Parent-Adolescent Weight Communication: Parental Psychosocial Correlates Among a Diverse National Sample.

Parental communication about body weight with their children is common across diverse families. The current study investigates how parents' feelings about their own bodies, beliefs about body weight, history of weight stigma, and weight-related characteristics contribute to the degree to which they talk about weight - both negatively and positively - with their adolescent children. The study sample was comprised of U.S. parents (N = 1936) from diverse racial/ethnic backgrounds with children aged 10-17 years old. Parents completed an online survey with measures assessing their frequency of engaging in negative and positive weight communication with their children, along with several relevant psychosocial factors (i.e. body satisfaction, experienced weight stigma, associative stigma, body appreciation, beliefs about weight controllability, weight bias internalization). Study findings paint a complex picture, including some psychosocial factors (e.g. weight bias internalization) that are related to both more frequent negative and positive weight communication. Notably, higher levels of associative stigma were related to more frequent negative parental weight comments, and less frequent positive weight socialization. Findings can inform healthcare professionals in raising parents' awareness about how their personal beliefs and feelings about their own weight and their child's weight can contribute to how they engage in communication about weight with their children.

Randomized Controlled Trial of Effects of Behavioral Weight Loss Treatment on Food Cue Reactivity.

BACKGROUND: It is not known whether behavioral weight loss can attenuate blood oxygen level-dependent responses to food stimuli. OBJECTIVES: This randomized controlled trial assessed the effects of a commercially available behavioral weight loss program (WW, WeightWatchers) compared to a wait-list control on blood oxygen level-dependent response to food cues. METHODS: Females with obesity ( N = 61) were randomized to behavioral weight loss or wait-list control. At baseline and follow-up, participants completed assessments that included functional magnetic resonance imaging scans to assess response to images of high-calorie foods (HCF) or low-calorie foods (LCF), and neutral objects. RESULTS: There were no significant between-group differences in change from baseline to follow-up in any regions of the brain in response to viewing HCF or LCF. From baseline to follow-up, participants in behavioral weight loss, compared with wait-list control, reported significantly greater increases in desire for LCF. Changes in liking and palatability of LCF and liking, palatability, and desire for HCF did not differ between groups. DISCUSSION: Behavioral weight loss was associated with increased desire for LCF without changes in neural reactivity to food cues. These results suggest that alteration of neurological processes underlying responsiveness to food is difficult to achieve through behavioral weight management alone.

Quantifying and correcting bias due to outcome dependent self-reported weights in longitudinal study of weight loss interventions.

In response to the escalating global obesity crisis and its associated health and financial burdens, this paper presents a novel methodology for analyzing longitudinal weight loss data and assessing the effectiveness of financial incentives. Drawing from the Keep It Off trial-a three-arm randomized controlled study with 189 participants-we examined the potential impact of financial incentives on weight loss maintenance. Given that some participants choose not to weigh themselves because of small weight change or weight gains, which is a common phenomenon in many weight-loss studies, traditional methods, for example, the Generalized Estimating Equations (GEE) method tends to overestimate the effect size due to the assumption that data are missing completely at random. To address this challenge, we proposed a framework which can identify evidence of missing not at random and conduct bias correction using the estimating equation derived from pairwise composite likelihood. By analyzing the Keep It Off data, we found that the data in this trial are most likely characterized by non-random missingness. Notably, we also found that the enrollment time (i.e., duration time) would be positively associated with the weight loss maintenance after adjusting for the baseline participant characteristics (e.g., age, sex). Moreover, the lottery-based intervention was found to be more effective in weight loss maintenance compared with the direct payment intervention, though the difference was non-statistically significant. This framework's significance extends beyond weight loss research, offering a semi-parametric approach to assess missing data mechanisms and robustly explore associations between exposures (e.g., financial incentives) and key outcomes (e.g., weight loss maintenance). In essence, the proposed methodology provides a powerful toolkit for analyzing real-world longitudinal data, particularly in scenarios with data missing not at random, enriching comprehension of intricate dataset dynamics.

New insights in the mechanisms of weight-loss maintenance: Summary from a Pennington symposium.

Obesity is a chronic disease that affects more than 650 million adults worldwide. Obesity not only is a significant health concern on its own, but predisposes to cardiometabolic comorbidities, including coronary heart disease, dyslipidemia, hypertension, type 2 diabetes, and some cancers. Lifestyle interventions effectively promote weight loss of 5% to 10%, and pharmacological and surgical interventions even more, with some novel approved drugs inducing up to an average of 25% weight loss. Yet, maintaining weight loss over the long-term remains extremely challenging, and subsequent weight gain is typical. The mechanisms underlying weight regain remain to be fully elucidated. The purpose of this Pennington Biomedical Scientific Symposium was to review and highlight the complex interplay between the physiological, behavioral, and environmental systems controlling energy intake and expenditure. Each of these contributions were further discussed in the context of weight-loss maintenance, and systems-level viewpoints were highlighted to interpret gaps in current approaches. The invited speakers built upon the science of obesity and weight loss to collectively propose future research directions that will aid in revealing the complicated mechanisms involved in the weight-reduced state.

Behavioral, psychological, and environmental predictors of weight regain in a group of successful weight losers in a widely available weight-management program.

OBJECTIVE: The aim of this study was to identify predictors of weight regain and continued weight maintenance among individuals already successful at long-term weight loss in a widely available weight-management program. METHODS: Participants were 2843 weight-loss maintainers in WeightWatchers who had maintained weight loss ≥9.1 kg for ≥1 year (average 25.5 kg for 3.5 years; BMI = 26.7 kg/m2 ). Validated behavioral, psychosocial, and home environmental questionnaires were administered at study entry and 1 year later. Discriminant analysis identified variables that discriminated gainers (≥2.3-kg gain) from maintainers (±2.3-kg change). RESULTS: Over the 1 year of follow-up, 43% were gainers (mean [SD], 7.2 [5.4] kg), and 57% were maintainers (0.4 [1.2] kg). Compared with maintainers, gainers were younger and had higher initial weight, more recent weight losses, and larger initial weight losses. Standardized canonical coefficients indicated that the 1-year changes that most discriminated gainers from maintainers were greater decreases in the ability to accept uncomfortable food cravings, urges, and desires to overeat (0.232); self-monitoring (0.166); body image (0.363); and body satisfaction (0.194) and greater increases in disinhibition (0.309) and bodily pain (0.147). The canonical correlation was 0.505 (p < 0.001). CONCLUSIONS: Future interventions to prevent regain should consider targeting overeating in response to internal and external food cues and declines in self-monitoring and body image.

The Personalized Nutrition Study (POINTS): evaluation of a genetically informed weight loss approach, a Randomized Clinical Trial.

Weight loss (WL) differences between isocaloric high-carbohydrate and high-fat diets are generally small; however, individual WL varies within diet groups. Genotype patterns may modify diet effects, with carbohydrate-responsive genotypes losing more weight on high-carbohydrate diets (and vice versa for fat-responsive genotypes). We investigated whether 12-week WL (kg, primary outcome) differs between genotype-concordant and genotype-discordant diets. In this 12-week single-center WL trial, 145 participants with overweight/obesity were identified a priori as fat-responders or carbohydrate-responders based on their combined genotypes at ten genetic variants and randomized to a high-fat (n = 73) or high-carbohydrate diet (n = 72), yielding 4 groups: (1) fat-responders receiving high-fat diet, (2) fat-responders receiving high-carbohydrate diet, (3) carbohydrate-responders receiving high-fat diet, (4) carbohydrate-responders receiving high-carbohydrate diet. Dietitians delivered the WL intervention via 12 weekly diet-specific small group sessions. Outcome assessors were blind to diet assignment and genotype patterns. We included 122 participants (54.4 [SD:13.2] years, BMI 34.9 [SD:5.1] kg/m2, 84% women) in the analyses. Twelve-week WL did not differ between the genotype-concordant (-5.3 kg [SD:1.0]) and genotype-discordant diets (-4.8 kg [SD:1.1]; adjusted difference: -0.6 kg [95% CI: -2.1,0.9], p = 0.50). With the current ability to genotype participants as fat- or carbohydrate-responders, evidence does not support greater WL on genotype-concordant diets. ClinicalTrials identifier: NCT04145466.

Qualitative inquiry with persons with obesity about weight management in primary care and referrals.

Introduction: Referrals to evidence-based weight management in the community-commercial sector are aligned with clinical recommendations but underutilized. Methods: This qualitative study explored patients' perceptions and expectations about obesity treatment in primary care and referral to community-commercial sector programs. Individual semi-structured interviews were conducted with a sample of US persons with obesity via telephone. Audiotape transcripts, interviewer notes, and independent review of data by two investigators allowed for data and investigator triangulation. Transcripts were analyzed using thematic analysis. Results: Data saturation was reached with 30 participants who had a mean age of 41.6 years (SD 9.4), 37% male, 20% Black/African American and 17% Hispanic, 57% college educated, and 50% were employed full-time. Three primary themes emerged: (1) frustration with weight management in primary care; (2) patients expect providers to be better informed of and offer treatment options; and (3) opportunities and challenges with referrals to community-commercial programs. Discussion: Patients expect that providers offer personalized treatment options and referrals to effective community-commercial programs are an acceptable option. If patient-level data are shared between clinical and community entities to facilitate referrals, then privacy and security issues need attention. Future research is needed to determine feasibility of implementing clinical to community-commercial referrals for obesity treatment in the United States.

Vertical and horizontal gene transfer shaped plant colonization and biomass degradation in the fungal genus Armillaria.

The fungal genus Armillaria contains necrotrophic pathogens and some of the largest terrestrial organisms that cause tremendous losses in diverse ecosystems, yet how they evolved pathogenicity in a clade of dominantly non-pathogenic wood degraders remains elusive. Here we show that Armillaria species, in addition to gene duplications and de novo gene origins, acquired at least 1,025 genes via 124 horizontal gene transfer events, primarily from Ascomycota. Horizontal gene transfer might have affected plant biomass degrading and virulence abilities of Armillaria, and provides an explanation for their unusual, soft rot-like wood decay strategy. Combined multi-species expression data revealed extensive regulation of horizontally acquired and wood-decay related genes, putative virulence factors and two novel conserved pathogenicity-induced small secreted proteins, which induced necrosis in planta. Overall, this study details how evolution knitted together horizontally and vertically inherited genes in complex adaptive traits of plant biomass degradation and pathogenicity in important fungal pathogens.

An Evaluation of a Personalized Multicomponent Commercial Digital Weight Management Program: Single-Arm Behavioral Trial.

BACKGROUND: Digital behavioral weight loss programs are scalable and effective, and they provide an opportunity to personalize intervention components. However, more research is needed to test the acceptability and efficacy of personalized digital behavioral weight loss interventions. OBJECTIVE: In a 6-month single-arm trial, we examined weight loss, acceptability, and secondary outcomes of a digital commercial weight loss program (WeightWatchers). This digital program included a personalized weight loss program based on sex, age, height, weight, and personal food preferences, as well as synchronous (eg, virtual workshops and individual weekly check-ins) and asynchronous (eg, mobile app and virtual group) elements. In addition to a personalized daily and weekly PersonalPoints target, the program provided users with personalized lists of ≥300 ZeroPoint foods, which are foods that do not need to be weighed, measured, or tracked. METHODS: We conducted a pre-post evaluation of this 6-month, digitally delivered, and personalized WeightWatchers weight management program on weight loss at 3 and 6 months in adults with overweight and obesity. The secondary outcomes included participation, satisfaction, fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, self-compassion, well-being, and behavioral automaticity. RESULTS: Of the 153 participants, 107 (69.9%) were female, and 65 (42.5%) identified as being from a minoritized racial or ethnic group. Participants' mean age was 41.09 (SD 13.78) years, and their mean BMI was 31.8 (SD 5.0) kg/m2. Participants had an average weight change of -4.25% (SD 3.93%) from baseline to 3 months and -5.05% (SD 5.59%) from baseline to 6 months. At 6 months, the percentages of participants who experienced ≥3%, ≥5%, and ≥10% weight loss were 63.4% (97/153), 51% (78/153), and 14.4% (22/153), respectively. The mean percentage of weeks in which participants engaged in ≥1 aspects of the program was 87.53% (SD 23.40%) at 3 months and 77.67% (SD 28.69%) at 6 months. Retention was high (132/153, 86.3%), and more than two-thirds (94/140, 67.1%) of the participants reported that the program helped them lose weight. Significant improvements were observed in fruit and vegetable intake, physical activity, sleep quality, hunger, food cravings, quality of life, and well-being (all P values <.01). CONCLUSIONS: This personalized, digital, and scalable behavioral weight management program resulted in clinically significant weight loss in half (78/153, 51%) of the participants as well as improvements in behavioral and psychosocial outcomes. Future research should compare personalized digital weight loss programs with generic programs on weight loss, participation, and acceptability.

How much food tracking during a digital weight-management program is enough to produce clinically significant weight loss?

OBJECTIVE: The aim of this study was to identify the levels of food-tracking adherence that best predict ≥3%, ≥5%, and ≥10% weight loss at 6 months and to identify distinctive food-tracking trajectories among participants in a 6-month, commercial digital weight-management program. METHODS: This study used data from 153 participants of a single-arm trial of a commercial digital weight-management program, WeightWatchers (WW). Receiver operating characteristic (ROC) curve analysis was conducted to identify the optimum thresholds of food tracking that can predict ≥3%, ≥5%, and ≥10% weight loss at 6 months. Time series clustering analysis was performed on weekly food-tracking data to identify trajectories and compare trajectories on weight loss at 6 months. RESULTS: ROC analyses showed that the optimum thresholds of food tracking were 28.5% of the intervention days to achieve ≥3% weight loss (area under the curve [AUC] = 0.820, p < 0.001), 39.4% to achieve ≥5% weight loss (AUC = 0.744, p < 0.001), and 67.1% to achieve 10% weight loss (AUC = 0.712, p = 0.002). Time series clustering analyses found three food-tracking trajectories. Trajectories differed significantly in weight loss at 6 months (F = 14.1, p < 0.001). CONCLUSIONS: Results suggest that perfect food-tracking adherence is not necessary to achieve clinically significant weight loss.

Parental Communication About Body Weight and Adolescent Health: The Role of Positive and Negative Weight-Related Comments.

OBJECTIVE: Research has consistently documented adverse effects of parent weight-related comments on adolescent health. However, little empirical attention has focused on isolating the impact of weight-related comments from mothers versus fathers, and the valence of their comments. The present study examined the extent to which positive and negative weight-related comments from mothers and fathers are related to adolescent health and wellbeing, and whether these associations differ according to adolescent sociodemographic characteristics. METHODS: Data were collected from a diverse sample of 2032 U.S.-based adolescents aged 10-17 years (59% female; 40% White, 25% Black or African American, 23% Latinx). Online questionnaires assessed perceived frequency of negative and positive weight-related comments from mothers and fathers, as well as four indicators of adolescent health and wellbeing: depression, unhealthy weight control behaviors, weight bias internalization (WBI), and body appreciation. RESULTS: More frequent negative weight-related comments from parents were associated with poorer adolescent health and wellbeing, while positive comments contributed to lower levels of WBI and body appreciation; these associations were documented regardless of whether mothers or fathers were the source of such comments, and considerable consistency was demonstrated across adolescent sociodemographic characteristics. CONCLUSION: Findings highlight differences in adolescent health based on how parents discuss their body weight (i.e., negatively or positively), and similarity in associations regardless of whether mothers or fathers are the source of weight communication. These findings reiterate the importance of efforts to educate parents on ways to engage in supportive communication about weight-related health with their children.

A randomized controlled trial examining the effects of behavioral weight loss treatment on hippocampal volume and neurocognition.

BACKGROUND/PURPOSE: Obesity in midlife is an established risk factor for dementia. In middle-aged adults, elevated body mass index (BMI) is associated with lower neurocognition and smaller hippocampal volumes. It is unclear whether behavioral weight loss (BWL) can improve neurocognition. The purpose of this study was to evaluate whether BWL, compared to wait list control (WLC), improved hippocampal volume and neurocognition. We also examined if baseline hippocampal volume and neurocognition were associated with weight loss. METHODS: We randomly assigned women with obesity (N = 61; mean±SD age=41.1 ± 9.9 years; BMI=38.6 ± 6.2 kg/m2; and 50.8% Black) to BWL or WLC. Participants completed assessments at baseline and follow-up including T1-weighted structural magnetic resonance imaging scans and the National Institutes of Health (NIH) Toolbox Cognition Battery. RESULTS: The BWL group lost 4.7 ± 4.9% of initial body weight at 16-25 weeks, which was significantly more than the WLC group which gained 0.2 ± 3.5% (p < 0.001). The BWL and WLC groups did not differ significantly in changes in hippocampal volume or neurocognition (ps>0.05). Baseline hippocampal volume and neurocognition scores were not significantly associated with weight loss (ps>0.05). CONCLUSIONS AND IMPLICATIONS: Contrary to our hypothesis, we found no overall benefit of BWL relative to WLC on hippocampal volumes or cognition in young- and middle-aged women. Baseline hippocampal volume and neurocognition were not associated with weight loss.

Family-based weight stigma and psychosocial health: A multinational comparison.

OBJECTIVE: Family-based weight stigma can be expressed as criticism, judgment, teasing, and mistreatment by family members because of an individual's body weight. The current study compared the prevalence and psychosocial correlates of family-based weight stigma among adult members of a weight-management program living in Australia, Canada, France, Germany, the UK, and the US. METHODS: Participants (N = 8100 adults who reported having ever experienced weight stigma; 95% female; 94% White) completed an identical online survey in their country's dominant language that assessed their experiences of weight stigma from 16 different family member sources, as well as internalized weight bias, body image, eating behaviors, perceived stress, and self-rated health. RESULTS: Family-based weight stigma, especially from mothers (49%-62%), spouses/romantic partners (40%-57%), and fathers (35%-48%), was highly prevalent across countries. Weight stigma from one's immediate family members was associated with indices of poorer psychosocial health across the six countries (ß coefficients = |0.08-0.13|). CONCLUSIONS: Findings highlight the need for weight stigma-reduction efforts to help family members distinguish between supportive, encouraging discourse and potentially weight-stigmatizing communication. Future research should examine the prevalence and correlates of family-based weight stigma in more diverse community samples, including among racially/ethnically and gender diverse adults, and in non-Western countries.

Parent-child communication about weight: Priorities for parental education and support.

BACKGROUND: Approximately 2/3 of parents talk about body weight with their children, which can include negative comments that have adverse health implications for youth. OBJECTIVES: To identify ways to improve supportive parent-child communication about weight, we assessed parent and youth perspectives of barriers to weight communication, preferences for educational resources and support, and whether perspectives differ across demographic groups and weight status. METHODS: In Fall 2021, online surveys were completed by two independent, unrelated samples of parents (N = 1936) and youth (N = 2032). Participants were asked about their perceived barriers to talking about weight, and what kinds of information and support would be most useful to them in fostering supportive communication. RESULTS: Parent and youth-reported barriers to weight communication included discomfort and lack of knowledge about weight, and views that weight does not need to be discussed. Most parents wanted guidance on how to navigate multiple weight-related topics with their children, including promoting positive body image and healthy behaviours, reducing weight criticism, focusing more on health and addressing weight-based bullying. Youth preferences for how their parents can be more supportive of their weight included avoiding weight-related criticism and pressures, increasing sensitivity and encouragement, and emphasizing healthy behaviours rather than weight. Few differences emerged based on sex and race/ethnicity, although several differences emerged for youth engaged in weight management. CONCLUSION: Parent and youth perspectives indicate a need for education to help parents engage in supportive conversations about body weight. Findings can inform efforts to reduce barriers and increase supportive weight-related communication in families.

Biosynthesis of pleuromutilin congeners using an Aspergillus oryzae expression platform.

Pleuromutilin is an antibiotic diterpenoid made by Clitopilus passeckerianus and related fungi, and it is the progenitor of a growing class of semi-synthetic antibiotics used in veterinary and human medicine. To harness the biotechnological potential of this natural product class, a full understanding of its biosynthetic pathway is essential. Previously, a linear pathway for pleuromutilin biosynthesis was established. Here we report two shunt pathways involving Pl-sdr and Pl-atf that were identified through the rational heterologous expression of combinations of pleuromutilin biosynthetic genes in Aspergillus oryzae. Three novel pleuromutilin congeners were isolated, and their antimicrobial activity was investigated, alongside that of an additional derivative produced through a semi-synthetic approach. It was observed that the absence of various functional groups - 3 ketone, 11 hydroxyl group or 21 ketone - from the pleuromutilin framework affected the antibacterial activity of pleuromutilin congeners. This study expands our knowledge on the biosynthesis of pleuromutilin and provides avenues for the development of novel pleuromutilin analogues by combining synthetic biology and synthetic chemistry.

A scalable, virtual weight management program tailored for adults with type 2 diabetes: effects on glycemic control.

BACKGROUND: The objective was to test the efficacy of a scalable, virtually delivered, diabetes-tailored weight management program on glycemic control in adults with type 2 diabetes (T2D). METHODS: This was a single arm, three-site clinical trial. Participants had baseline HbA1c between 7-11% and BMI between 27-50 kg/m2. Primary outcome was change in HbA1c at 24 weeks. Secondary outcomes were changes in body weight, waist circumference, the Diabetes Distress Scale (DDS), quality of life (IWQOL-L), and hunger (VAS). Generalized linear effects models were used for statistical analysis. RESULTS: Participants (n = 136) were 56.8 ± 0.8 y (Mean ± SEM), 36.9 ± 0.5 kg/m2, 80.2% female, 62.2% non-Hispanic white. Baseline HbA1c, weight, and total DDS score were 8.0 ± 0.09%, 101.10 ± 1.47 kg, and 2.35 ± 0.08, respectively. At week 24, HbA1c, body weight, and total DDS decreased by 0.75 ± 0.11%, 5.74 ± 0.50%, 0.33 ± 0.10 units, respectively (all p < 0.001). Also, at week 24, quality of life increased by 9.0 ± 1.2 units and hunger decreased by 14.3 ± 2.4 units, (both p < 0.0001). CONCLUSIONS: The scalable, virtually delivered T2D-tailored weight management program had favorable and clinically meaningful effects on glycemic control, body weight, and psychosocial outcomes.

Enabling Informed Decision Making in the Absence of Detailed Nutrition Labels: A Model to Estimate the Added Sugar Content of Foods.

Obesity and diabetes have emerged as an increasing threat to public health, and the consumption of added sugar can contribute to their development. Though nutritional content information can positively influence consumption behavior, added sugar is not currently required to be disclosed in all countries. However, a growing proportion of the world's population has access to mobile devices, which allow for the development of digital solutions to support health-related decisions and behaviors. To test whether advances in computational science can be leveraged to develop an accurate and scalable model to estimate the added sugar content of foods based on their nutrient profile, we collected comprehensive nutritional information, including information on added sugar content, for 69,769 foods. Eighty percent of this data was used to train a gradient boosted tree model to estimate added sugar content, while 20% of it was held out to assess the predictive accuracy of the model. The performance of the resulting model showed 93.25% explained variance per default portion size (84.32% per 100 kcal). The mean absolute error of the estimate was 0.84 g per default portion size (0.81 g per 100 kcal). This model can therefore be used to deliver accurate estimates of added sugar through digital devices in countries where the information is not disclosed on packaged foods, thus enabling consumers to be aware of the added sugar content of a wide variety of foods.

"Look beyond the weight and accept me": Adolescent perspectives on parental weight communication.

Critical weight communication between parents and their adolescent children is prevalent and harmful. However, research on adolescent perspectives about parental weight communication is limited. The present mixed-methods study aimed to address this gap using inductive thematic analysis of 1743 adolescents' (Mage=14.61 years, SDage=2.48) preferences regarding parental weight communication in response to an open-ended prompt, and quantitative analyses to examine age, gender, race/ethnicity, and weight-related differences in subthemes. In their responses, adolescents articulated 1) whether and 2) how parental weight communication should-or should not-occur, and 3) what these conversations should entail. We identified 15 subthemes across these categories-the endorsement of which often varied by adolescents' demographic and anthropometric characteristics. For example, some adolescents (especially cisgender girls and transgender/gender diverse adolescents) preferred that their parents talk about weight less often (n = 184), while others (especially multiracial/ethnic or Hispanic/Latinx adolescents) hoped that, if parents were to discuss weight with them, they do so in a manner that was compassionate and respectful (n = 150). Across most subthemes, adolescents described adverse responses (e.g., feeling insecure, embarrassed, or hurt) when parents discussed their weight in non-preferred ways. Collectively, findings can inform interventions to promote more supportive health-focused communication in families.

Effectiveness of a Scalable mHealth Intervention for Children With Overweight and Obesity.

Background: Multicomponent interventions are the first line of treatment for pediatric obesity, but are challenging to access. Mobile health (mHealth) interventions hold promise as they address commonly cited barriers for attending in person programs and have potential for wide scale dissemination. Methods: This retrospective cohort study examined data from youth who enrolled in the Kurbo program, which includes personal health coaching and a mobile app. Hierarchical linear regression was used to examine the impact of baseline percentage of the 95th% percentile for body mass index (%BMIp95), number of coaching sessions, and length of time enrolled in the program on change in %BMIp95, controlling for baseline age and sex. Results: A total of 3500 youth (mean age of 12.79 years, 71.3% female) were included. Youth experienced a 0.70 U decrease in BMI [standard deviation (SD) = 2.19] and a 4.45% decrease (SD = 8.5) in %BMIp95 over a mean of 31.5 weeks. The overall regression model was significant, R2 = 0.066, F(3,3494) = 77.18, and p < 0.001. Predictors of decrease in weight status included being female (b = -1.11, p < 0.001), higher baseline %BMIp95, (b = -0.58, p < 0.001), and greater number of coaching sessions (b = -0.12, p < 0.001), while greater time enrolled in the program (b = 0.02, p < 0.001) was associated with less change. Conclusion: Findings suggest a scalable coaching program with integrated digital tools for monitoring diet and activity can lead to significant reductions in weight status. Findings need to be replicated with more rigorous study designs, including a comparison condition and verified assessment of height and weight.