LIVE SMART: Smartphone Intervention for Weight Control

描述（由申请人提供）：行为减肥治疗（BWL）的疗效已在糖尿病预防计划和LookAHEAD等大型试验中得到证实。然而，用于BWL交付的模式（几个月内频繁的小组治疗）已被证明在研究环境之外是不切实际的。因此，需要BWL递送的替代方法。通过互联网和社区组织提供BWL的初步尝试显示出了希望，并且已经学到了很多关于通过非传统渠道提供BWL的经验。然而，由于行为依从性差，这些研究中的体重减轻往往是次优的。因此，我们面临着寻找新的方法来提供经验验证的BWL的挑战，这些方法（1）与金标准BWL一样有效，（2）促进行为依从性，（3）如果证明有效，则显示出传播的希望。 我们通过广泛采用的智能手机技术提供BWL的移动的健康（mHealth）方法显示了应对这一挑战的前景。智能手机是一种理想的媒介，用于提供BWL，因为可以通过以下方式提高依从性：（a）在自然环境中实时干预行为，（B）简化和个性化自我监测，这是一种重要的减肥策略，（c）提供即时的个性化反馈，以塑造饮食和体育活动行为，以及（d）提供定制的教育和技能培训， 频繁短暂的“爆发”。此外，44%的非洲裔美国人和西班牙裔美国人拥有智能手机（白人为30%），预计今年的渗透率将超过50%。鉴于这些好处，显然需要在大规模试验中检查基于智能手机的BWL的功效，并确定这种方法的优点和缺点。 我们建议将270名超重/肥胖成年人随机分配到18个月的（a）金标准组- BWL，（B）mHealth-BWL，或（c）对照组。Group-BWL的参与者将参加以饮食，体育活动和行为矫正为重点的小组治疗课程。在第1-6、7-12和13-18个月期间，分别每周、每两周和每月进行一次分组。自我监测将通过纸质日记进行，并提供人工反馈。mHealth-BWL的参与者将通过智能手机获得相同的干预组件。频繁，简短，视频将用于提供减肥课程。自我监测将通过“应用程序”进行，并提供自动和人工反馈。初始会议和每月称重将用于促进遵守。对照组将接受相同的初始会话和每月称重，以及纸质日记上的人类反馈，以控制mHealth-BWL中的联系。将在基线、3、6、12和18个月时进行评估，以体重减轻为主要结局。 拟议的项目通过探索流行的智能手机技术提供经验验证的行为策略的好处来解决肥胖的重大问题。如果有效，移动健康方法可以用于使用广泛采用的智能手机技术以相对较低的成本提供BWL。

DESCRIPTION (provided by applicant): The efficacy of behavioral weight loss treatment (BWL) has been demonstrated in large trials such as the Diabetes Prevention Program and LookAHEAD. However, the modality used for BWL delivery (frequent group treatment sessions over several months) has proven impractical outside the research setting. Thus, alternative methods of BWL delivery are need. Initial attempts to deliver BWL via the Internet and community organizations show promise and much has been learned about adapting BWL for delivery through non- traditional channels. However, the weight losses in these studies are often suboptimal due to poor behavioral adherence. We are therefore faced with the challenge of finding new methods of delivering empirically validated BWL that (1) are as efficacious as gold standard BWL, (2) facilitate behavioral adherence, and (3) show promise for dissemination if demonstrated efficacious. Our mobile health (mHealth) approach to delivering BWL via widely adopted smartphone technology shows promise for meeting this challenge. Smartphones are an ideal medium for delivering BWL because adherence may be improved by: (a) intervening on behaviors in real-time in the natural environment, (b) simplifying and personalizing self-monitoring, a vital weight loss strategy, (c) providing immediate personalized feedback to shape eating and physical activity behaviors, and (d) providing tailored education and skills training in frequent brief "bursts." Furthermore, 44 percent of African Americans and Hispanics own a smartphone (30% of Whites) with >50% penetration expected this year. Given these benefits, there is a clear need to examine the efficacy of a smartphone-based BWL within a large-scale trial, and to identify strengths and weaknesses of this approach. We propose to randomly assign 270 overweight/obese adults to 18 months of (a) gold standard Group- BWL, (b) mHealth-BWL, or (c) Control. Participants in Group-BWL will attend group treatment sessions focused on diet, physical activity, and behavior modification. Groups will occur weekly, biweekly, and monthly during months 1-6, 7-12, and 13-18, respectively. Self-monitoring will be conducted via paper diaries with human feedback. Participants in mHealth-BWL will receive the same intervention components delivered via smartphone. Frequent, brief, videos will be used to deliver weight loss lessons. Self-monitoring will be conducted via "apps" with automatic and human feedback. An initial session and monthly weigh-ins will be used to facilitate adherence. The Control group will receive the same initial session and monthly weigh-ins, and human feedback on paper diaries to control for contact in mHealth-BWL. Assessments will be conducted at baseline, 3, 6, 12, and 18 months, with weight loss as the primary outcome. The proposed project addresses the significant problem of obesity by exploring the benefits of popular smartphone technology for delivering empirically validated behavioral strategies. If efficacious, an mHealth approach could be used to deliver BWL for relatively low cost using widely adopted smartphone technology.