Optimizing a Just-in-Time Adaptive Intervention to Improve Dietary Adherence in Behavioral Obesity Treatment: Protocol for a Microrandomized Trial.

BACKGROUND: Behavioral obesity treatment (BOT) is a gold standard approach to weight loss and reduces the risk of cardiovascular disease. However, frequent lapses from the recommended diet stymie weight loss and prevent individuals from actualizing the health benefits of BOT. There is a need for innovative treatment solutions to improve adherence to the prescribed diet in BOT. OBJECTIVE: The aim of this study is to optimize a smartphone-based just-in-time adaptive intervention (JITAI) that uses daily surveys to assess triggers for dietary lapses and deliver interventions when the risk of lapse is high. A microrandomized trial design will evaluate the efficacy of any interventions (ie, theory-driven or a generic alert to risk) on the proximal outcome of lapses during BOT, compare the effects of theory-driven interventions with generic risk alerts on the proximal outcome of lapse, and examine contextual moderators of interventions. METHODS: Adults with overweight or obesity and cardiovascular disease risk (n=159) will participate in a 6-month web-based BOT while using the JITAI to prevent dietary lapses. Each time the JITAI detects elevated lapse risk, the participant will be randomized to no intervention, a generic risk alert, or 1 of 4 theory-driven interventions (ie, enhanced education, building self-efficacy, fostering motivation, and improving self-regulation). The primary outcome will be the occurrence of lapse in the 2.5 hours following randomization. Contextual moderators of intervention efficacy will also be explored (eg, location and time of day). The data will inform an optimized JITAI that selects the theory-driven approach most likely to prevent lapses in a given moment. RESULTS: The recruitment for the microrandomized trial began on April 19, 2021, and is ongoing. CONCLUSIONS: This study will optimize a JITAI for dietary lapses so that it empirically tailors the provision of evidence-based intervention to the individual and context. The finalized JITAI will be evaluated for efficacy in a future randomized controlled trial of distal health outcomes (eg, weight loss). TRIAL REGISTRATION: ClinicalTrials.gov NCT04784585; http://clinicaltrials.gov/ct2/show/NCT04784585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/33568.

Web-based virtual reality to enhance behavioural skills training and weight loss in a commercial online weight management programme: The Experience Success randomized trial.

OBJECTIVE: Commercial online weight management programmes are popular and easily accessible but often lack training in empirically validated behaviour change strategies and produce suboptimal outcomes. This study evaluated the effects of a Web-based virtual reality (VR) programme for enhancing behavioural skills training and weight loss when offered as an adjunct to a commercial online weight management programme. METHODS: N = 146 adults with overweight/obesity (body mass index [BMI] 27-40 kg/m2) were randomized to 6 months of no-cost access to the Weight Watchers (WW) online platform alone or enhanced with the Experience Success (WW + ES) programme, consisting of four Web-based VR sessions for training in behavioural weight-loss skills related to the home environment, the workplace, physical activity and social situations (i.e., a party at a friend's house). Weight was measured at the research centre at baseline, 3 and 6 months. RESULTS: Both groups achieved statistically significant weight loss across the trial, with no difference in mean ± standard error (SE) weight loss between WW and WW + ES at 3 months (2.7 ± 1.1 kg vs. 4.2 ± 1.1 kg, respectively; P = .086) but greater weight loss in WW + ES at 6 months (2.6 ± 1.3 kg vs. 4.9 ± 1.3 kg, respectively; P = .042). CONCLUSIONS: This study demonstrates the potential of Web-based VR skills training to enhance outcomes of commercial online weight management programmes that are widely accessible. Compared with traditional didactic methods for online skills training, VR simulation provides opportunities to learn behavioural skills via modelling and experiment with skills in real-world situations. More research is needed to identify specific behavioural mechanisms by which ES may improve outcomes.

Latent trajectories of eating disorder treatment response among female patients in residential care.

OBJECTIVE: Eating disorder (ED) treatment outcomes are highly variable from beginning to end of treatment; however, little is known about differential trajectories during the course of treatment. This study sought to characterize heterogeneous patterns of ED treatment response during residential care. METHOD: Participants were adolescent girls and adult women (N = 360) receiving residential ED treatment for anorexia nervosa, bulimia nervosa, binge-eating disorder, other specified feeding or eating disorder, unspecified feeding or eating disorder, or avoidant/restrictive food intake disorder. Self-report symptom assessments were completed at admission, discharge, and approximately weekly throughout the residential stay to assess curvilinear patterns of change. Latent growth mixture modeling was applied to identify subgroups of patients with similar treatment response trajectories. RESULTS: Three latent groups emerged, including gradual response (58.3%; steady improvements from admission to discharge), rapid response (23.9%; steep early improvements that were maintained through discharge), and low-symptom static response (17.8%; nearly nonclinical self-reported symptoms at admission that remained static through discharge). Groups differed on important clinical characteristics, such as body mass index, endorsement of compensatory behaviors, severity of global ED psychopathology at admission, and degree of symptom improvement by end of treatment. DISCUSSION: Patients follow heterogeneous response patterns in residential ED treatment, and these patterns are associated with differential treatment outcome. Future work should explore whether these trajectories are associated with differential outcomes at follow-up and whether tailoring clinical intervention to a patient's trajectory type can improve treatment response.

Evaluating iatrogenic risk of youth suicide screening programs: a randomized controlled trial.

CONTEXT: Universal screening for mental health problems and suicide risk is at the forefront of the national agenda for youth suicide prevention, yet no study has directly addressed the potential harm of suicide screening. OBJECTIVE: To examine whether asking about suicidal ideation or behavior during a screening program creates distress or increases suicidal ideation among high school students generally or among high-risk students reporting depressive symptoms, substance use problems, or suicide attempts. DESIGN, SETTING, AND PARTICIPANTS: A randomized controlled study conducted within the context of a 2-day screening strategy. Participants were 2342 students in 6 high schools in New York State in 2002-2004. Classes were randomized to an experimental group (n = 1172), which received the first survey with suicide questions, or to a control group (n = 1170), which did not receive suicide questions. MAIN OUTCOME MEASURES: Distress measured at the end of the first survey and at the beginning of the second survey 2 days after the first measured on the Profile of Mood States adolescent version (POMS-A) instrument. Suicidal ideation assessed in the second survey. RESULTS: Experimental and control groups did not differ on distress levels immediately after the first survey (mean [SD] POMS-A score, 5.5 [9.7] in the experimental group and 5.1 [10.0] in the control group; P = .66) or 2 days later (mean [SD] POMS-A score, 4.3 [9.0] in the experimental group and 3.9 [9.4] in the control group; P = .41), nor did rates of depressive feelings differ (13.3% and 11.0%, respectively; P = .19). Students exposed to suicide questions were no more likely to report suicidal ideation after the survey than unexposed students (4.7% and 3.9%, respectively; P = .49). High-risk students (defined as those with depression symptoms, substance use problems, or any previous suicide attempt) in the experimental group were neither more suicidal nor distressed than high-risk youth in the control group; on the contrary, depressed students and previous suicide attempters in the experimental group appeared less distressed (P = .01) and suicidal (P = .02), respectively, than high-risk control students. CONCLUSIONS: No evidence of iatrogenic effects of suicide screening emerged. Screening in high schools is a safe component of youth suicide prevention efforts.

Teenagers' attitudes about coping strategies and help-seeking behavior for suicidality.

OBJECTIVE: To identify youths' attitudes about coping and help-seeking strategies for suicidal ideation/behavior and examine their demographic and clinical correlates. METHOD: A self-report survey was completed by high school students (N = 2,419) in six New York State schools from 1998 through 2001. The relationship between suicide attitudes and gender, depression, substance problems, serious suicidal ideation/behavior, and first-hand experience with a suicidal peer was examined. RESULTS: Two factors that approximate avoidance and approach coping responses, maladaptive coping strategies and help-seeking strategies, respectively, were identified. Boys scored higher than girls (t = 7.96, df = 2341, p < .001), and depressed youths (t = 15.56, df = 2323, p < .001), students with substance problems (t = 11.07, df = 2340, p < .001), and suicidal youths (t = 15.14, df = 2341, p < .001) scored significantly higher than their healthy counterparts on the maladaptive coping strategies factor. Students with first-hand experience with a suicidal peer scored significantly higher on the maladaptive coping strategies factor than those without this experience (t = 7.95, df = 2321, p < .001). Lower risk groups scored significantly higher on an adaptive help-seeking strategies factor. CONCLUSIONS: High-risk adolescents' attitudes are characterized by core beliefs that support the use of maladaptive coping strategies in response to depression and suicidal thoughts and behaviors. Targeting such attitudes is a recommended component of youth suicide prevention efforts.