dependence (besides nicotine dependence)
• Require assistive device for mobility or current condition that may limit or prevent participation in moderate activity
• Use of pacemaker or other electrical implanted device
• History of bariatric (or LapBand) surgery, or considering or currently on a wait-list for bariatric or LapBand surgery
• May not live with a current or past SMART study participant

Trial design

Primary purpose: Treatment

Allocation: Randomized

Interventional model: Factorial Assignment

Masking: Single Blind

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400 participants in 2 patient groups

Step 1: Optimal First Line Treatment

Experimental group

Description:

Participants will first be randomized to an optimal first line treatment in order to compare APP vs. APP + coaching. Participants assigned to Step 1 treatment "APP" will receive a study-specific smartphone application. Participants assigned to Step 1 treatment "APP + coaching" will receive a study-specific smartphone application plus 12 weekly telephone coaching sessions.

Treatment:

Behavioral: Step 1 Treatment: APP + Coaching

Behavioral: Step 1 Treatment: APP

Step 2: Optimal Strategy to Address Nonresponse

Experimental group

Description:

Beginning at week 2, participants who are identified as treatment non-responders will be re-randomized in order to compare two strategies to address non-response: a modest step-up or vigorous step-up treatment augmentation tactic. Step 2 treatment strategy: modest step-up will include provision of an additional mHealth intervention component (push notifications). Step 2 treatment strategy vigorous step-up will include provision of an additional mHealth intervention component (push notifications), plus a traditional weight loss intervention component (coaching, meal replacements). Participants will continue to receive their first line treatment.

Treatment:

Behavioral: Step 2 Treatment Strategy: Vigorous Step-up

Behavioral: Step 2 Treatment Strategy: Modest Step-up