Michele L. Patel, PhD is an Instructor at the Stanford University School of Medicine. Her research focuses on optimizing digital health interventions for treating obesity. She is particularly interested in improving engagement in these interventions and examining the impact of psychosocial factors on treatment success.
Dr. Patel received a K23 career development award from NIH (2022-2027). This work investigates the most potent combination of self-monitoring strategies in a behavioral weight loss intervention for adults with overweight or obesity. Dr. Patel is interested in using digital tools such as commercial apps, wearables, text-messaging, and telehealth to improve access to and engagement in treatment.
Dr. Patel received her BA in psychology from Duke University in 2010 and her PhD in clinical psychology from Duke in 2018. She completed her clinical internship at the VA Palo Alto, specializing in behavioral medicine, and her postdoctoral fellowship at the Stanford Prevention Research Center.
Primary Research Interests:
-- Conducting clinical trials to evaluate digital health interventions for obesity
-- Improving engagement in self-monitoring and other behavioral intervention strategies
-- Examining the impact of psychosocial factors (e.g., health literacy, stress) on treatment success
-- Applying the Multiphase Optimization Strategy (MOST) framework to efficiently construct behavioral interventions
Instructor, Medicine - Stanford Prevention Research Center
Honors & Awards
K23 Mentored Patient-Oriented Research Career Development Award, NIDDK/NIH (2022-2027)
Outstanding Dissertation Award, Society of Behavioral Medicine (2019)
Aleane Webb Dissertation Research Fellowship, The Graduate School, Duke University (2017)
Dissertation Research Award, American Psychological Association (2016)
E. Bayard Halsted Scholarship (full tuition), The Graduate School, Duke University (2016)
George A. Bray Master's Thesis Award, The Obesity Society (2015)
Karl E. Zener Award for Outstanding Performance of a Major in Psychology, Duke University (2010)
Boards, Advisory Committees, Professional Organizations
Member, The Obesity Society
Member, Society of Behavioral Medicine
Member, American Psychological Association
Postdoctoral Fellowship, Stanford University (2021)
PhD, Duke University (2018)
Internship, Clinical Psychology, VA Palo Alto Health Care System (2018)
Master of Arts, Duke University (2014)
Bachelor of Arts, Duke University (2010)
Ignite Pilot: Goal Setting in a Digital Weight Loss Intervention
The goal of this pilot trial is to learn about the optimal intensity level of goals in a digital weight loss intervention among adults with overweight or obesity. The main questions of the study are to assess the feasibility and acceptability of different goal intensities across four domains (calorie goal, step goal, eating window goal, red zone food goal). The investigators will recruit 32 total participants to the trial. Recruitment will occur through remote channels. Interested individuals will be directed to an online screening questionnaire; those who are eligible will then be invited to attend an initial remote session with study personnel to ensure interest and eligibility in the study. The weight loss intervention will last 10 weeks, and all participants will receive a "core" treatment consisting of self-monitoring weight, food intake, and steps (all via digital tools provided by the study team), along with behavioral lessons, action plans, and tailored feedback. Depending on which group participants are assigned to in the study, individuals will receive either a more or less challenging goal across the four domains. All study tasks will occur remotely, thus, participants will never come in-person for any tasks. Assessment of body weight and other measures will occur at the beginning of the trial ("baseline"), and at 4 weeks and 10 weeks. The investigators will use the Multiphase Optimization Strategy (MOST) framework to identify which of the goal intensity levels result in meaningful engagement and weight loss. The current study is the first step towards answering this question; it is designed as a pilot factorial trial, which focuses on feasibility and acceptability. In total, there will be 16 treatment conditions.
Spark: Finding the Optimal Tracking Strategy for Weight Loss in a Digital Health Intervention
This optimization trial will examine three tracking (or "self-monitoring") strategies for weight loss -- tracking dietary intake, steps, and/or body weight -- all delivered through digital health tools. The purpose of the study is to evaluate the combination of these strategies that maximizes 6-month weight loss in the context of a standalone digital health intervention for adults with overweight or obesity. The investigators will recruit 176 total participants to the trial. Recruitment will occur through remote channels. Interested individuals will be directed to an online screening questionnaire; those who are eligible will then be invited to attend an initial remote session with study personnel to ensure interest and eligibility in the study. The weight loss intervention will last 6 months, and all participants will receive a "core" treatment consisting of goal setting, behavioral lessons, action plans, and tailored feedback - all of which will be delivered remotely. Depending on which group participants are assigned to in the study, some individuals will be asked to track their dietary intake, their steps, and/or their body weight via digital tools. All study tasks will occur remotely, thus, participants never need to come in-person for any intervention or assessment tasks. The investigators will use the Multiphase Optimization Strategy (MOST) framework to identify the most effective combination of self-monitoring strategies. The factorial design will allow the research team to determine the unique and combined impact of each self-monitoring component on weight change. The primary outcome is weight change from baseline to 6 months. The research team will also assess self-monitoring engagement over 6 months and its association with weight change. To complement the main trial, the research team will also randomize half of participants to receive an interactive orientation video, in order to assess its impact on trial retention at 6 months. Overall, the information gathered from this trial will enable the construction of an optimized digital health intervention for weight loss that can be delivered remotely, which, if found to be effective, could have high potential for scalability.
Pilot Grant: Optimizing behavioral obesity treatment using digital health for racial/ethnic minority populations, Stanford University Spectrum Pilot Grants Program (2020 - 2021)
Obesity disproportionately affects racial/ethnic minority populations, yet these groups are under-represented in behavioral weight loss treatment. Remotely-delivered digital interventions have the potential to broaden reach and minimize some of the traditional barriers to enrolling in these treatments. Self-monitoring, such as tracking dietary intake, is an effective behavioral approach that can be delivered remotely; however, it is unknown whether a detailed versus simplified diet tracking approach is most acceptable and feasible among racial/ethnic minority groups. Using mixed methods, this project will first compare these two strategies in the context of a 3-month digital weight loss intervention among 40 racial/ethnic minority adults with overweight/obesity to determine feasibility and acceptability of study procedures; then, qualitative interviews with 10 participants will gather feedback on acceptability of each self-monitoring approach as well as barriers to and facilitators of intervention engagement.
Palo Alto, California
For More Information:
K23: Optimizing self-monitoring in a digital health intervention for weight loss, Stanford University (2022 - 2027)
NIH Career Development Award (K23DK129805): Behavioral obesity treatments can produce clinically significant weight loss but are often too costly or intensive to be implemented on a large scale. Standalone digital health interventions offer greater scalability than traditional in-person approaches, but produce only modest weight loss. To maximize efficacy, it is vital to determine the “active ingredients” of an intervention and eliminate the ineffective, or even detrimental, ones. Self-monitoring is a core component of behavioral obesity treatment that can be delivered via digital tools, yet little is known about the unique and combined impact of different self-monitoring strategies. Dr. Michele Patel will address this gap by applying an innovative framework – the Multiphase Optimization Strategy (MOST) – to identify the most potent combination of digital self-monitoring strategies for weight loss.
Dr. Patel will conduct a 6-month optimization trial that randomizes 176 adults with overweight/obesity to 0-3 self-monitoring components (tracking dietary intake, physical activity, and/or body weight) using a full factorial design. This study will leverage existing commercial platforms for self-monitoring, including a mobile app, wearable activity monitor, and wireless electronic scale. All participants will also receive an empirically- and theory-informed core weight loss intervention that includes goal setting, weekly tailored feedback, action plans, and behavioral skills training – components that enhance engagement and are well-supported by prior research.
Aim 1a: examine the optimal combination of self-monitoring strategies that maximizes 6-month weight loss
Aim 1b: examine self-monitoring engagement and its association with weight loss
Aim 2: evaluate barriers to and facilitators of engaging in these self-monitoring strategies, which will be assessed via semi-structured qualitative interviews
Aim 3: assess a novel, interactive recruitment strategy via an embedded trial
Remote (anywhere in the U.S.)
For More Information:
Pilot Grant: Goal-setting in a standalone, digital weight loss intervention: a pilot factorial trial (2023 - Present)
Using a mixed methods approach, this project will first consist of a pilot factorial trial of four types of goals that vary in how challenging they are to attain. We will evaluate the feasibility and acceptability of these different types of goals among 32 adults with overweight/obesity in a 3-month digital weight loss intervention. Next, we will evaluate barriers to and facilitators of intervention engagement through semi-structured qualitative interviews with a subset of participants. Integrating the trial’s quantitative findings with the qualitative feedback will allow our study team to make any needed modifications prior to conducting a fully-powered trial to evaluate efficacy of these goals.
Palo Alto, California
For More Information:
Independent Studies (3)
- Community Health and Prevention Research Master's Thesis Writing
CHPR 399 (Win)
- Curricular Practical Training and Internship
CHPR 290 (Win)
- Undergraduate Research
CHPR 199 (Aut, Win, Spr, Sum)
- Community Health and Prevention Research Master's Thesis Writing
Moderators of a diet and physical activity intervention: who responds best to sequential vs. simultaneous approaches
International Journal of Behavioral Medicine
View details for DOI 10.1007/s12529-023-10223-9
Detailed Versus Simplified Dietary Self-monitoring in a Digital Weight Loss Intervention Among Racial and Ethnic Minority Adults: Fully Remote, Randomized Pilot Study.
JMIR formative research
2022; 6 (12): e42191
Detailed self-monitoring (or tracking) of dietary intake is a popular and effective weight loss approach that can be delivered via digital tools, although engagement declines over time. Simplifying the experience of self-monitoring diet may counteract this decline in engagement. Testing these strategies among racial and ethnic minority groups is important as these groups are often disproportionately affected by obesity yet underrepresented in behavioral obesity treatment.In this 2-arm pilot study, we aimed to evaluate the feasibility and acceptability of a digital weight loss intervention with either detailed or simplified dietary self-monitoring.We recruited racial and ethnic minority adults aged ≥21 years with a BMI of 25 kg/m2 to 45 kg/m2 and living in the United States. The Pacific time zone was selected for a fully remote study. Participants received a 3-month stand-alone digital weight loss intervention and were randomized 1:1 to either the detailed arm that was instructed to self-monitor all foods and drinks consumed each day using the Fitbit mobile app or to the simplified arm that was instructed to self-monitor only red zone foods (foods that are highly caloric and of limited nutritional value) each day via a web-based checklist. All participants were instructed to self-monitor both steps and body weight daily. Each week, participants were emailed behavioral lessons, action plans, and personalized feedback. In total, 12 a priori benchmarks were set to establish feasibility, including outcomes related to reach, retention, and self-monitoring engagement (assessed objectively via digital tools). Acceptability was assessed using a questionnaire. Weight change was assessed using scales shipped to the participants' homes and reported descriptively.The eligibility screen was completed by 248 individuals, of whom 38 (15.3%) were randomized, 18 to detailed and 20 to simplified. At baseline, participants had a mean age of 47.4 (SD 14.0) years and BMI of 31.2 (SD 4.8) kg/m2. More than half (22/38, 58%) were identified as Hispanic of any race. The study retention rate was 92% (35/38) at 3 months. The detailed arm met 9 of 12 feasibility benchmarks, while the simplified arm met all 12. Self-monitoring engagement was moderate to high (self-monitoring diet: median of 49% of days for detailed, 97% for simplified; self-monitoring steps: 99% for detailed, 100% for simplified; self-monitoring weight: 67% for detailed, 80% for simplified). Participants in both arms reported high satisfaction, with 89% indicating that they would recommend the intervention. Weight change was -3.4 (95% CI -4.6 to -2.2) kg for detailed and -3.3 (95% CI -4.4 to -2.2) kg for simplified.A digital weight loss intervention that incorporated either detailed or simplified dietary self-monitoring was feasible, with high retention and engagement, and acceptable to racial and ethnic minority adults.ASPREDICTED #66674; https://aspredicted.org/ka478.pdf.
View details for DOI 10.2196/42191
View details for PubMedID 36512404
Self-monitoring via digital health in weight loss interventions: A systematic review among adults with overweight or obesity
View details for DOI 10.1002/oby.23088
Comparing Self-Monitoring Strategies for Weight Loss in a Smartphone App: Randomized Controlled Trial.
JMIR mHealth and uHealth
2019; 7 (2): e12209
BACKGROUND: Self-monitoring of dietary intake is a valuable component of behavioral weight loss treatment; however, it declines quickly, thereby resulting in suboptimal treatment outcomes.OBJECTIVE: This study aimed to examine a novel behavioral weight loss intervention that aims to attenuate the decline in dietary self-monitoring engagement.METHODS: GoalTracker was an automated randomized controlled trial. Participants were adults with overweight or obesity (n=105; aged 21-65 years; body mass index, BMI, 25-45 kg/m2) and were randomized to a 12-week stand-alone weight loss intervention using the MyFitnessPal smartphone app for daily self-monitoring of either (1) both weight and diet, with weekly lessons, action plans, and feedback (Simultaneous); (2) weight through week 4, then added diet, with the same behavioral components (Sequential); or (3) only diet (App-Only). All groups received a goal to lose 5% of initial weight by 12 weeks, a tailored calorie goal, and automated in-app reminders. Participants were recruited via online and offline methods. Weight was collected in-person at baseline, 1 month, and 3 months using calibrated scales and via self-report at 6 months. We retrieved objective self-monitoring engagement data from MyFitnessPal using an application programming interface. Engagement was defined as the number of days per week in which tracking occurred, with diet entries counted if ≥800 kcal per day. Other assessment data were collected in-person via online self-report questionnaires.RESULTS: At baseline, participants (84/100 female) had a mean age (SD) of 42.7 (11.7) years and a BMI of 31.9 (SD 4.5) kg/m2. One-third (33/100) were from racial or ethnic minority groups. During the trial, 5 participants became ineligible. Of the remaining 100 participants, 84% (84/100) and 76% (76/100) completed the 1-month and 3-month visits, respectively. In intent-to-treat analyses, there was no difference in weight change at 3 months between the Sequential arm (mean -2.7 kg, 95% CI -3.9 to -1.5) and either the App-Only arm (-2.4 kg, -3.7 to -1.2; P=.78) or the Simultaneous arm (-2.8 kg, -4.0 to -1.5; P=.72). The median number of days of self-monitoring diet per week was 1.9 (interquartile range [IQR] 0.3-5.5) in Sequential (once began), 5.3 (IQR 1.8-6.7) in Simultaneous, and 2.9 (IQR 1.2-5.2) in App-Only. Weight was tracked 4.8 (IQR 1.9-6.3) days per week in Sequential and 5.1 (IQR 1.8-6.3) days per week in Simultaneous. Engagement in neither diet nor weight tracking differed between arms.CONCLUSIONS: Regardless of the order in which diet is tracked, using tailored goals and a commercial mobile app can produce clinically significant weight loss. Stand-alone digital health treatments may be a viable option for those looking for a lower intensity approach.TRIAL REGISTRATION: ClinicalTrials.gov NCT03254953; https://clinicaltrials.gov/ct2/show/NCT03254953 (Archived by WebCite at http://www.webcitation.org/72PyQrFjn).
View details for PubMedID 30816851
DEVELOPMENT, FEASIBILITY, AND ACCEPTABILITY OF A BEHAVIORAL WEIGHT AND SYMPTOM MANAGEMENT INTERVENTION FOR BREAST CANCER SURVIVORS AND INTIMATE PARTNERS.
Journal of cancer rehabilitation
2022; 5: 7-16
Background: Weight gain is common for breast cancer survivors and associated with disease progression, recurrence, and mortality. Traditional behavioral programs fail to address symptoms (i.e., pain, fatigue, distress) experienced by breast cancer survivors that may interfere with weight loss and fail to capitalize on the concordance in weight-related health behaviors of couples. This study aimed to develop and examine the feasibility and acceptability of a behavioral weight and symptom management intervention for breast cancer survivors and their intimate partners.Materials and Methods: Interviews were conducted with N=14 couples with overweight/obesity to develop the intervention. Intervention feasibility and acceptability were examined through a single-arm pilot trial (N=12 couples). Patterns of change in intervention targets were examined for survivors and partners.Results: Themes derived from interviews were used to develop the 12-session couple-based intervention, which included components from traditional behavioral weight management interventions, appetite awareness training, and cognitive and behavioral symptom management protocols. Couples also worked together to set goals, create plans for health behavior change, and adjust systemic and relationship barriers to weight loss. Examples were tailored to the experiences and symptom management needs of breast cancer survivors and partners. The intervention demonstrated feasibility (attrition: 8%; session completion: 88%) and acceptability (satisfaction). Survivors and partners experienced reductions in weight and improvements in physical activity, eating behaviors, emotional distress, and self-efficacy. Survivors evidenced improvements in fatigue and pain.Conclusions: A behavioral weight and symptom management intervention for breast cancer survivors and partners is feasible, acceptable, and is potentially efficacious.
View details for DOI 10.48252/JCR57
View details for PubMedID 35253020
An in-depth comparison of well-being among Latinx and non-Latinx White adults: A cautionary tale.
Preventive medicine reports
2021; 24: 101513
Understanding how to optimize the health and well-being of Latinxs is crucial and will aid in informing actions to address inequities. Latinxs' unique cultural backgrounds and lived experiences could have implications for their well-being, which may differ from other racial/ethnic groups. We compared overall and domain-specific well-being and their socio-demographic correlates among two samples of Latinxs and a sample of non-Latinx Whites. Cross-sectional samples were independently drawn from the Stanford WELL Initiative (n=217 Latinxs, n=943 non-Latinx Whites) and the On the Move Trial (n=238 Latinxs), both recruiting in Northern California. Well-being was assessed using the Stanford WELL scale, a novel multifaceted measure. Propensity score matching and mixed effect regressions were employed to compare well-being between samples. Overall well-being levels did not differ between groups. However, when examining constituent domains of well-being, several differences were found. Both Latinx samples reported experiencing more stress, having worse physical health, and being more religious than did the matched non-Latinx White sample. However, on four other well-being domains, only one of the Latinx samples differed from the non-Latinx White sample. Moreover, the two Latinx samples differed from each other in four out of nine domains examined. When evaluating well-being across racial/ethnic groups, we recommend employing multidimensional measures and multiple samples to promote greater confidence in the conclusions. This approach can better inform future research and the tailoring of public health efforts by furthering our understanding of the nature of group well-being differences. Our methods offer a blueprint for similar studies examining well-being in multi-ethnic groups.
View details for DOI 10.1016/j.pmedr.2021.101513
View details for PubMedID 34401222
Testing the effectiveness of physical activity advice delivered via text messaging vs. human phone advisors in a Latino population: The On The Move randomized controlled trial design and methods.
Contemporary clinical trials
Physical inactivity is a key risk factor for a range of chronic diseases and conditions, yet, approximately 50% of U.S. adults fall below recommended levels of regular aerobic physical activity (PA). This is particularly true for ethnic minority populations such as Latino adults for whom few culturally adapted programs have been developed and tested. Text messaging (SMS) represents a convenient and accessible communication channel for delivering targeted PA information and support, but has not been rigorously evaluated against standard telehealth advising programs. The objective of the On The Move randomized controlled trial is to test the effectiveness of a linguistically and culturally targeted SMS PA intervention (SMS PA Advisor) versus two comparison conditions: a) a standard, staff-delivered phone PA intervention (Telephone PA Advisor) and b) an attention-control arm consisting of a culturally targeted SMS intervention to promote a healthy diet (SMS Nutrition Advisor). The study sample (N = 350) consists of generally healthy, insufficiently active Latino adults ages 35 years and older living in five northern California counties. Study assessments occur at baseline, 6, and 12 months, with a subset of participants completing 18-month assessments. The primary outcome is 12-month change in walking, and secondary outcomes include other forms of PA, assessed via validated self-report measures and supported by accelerometry, and physical function and well-being variables. Potential mediators and moderators of intervention success will be explored to better determine which subgroups do best with which type of intervention. Here we present the study design and methods, including recruitment strategies and yields. Trial Registration: clinicaltrial.gov Identifier = NCT02385591.
View details for DOI 10.1016/j.cct.2020.106084
View details for PubMedID 32659437
Weight Perceptions and Weight Loss Attempts: Military Service Matters.
INTRODUCTION: People who do not perceive themselves as overweight or obese are less likely to use weight loss treatments. However, little is known about weight perceptions and their association with weight loss attempts among people who have served in the military. They represent a special population with regard to weight perceptions as military personnel must meet strict weight standards to remain in military service.MATERIALS AND METHODS: Using data from the U.S.-based 2013-2014 and 2015-2016 National Health and Nutrition Examination Surveys, we fit logistic regression models to determine whether people with overweight or obesity were: (1) more or less likely to underestimate their weight if they reported military service and (2) less likely to attempt weight loss if they underestimated their weight (stratifying by military status). Estimates were adjusted for sociodemographic factors, including objective weight class, gender, age, race/ethnicity, income ratio, comorbidities, and education. This work received exempt status from the Stanford University institutional review board.RESULTS: Among 6,776 participants, those reporting military service had higher odds of underestimating their weight compared to those not reporting military service [OR (odds ratio): 1.44; 95% confidence interval (CI): 1.15, 1.79]. Underestimating weight was associated with lower odds of attempting weight loss among those reporting military service (OR: 0.20; CI: 0.11, 0.36) and those not reporting military service (OR: 0.27; CI: 0.22, 0.34).CONCLUSIONS: This study offers the new finding that underestimating weight is more likely among people reporting military service compared to those not reporting military service. Findings are consistent with past work demonstrating that underestimating weight is associated with a lower likelihood of pursuing weight loss. To combat weight misperceptions, clinicians may need to spend additional time discussing weight-related perceptions and beliefs with patients. The present findings suggest such conversations may be especially important for people reporting military service. Future research should be designed to understand the effects of correcting weight misperceptions. This work would advance the science of weight management and offer ways to increase weight loss treatment engagement, prevent chronic conditions, and improve health outcomes, especially among people reporting military service.
View details for DOI 10.1093/milmed/usz413
View details for PubMedID 31822913
Consistent self-monitoring in a commercial app-based intervention for weight loss: results from a randomized trial.
Journal of behavioral medicine
Self-monitoring is the strongest predictor of success in lifestyle interventions for obesity. In this secondary analysis of the GoalTracker trial, we describe outcomes of consistently self-monitoring in a standalone weight loss intervention. The 12-week intervention focused on daily self-monitoring of diet and/or body weight in a commercial app (MyFitnessPal). Participants (N=100; 21-65years; BMI 25-45kg/m2) were categorized as Consistent Trackers if they tracked ≥6 out of 7days for at least 75% of the targeted weeks. One-fourth of participants were Consistent Trackers. This subset was more likely to be married or living with a partner, be non-Hispanic White, and have higher health literacy than Inconsistent Trackers (ps<.05). Consistent tracking was associated with greater weight change than inconsistent tracking at 1month (mean difference [95% CI] -1.11kg [-2.12, -0.10]), 3months (-2.42kg [-3.80, -1.04]), and 6months (-2.13kg [-3.99, -0.27]). Over 3 times as many Consistent Trackers as Inconsistent Trackers achieved ≥5% weight loss at 3months (48 vs. 13%) and at 6months (54 vs. 15%; ps<.001). Though causality cannot be determined by the present study, tracking weight and/or diet nearly every day per week for 12weeks in a commercial app may serve as an effective strategy for weight loss. Strategies are needed to promote greater consistency in tracking.
View details for DOI 10.1007/s10865-019-00091-8
View details for PubMedID 31396820
Early weight loss in a standalone mHealth intervention predicting treatment success
OBESITY SCIENCE & PRACTICE
2019; 5 (3): 231–37
Early weight loss is a strong predictor of longer-term and clinically meaningful weight loss but has not been studied in the context of mobile health ('mHealth') interventions.GoalTracker was a randomized trial among adults (21-65 years) with overweight or obesity comparing three 12-week standalone mHealth interventions for weight loss. All arms received a free commercial mobile app (MyFitnessPal) for daily self-monitoring of diet and/or weight and a goal to lose 5% of weight by 3 months. Collapsing across arms, this analysis examined participants with a 1-month weight (n = 84), categorizing them as either early responders (≥2% weight loss at 1 month) or early non-responders (<2% weight loss at 1 month).Early responders - 36% of participants - had greater per cent weight change at 3 months (-5.93% [95% confidence interval: -6.82%, -5.03%]) than early non-responders (-1.45% [-2.15%, -0.75%]), which was sustained at 6 months (-5.91% [-7.33%, -4.48%] vs. -1.28% [-2.37%, -0.19%]; ps < 0.0001). Over half (57%) of early responders achieved ≥5% weight loss at 3 months vs. 11% of early non-responders. At 4 weeks, self-monitoring frequency (weight/diet) was significantly greater among early responders, which continued across 12 weeks.Responding early to an mHealth treatment is associated with higher engagement and greater likelihood of achieving clinically meaningful weight loss.
View details for DOI 10.1002/osp4.329
View details for Web of Science ID 000472584400004
View details for PubMedID 31275596
View details for PubMedCentralID PMC6587307
Baseline Psychosocial and Demographic Factors Associated with Study Attrition and 12‐Month Weight Gain in the DIETFITS Trial
View details for DOI 10.1002/oby.22650
Motivational interviewing in eHealth and telehealth interventions for weight loss: A systematic review.
The alarming prevalence of adult obesity warrants consideration of treatments with broad reach; digital health interventions meet this need and have demonstrated efficacy for weight loss. One approach that can be delivered remotely is motivational interviewing - a counseling style that helps resolve ambivalence to change unhealthy behavior. This is the first review to systematically examine eHealth and telehealth interventions that incorporate motivational interviewing for weight loss. We searched four electronic databases (PubMed, Embase, PsycInfo, CINAHL) for publications from November 2009-May 2018. Included papers were weight loss RCTs conducted among adults with overweight or obesity that examined eHealth or telehealth interventions with motivational interviewing, compared to any type of treatment arm without it. Results were presented separately by comparison arm (control vs. active comparator). Sixteen papers (15 trials) were included. Twelve used telephone-based counseling to deliver motivational interviewing, two used email and phone, and one used online chats. When compared to a no-treatment control arm, the motivational interviewing arm was associated with greater weight loss on 6 of 11 occasions, but performed better than an active comparator on only 1 of 7 occasions. Retention and engagement were generally high, though few trials examined the relation with weight loss. No trial had high risk of bias, but five lacked power calculations and only two reported fidelity to motivational interviewing. Telephone-based interventions that incorporate motivational interviewing hold promise as effective obesity treatments. There is a dearth of evidence to support the use of motivational interviewing via eHealth, signaling a needed research area.
View details for DOI 10.1016/j.ypmed.2019.05.026
View details for PubMedID 31153917
A smoking cessation and pain management program for cancer survivors
JOURNAL OF CANCER SURVIVORSHIP
2018; 12 (6): 821–27
Many cancer survivors continue to smoke. Further, most survivors also report high levels of persistent pain and smoke in response to pain. The investigators tested the feasibility, acceptability, and preliminary efficacy of a smoking cessation program paired with a pain management program for cancer survivors.The investigators conducted a two-arm, wait-list randomized controlled pilot study in which they delivered a combined smoking cessation and pain management intervention.The investigators randomized 30 survivors (14 intervention and 16 wait-list control). Seventy-one percent of the survivors who received the intervention rated it as extremely useful (5 out of 5) in helping them quit smoking. Further, 86% would recommend the program to other survivors. Although we could not conduct inferential statistics, 14% of those in the intervention arm, compared to 6% in the control condition had biochemically validated cessation at 2-months post-randomization. Survivors in the intervention also reported less pain, had improvements in depressive symptoms, and better physical function than those in the control arm.Our pilot data suggest the feasibility, acceptability, and preliminary efficacy of this approach. The next step is to conduct a large randomized controlled trial to fully test the efficacy of the intervention.A combined smoking cessation and pain program might help improve both issues simultaneously.
View details for DOI 10.1007/s11764-018-0719-3
View details for Web of Science ID 000449874500011
View details for PubMedID 30328056
Health Literacy and Weight Change in a Digital Health Intervention for Women: A Randomized Controlled Trial in Primary Care Practice
JOURNAL OF HEALTH COMMUNICATION
2016; 21: 34–42
In the United States, 90 million adults have low health literacy. An important public health challenge is developing obesity treatment interventions suitable for those with low health literacy. The objective of this study was to examine differences in sociodemographic and clinical characteristics as well as weight and intervention engagement outcomes by health literacy. We randomized 194 participants to usual care or to the Shape Program intervention, a 12-month digital health treatment aimed at preventing weight gain among overweight and Class I obese Black women in primary care practice. We administered the Newest Vital Sign instrument to assess health literacy. More than half (55%) of participants had low health literacy, which was more common among those with fewer years of education and lower income. There was no effect of health literacy on 12-month weight change or on intervention engagement outcomes (completion of coaching calls and interactive voice response self-monitoring calls). Low health literacy did not preclude successful weight gain prevention in the Shape Program intervention. Goal-focused behavior change approaches like that used in Shape may be particularly helpful for treating and engaging populations with low health literacy.
View details for PubMedID 27043756
View details for PubMedCentralID PMC4935541
Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review
2014; 15: 146–58
Electronic health (eHealth) interventions have demonstrated efficacy for weight management. However, little is known about their efficacy among racial/ethnic minority populations, in whom there is a disproportionate prevalence of obesity. This systematic review evaluated the efficacy of eHealth weight management interventions among overweight and obese racial/ethnic minority adults. We required that trial samples be comprised of at least 50% racial/ethnic minorities or report outcomes by race/ethnicity. We searched five electronic databases for trials conducted through June 2012. Six papers met our eligibility criteria. These studies provide suggestive evidence that eHealth interventions can produce low magnitude, short-term weight loss among racial/ethnic minorities. Trials were methodologically sound, with high retention and participant engagement. There was no evidence detailing the efficacy of mobile health approaches, although this area is promising given high utilization rates of mobile devices among racial/ethnic minorities. More evidence, particularly from longer-term trials, is necessary to demonstrate that eHealth intervention approaches can produce clinically meaningful (≥ 5% of initial body weight) weight loss among racial/ethnic minority populations.
View details for DOI 10.1111/obr.12218
View details for Web of Science ID 000341832700009
View details for PubMedID 25196411
The Effect of a "Maintain, Don't Gain" Approach to Weight Management on Depression Among Black Women: Results From a Randomized Controlled Trial
AMERICAN JOURNAL OF PUBLIC HEALTH
2014; 104 (9): 1766–73
We evaluated the effect of a weight gain prevention intervention (Shape Program) on depression among socioeconomically disadvantaged overweight and obese Black women.Between 2009 and 2012, we conducted a randomized trial comparing a 12-month electronic health-based weight gain prevention intervention to usual primary care at 5 central North Carolina community health centers. We assessed depression with the Patient Health Questionnaire (PHQ-8). We analyzed change in depression score from baseline to 12- and 18-month follow-up across groups with mixed models. We used generalized estimating equation models to analyze group differences in the proportion above the clinical threshold for depression (PHQ-8 score ≥ 10).At baseline, 20% of participants reported depression. Twelve-month change in depression scores was larger for intervention participants (mean difference = -1.85; 95% confidence interval = -3.08, -0.61; P = .004). There was a significant reduction in the proportion of intervention participants with depression at 12 months with no change in the usual-care group (11% vs 19%; P = .035). All effects persisted after we controlled for weight change and medication use. We saw similar findings at 18 months.The Shape Program, which includes no mention of mood, improved depression among socioeconomically disadvantaged Black women.
View details for PubMedID 25033150
View details for PubMedCentralID PMC4151935
Availability of and Ease of Access to Calorie Information on Restaurant Websites
2013; 8 (8): e72009
Offering calories on restaurant websites might be particularly important for consumer meal planning, but the availability of and ease of accessing this information are unknown.We assessed websites for the top 100 U.S. chain restaurants to determine the availability of and ease of access to calorie information as well as website design characteristics. We also examined potential predictors of calorie availability and ease of access.Eighty-two percent of restaurants provided calorie information on their websites; 25% presented calories on a mobile-formatted website. On average, calories could be accessed in 2.35±0.99 clicks. About half of sites (51.2%) linked to calorie information via the homepage. Fewer than half had a separate section identifying healthful options (46.3%), or utilized interactive meal planning tools (35.4%). Quick service/fast casual, larger restaurants, and those with less expensive entrées and lower revenue were more likely to make calorie information available. There were no predictors of ease of access.Calorie information is both available and largely accessible on the websites of America's leading restaurants. It is unclear whether consumer behavior is affected by the variability in the presentation of calorie information.
View details for PubMedID 23977193
Weight gain prevention among black women in the rural community health center setting: The Shape Program
BMC PUBLIC HEALTH
2012; 12: 305
Nearly 60% of black women are obese. Despite their increased risk of obesity and associated chronic diseases, black women have been underrepresented in clinical trials of weight loss interventions, particularly those conducted in the primary care setting. Further, existing obesity treatments are less effective for this population. The promotion of weight maintenance can be achieved at lower treatment intensity than can weight loss and holds promise in reducing obesity-associated chronic disease risk. Weight gain prevention may also be more consistent with the obesity-related sociocultural perspectives of black women than are traditional weight loss approaches.We conducted an 18-month randomized controlled trial (the Shape Program) of a weight gain prevention intervention for overweight black female patients in the primary care setting. Participants include 194 premenopausal black women aged 25 to 44 years with a BMI of 25-34.9 kg/m2. Participants were randomized either to usual care or to a 12-month intervention that consisted of: tailored obesogenic behavior change goals, self-monitoring via interactive voice response phone calls, tailored skills training materials, 12 counseling calls with a registered dietitian and a 12-month YMCA membership.Participants are followed over 18 months, with study visits at baseline, 6-, 12- and 18-months. Anthropometric data, blood pressure, fasting lipids, fasting glucose, and self-administered surveys are collected at each visit. Accelerometer data is collected at baseline and 12-months.At baseline, participants were an average of 35.4 years old with a mean body mass index of 30.2 kg/m2. Participants were mostly employed and low-income. Almost half of the sample reported a diagnosis of hypertension or prehypertension and 12% reported a diagnosis of diabetes or prediabetes. Almost one-third of participants smoked and over 20% scored above the clinical threshold for depression.The Shape Program utilizes an innovative intervention approach to lower the risk of obesity and obesity-associated chronic disease among black women in the primary care setting. The intervention was informed by behavior change theory and aims to prevent weight gain using inexpensive mobile technologies and existing health center resources. Baseline characteristics reflect a socioeconomically disadvantaged, high-risk population sample in need of evidence-based treatment strategies.The trial is registered with clinicaltrials.gov NCT00938535.
View details for DOI 10.1186/1471-2458-12-305
View details for Web of Science ID 000305278200001
View details for PubMedID 22537222
View details for PubMedCentralID PMC3439671