Lifestyle interventions have had established efficacy for decades but they are costly and have poor scalability.
Remotely delivered lifestyle interventions have increased the potential for scale and systematic reviews have
found that they are effective, especially those that include human coaching. Some remote lifestyle
interventions are synchronous, such that they are delivered via videoconferencing or phone. Other remote
lifestyle interventions are asynchronous, such that they are delivered via online platforms that allow for
clinicians and patients to engage via text exchanges or via online groups where patients engage with a
clinician and each other by posting messages and contributing to discussion threads. The advantage of
asynchronous approaches is 24/7 accessibility which makes them conducive to “just in time” support, allowing
patients to engage anytime they want to, as opposed to in scheduled blocks of time each week. Asynchronous,
remote interventions may also be more scalable than synchronous remote interventions. We conducted a trial
of two asynchronous, remote lifestyle interventions—one with a group of 94 participants and one with a group
of 40 participants. Findings revealed similar weight loss and acceptability between conditions. We also found
that the larger group was more sustainable, such that participants continued to engage in the group for longer
when we turned the groups over to participants to lead themselves for a year after the intervention ended—a
period we referred to as the peer-led maintenance phase. The next step in this research is to examine how an
asynchronous, remote intervention compares to a synchronous, remote intervention, not only in short term
weight loss, but also in sustainability, scalability, and weight loss maintenance. Now that we’ve established the
feasibility of conducing large asynchronous, remote groups, in the proposed trial we will randomize participants
to large groups (n=82) in both conditions, which will allow us to compare synchronous to asynchronous remote
interventions that are scaled up to a level that we have established is acceptable for asynchronous remote
interventions. The purpose of the proposed trial is to determine whether an asynchronous, remote lifestyle
intervention is non-inferior to a synchronous, remote lifestyle intervention in weight loss at 6 and 12 months,
but more scalable and sustainable, and thus producing greater weight loss maintenance at 18 and 24 months.
Establishing evidence for asynchronous interventions is more important than ever given that telehealth
reimbursement for behavioral health has recently expanded but is still limited to synchronous forms of remote
care. Asynchronous interventions may be more convenient for some people and possibly more scalable but for
this treatment model to reach its potential, evidence for efficacy is needed to inform reimbursement policy. We
hypothesize that an asynchronous, remote lifestyle intervention will produce similar initial weight loss as a
synchronous, remote version but will be less expensive, more sustainable, and generate greater collective
efficacy, which will drive greater weight loss maintenance at 18 and 24 months.
