A low-burden, self-weighing intervention to prevent weight gain in adults with obesity who do not enroll in comprehensive treatment.

Background: For individuals who are eligible but unlikely to join comprehensive weight loss programs, a low burden self-weighing intervention may be a more acceptable approach to weight management. Methods: This was a single-arm feasibility trial of a 12-month self-weighing intervention. Participants were healthcare patients with a BMI ≥25 kg/m2 with a weight-related comorbidity or a BMI >30 kg/m2 who reported lack of interest in joining a comprehensive weight loss program, or did not enroll in a comprehensive program after being provided program information. In the self-weighing intervention, participants were asked to weigh themselves daily on a cellular connected scale and were sent text messages every other week with tailored weight change feedback, including messages encouraging use of comprehensive programs if weight gain occurred. Results: Of 86 eligible patients, 39 enrolled (45.3%) in the self-weighing intervention. Self-weighing occurred on average 4.6 days/week (SD = 1.4). At 12 months, 12 participants (30.8%) lost ≥3% baseline weight, 11 (28.2%) experienced weight stability (±3% baseline), 6 (15.4%) gained ≥3% of baseline weight, and 10 (25.6%) did not have available weight data to evaluate. Three participants reported joining a weight loss program during the intervention (7.7%). Participants reported high intervention satisfaction in quantitative ratings (4.1 of 5), and qualitative interviews identified areas of satisfaction (e.g., timing and content of text messages) and areas for improvement (e.g., increasing personalization of text messages). Conclusion: A low-burden self-weighing intervention can reach adults with overweight/obesity who would be unlikely to engage in comprehensive weight loss programs; the efficacy of this intervention for preventing weight gain should be further evaluated in a randomized trial.

Exploring potential reach and representativeness of a self-weighing weight gain prevention intervention in adults with overweight and obesity.

Most adults with obesity do not enrol in comprehensive weight loss interventions when offered. For these individuals, lower burden self-weighing interventions may offer an acceptable alternative, though data is lacking on the potential for reach and representativeness of such interventions. Health system patients with BMI ≥30 kg/m2 (or 25-30 kg/m2 with an obesity comorbidity) completed a general health survey. During the survey, patients were given information about comprehensive weight loss interventions. If they denied interest or did not enrol in a comprehensive intervention, they were offered enrolment in a low-burden weight gain prevention intervention focused on daily self-weighing using a cellular network-connected in-home scale without any dietary or physical activity prescriptions. Enrolment in this program was documented. Among patients offered the self-weighing intervention (n = 85; 55.3% men; 58.8% White; BMI = 34.2 kg/m2), 44.2% enrolled. Compared to those who did not enrol, enrollers had higher educational attainment (57.1% vs. 42.9% with bachelor's degree p = .02), social anxiety (5.8 vs. 2.8, p < .001), and perceptions of the effectiveness of the self-weighing intervention (25.8 vs. 20.9 on 35, p = .007). The most highly endorsed reason for not enrolling in the self-weighing intervention was that it would make individuals overly focused on weight. A low-intensity weight gain prevention intervention may serve as a viable alternative to comprehensive weight loss interventions for the substantial portion of patients who are at risk for continued weight gain but would otherwise not enrol in a comprehensive intervention. Differential enrolment by education, however, suggests potential for inequitable uptake.

Pre-Enrollment Steps and Run-Ins in Weight Loss Trials: A Meta-Regression.

INTRODUCTION: The generalizability of study findings may be influenced by pre-enrollment trial procedures, including the use of behavioral run-in periods. The study goals were to determine whether behavioral run-in periods and other pre-enrollment processes affect outcomes in randomized trials of behavioral weight loss interventions that have contributed to clinical guidelines. METHODS: The sample was behavioral weight loss intervention trials included in the 2018 U.S. Preventive Services Task Force systematic review. Information on pre-enrollment processes (total steps, in-person steps, behavioral run-in) was abstracted, and meta-regressions were conducted in 2022 to test whether pre-enrollment processes were associated with weight loss at 6 or 12 months and trial retention at 12 months. RESULTS: Across 80 trials, the median number of total pre-enrollment steps was 2 (range=1-5), and that of in-person pre-enrollment steps was 1 (range=0-4). Almost one-third of the trials (k=24; 30%) used a behavioral run-in. The most common run-in tasks were self-monitoring physical activity (k=9) or both physical activity and diet (k=6). Greater weight loss was observed in trials with behavioral run-ins at 6 months (-2.33 kg; 95% CI= -3.72, -0.93) and, to an attenuated extent, at 12 months (-0.86 kg; 95% CI= -1.72, 0.01) compared to those without run-ins. The total number of pre-enrollment steps was also associated with greater 6-month weight loss (-0.85 kg; 95% CI= -1.59, -0.11). Higher retention was associated with total number of pre-enrollment steps and in-person steps and marginally with the presence of run-ins. DISCUSSION: The use of more pre-enrollment processes is associated with greater weight loss in behavioral weight loss trials and may impact the generalizability of outcomes.

Engaging adults with obesity in organic online communities to support weight loss: a mixed methods pilot study.

OBJECTIVES: Organic online communities have shown potential for aiding weight loss, but few adults use them. We sought to test strategies to encourage adults to select and engage in online communities for weight loss. DESIGN: 4-week single-arm, mixed-methods pilot. MAIN OUTCOME MEASURES: Quantitative and qualitative data on selection of online community, engagement with community, and engagement and satisfaction with tasks. RESULTS: On average, participants (n = 25) were female (80.0%) and white (68.0%), 45.2 ± 18.1 years old, with a BMI of 36.2 ± 6.5 kg/m2. Selection of online community varied across participants (13 MyFitnessPal, 5 Facebook, 5 Reddit). In qualitative analyses, reasons for selection included experience with community, privacy considerations, and seeking people similar to them. Most tasks were fully or partially completed by a majority of participants (>80.0%). For most tasks, ∼50% of participants felt the task helped them with weight loss support. Variability in response was observed, especially between tasks that requested reading compared to posting/commenting in the community. Frequent reading of community content throughout the study was reported by >70.0% of participants, though posting/commenting was less frequent. Barriers to further engagement included concerns about privacy, judgement, and misinformation. CONCLUSIONS: This study provides insights about strategies for engaging individuals in online health communities.

Evaluation of sexual orientation and gender identity documentation at school-based health centers in New York City.

RATIONALE: National organizations have called for routine collection of data on sexual orientation and gender identity (SOGI) in clinical settings to track access to and quality of care provided to sexual and gender minority patients to improve health outcomes. However, there are limited data on this implementation for among adolescent populations. METHODS: A secondary data analysis from seven school-based health centers (SBHCs) in New York City explored SOGI documentation for 8888 adolescent patients in 2015 to 2018. Using Electronic Health Records, SBHC medical providers' implementation rate of patient SOGI documentation was assessed. Trends in SOGI documentation were reviewed. RESULTS: At 18-month post-EHR modification and training, SOGI documentation increased and was sustained at 47%. Those documented as female were significantly more likely to have SOGI documentation compared to those documented as male (36% vs 26% for SO; 36% vs 25% for GI). CONCLUSIONS: This study identified incomplete data collection in SOGI documentation among adolescents receiving medical and mental health services in SBHCs.