PROJECT SUMMARY
In-person behavioral weight loss (WL) programs are the gold standard of obesity treatment, but remote-based
interventions are becoming increasingly utilized as they overcome barriers common to in-person programs
(e.g., geographical, time, and travel constraints) and represent a more translatable intervention model. Yet,
remote WL interventions can vary substantially, and questions remain regarding which type is most effective
and whether there are certain groups of individuals who respond best to one type over another. For example,
our fully automated, online program produces a 4.5% WL on average and about half of participants achieve a
WL ≥5%. While this low-touch intervention is effective for many, others have limited success and may benefit
from a different type of remote intervention (e.g., group-based videoconference program, resembling in-person
treatment) or more individual support (e.g., via coaching). This trial utilizes a 2x2 factorial design to compare
two remote-delivery formats (automated online program vs. group-based videoconference program) and the
added effect of coaching (vs. no coaching) on 12-month WL. Direct comparisons of these approaches have
been limited. From a personalized medicine perspective, it is also important to understand for whom each
remote approach should be recommended. Thus, an additional aim is to develop two algorithms which could
be used to refer patients into remote WL programs. The ‘widely-applicable’ algorithm will use metrics common
to electronic medical records (sex, BMI, age, race, ethnicity), and the ‘more comprehensive’ algorithm will
further include additional baseline characteristics (e.g., education, household income, health literacy, group
preference, etc). Participants will be randomized at baseline (out of 4 possible combinations) and receive a 12-
month, remote-based behavioral WL program. All programs include daily self-monitoring of diet, exercise, and
weight and the provision of automated feedback. Those receiving the online program will also be instructed to
view video lessons (24 in total, 10-15 min each) which focus on behavioral strategies for changing diet and
exercise. Individuals randomized to the videoconference program will participate in 24 group sessions (1 hour
each) designed to mimic in-person treatment and allow for participant interaction via large and small group
discussions. Coaching calls (10-15 min each) will be monthly and focus on individual barriers, problem solving,
goal setting, and fostering support and accountability. Assessments will occur at baseline, 6 (mid-treatment),
12 (post-treatment), and 18 months (following 6 months of no intervention). Secondary aims will examine the
effects of delivery format and coaching on intervention engagement (e.g., frequency of self-monitoring),
psychosocial outcomes (e.g., perceived support, self-efficacy, and motivation), 18-month WL, and the cost per
kilogram of WL (to examine whether the addition of human support is cost-effective). Study findings have the
potential to inform patient referrals and insurance coverage decisions for remote WL treatment.
