Novel approches to weight loss

More than 40% of emerging adults ages 18-25 meet criteria for overweight or obesity, with rates exceeding 50% in African-American and Hispanic / Latino emerging adults.  Further, obesity during these years is associated with an increased risk of Type 2 diabetes, hypertension and hyperlipidemia.

Jessica LaRose, Ph.D., an assistant professor of Health Behavior and Policy in the Virginia Commonwealth University School of Medicine, believes the 18-to-25 age group is key to combating the obesity epidemic.

“We have obesity treatment programs that target children and adults but we do a poor job of transitioning from adolescence into early adulthood,” says LaRose, a clinical psychologist who specializes in behavioral and preventative medicine. “This is a critical time developmentally and effective intervention could reduce medical and economic consequences of obesity as this generation ages.”

LaRose is the principal investigator of “Low-Intensity Weight Loss for Young Adults: Autonomous vs. Extrinsic Motivation,” a five-year study funded by a $3.1 million grant from the National Institutes of Health. It is the first large-scale randomized controlled trial to investigate behavioral weight loss programs designed specifically for emerging adults.

The study will include 381 participants, ages 18 to 25 and with a body mass index of 25 to 45. Participants will spend six months in the behavioral weight loss program. The aim is to test the efficacy of novel lifestyle interventions that are designed to increase motivation for behavior change.

Participants in the REACH Trial will be randomly assigned to one of three groups.  All the groups receive an evidence-based behavioral weight loss program that includes two in-person treatment sessions, followed by a technology driven platform where they receive their weekly treatment content and personalized feedback from their coach. Each participant will also receive a Bluetooth- and Wi-Fi-connected scale, which will allow coaches to monitor participants’ progress objectively and provide suggestions and support as needed.

The first group is the gold standard behavioral treatment adapted specifically for emerging adults, and serves as the base group against which the study will compare the efficacy of the other two approaches. It includes personalized dietary and physical activity goals and coaching, as well as evidence based behavioral strategies to navigate social, emotional and environmental challenges to weight loss.

The second group will focus on promoting autonomous motivation based on self-determination theory. So what does that mean, exactly? LaRose says the focus is on motivating individuals to take control, partly by helping the participants decide what’s important to them and emphasizing those factors throughout the program to increase self-monitoring behaviors and weight loss. Participants in this group will also receive the option to attend various experiential group sessions in the community to help them achieve competency in their nutrition and activity behaviors.

The third group will promote extrinsic motivation, and is based on principles of learning theory and behavioral economics. Essentially, they will receive modest financial rewards for their performance, but not based solely on the end result of weight loss, says LaRose.

“We use small and variable incentives on a weekly basis that are linked to self-monitoring, with rewards for stepping on the scale and monitoring dietary intake at least four out of seven days,” she says. In addition, participants will be entered into a lottery for weight loss and their feedback will be framed to enhance the effects of these incentives.

After participants complete the six-month program, the study will follow up with them after an additional six months to see which group was most successful in maintaining weight loss. The study will also assess impact on cardiometabolic risk factors and examine whether there are participant characteristics that affect response to the interventions.

In addition, they will collect data on participant satisfaction and the cost of implementation to identify barriers and facilitators to real-world dissemination. “Hopefully we have positive results and the next step will be to test in a real-world setting,” says LaRose.