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Journal article
BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight Loss Treatment Sequences
Annals of behavioral medicine, v 56(3)
01 Mar 2022
PMID: 34415011
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
State-of-the-art behavioral weight loss treatment (SBT) can lead to clinically meaningful weight loss, but only 30-60% achieve this goal. Developing adaptive interventions that change based on individual progress could increase the number of people who benefit.
Conduct a Sequential Multiple Assignment Randomized Trial (SMART) to determine the optimal time to identify SBT suboptimal responders and whether it is better to switch to portion-controlled meals (PCM) or acceptance-based treatment (ABT).
The BestFIT trial enrolled 468 adults with obesity who started SBT and were randomized to treatment response assessment at Session 3 (Early TRA) or 7 (Late TRA). Suboptimal responders were re-randomized to PCM or ABT. Responders continued SBT. Primary outcomes were weight change at 6 and 18 months.
PCM participants lost more weight at 6 months (-18.4 lbs, 95% CI -20.5, -16.2) than ABT participants (-15.7 lbs, 95% CI: -18.0, -13.4), but this difference was not statistically significant (-2.7 lbs, 95% CI: -5.8, 0.5, p = .09). PCM and ABT participant 18 month weight loss did not differ. Early and Late TRA participants had similar weight losses (p = .96), however, Early TRA PCM participants lost more weight than Late TRA PCM participants (p = .03).
Results suggest adaptive intervention sequences that warrant further research (e.g., identify suboptimal responders at Session 3, use PCMs as second-stage treatment). Utilizing the SMART methodology to develop an adaptive weight loss intervention that would outperform gold standard SBT in a randomized controlled trial is an important next step, but may require additional optimization work.
ClinicalTrials.gov identifier; NCT02368002.
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Details
- Title
- BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight Loss Treatment Sequences
- Creators
- Nancy E Sherwood (Corresponding Author) - University of MinnesotaA Lauren Crain - HealthPartnersElisabeth M Seburg - HealthPartnersMeghan L Butryn - Drexel UniversityEvan M Forman - Drexel UniversityMelissa M Crane - Rush UniversityRona L Levy - University of WashingtonAlicia S Kunin-Batson - University of MinnesotaRobert W Jeffery - University of Minnesota
- Publication Details
- Annals of behavioral medicine, v 56(3)
- Publisher
- Oxford University Press
- Grant note
- R01 CA188892 / NCI NIH HHS P30 DK111022 / NIDDK NIH HHS P30 DK092924 / NIDDK NIH HHS T32 DK083250 / NIDDK NIH HHS P30 DK050456 / NIDDK NIH HHS
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Psychological and Brain Sciences (Psychology); WELL Center
- Web of Science ID
- WOS:000756701600001
- Scopus ID
- 2-s2.0-85121457727
- Other Identifier
- 991019168188804721
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- Collaboration types
- Domestic collaboration
- Web of Science research areas
- Psychology, Multidisciplinary