Effect of teammates on changes in physical activity in a statewide campaign

Objective—Most Americans do not meet physical activity recommendations. Statewide campaigns can effectively increase activity levels. Reported herein are physical activity outcomes from Shape Up Rhode Island (SURI) 2007, a statewide campaign to increase steps through team-based competition. Given the importance of social networks in behavior change, this paper focused on the effects of team and team characteristics on activity outcomes. Method—For 16-weeks, 5333 adults comprising 652 teams wore pedometers and reported their steps online. Results—Participants’ daily steps increased from 7029(3915) at baseline to 9393(5976) at SURI end (p\u3c.001). There was a significant intraclass correlation for step change among team members (ICC=.09); thus, an individual’s change in steps was influenced by what team they were on. Moreover, baseline team characteristics predicted individual step change; being on a more active team was associated with greater increases in activity for individual members (p\u3c.001), whereas being on a team with a broad range of steps was associated with smaller changes in activity for individual members (p=.02). Conclusion—These findings are the first to suggest that team members influence individual activity outcomes in team-based statewide campaigns. Future research should explore ways to use social network factors to enhance team-based physical activity programs

Personalization Paradox in Behavior Change Apps:Lessons from a Social Comparison-Based Personalized App for Physical Activity

Social comparison-based features are widely used in social computing apps. However, most existing apps are not grounded in social comparison theories and do not consider individual differences in social comparison preferences and reactions. This paper is among the first to automatically personalize social comparison targets. In the context of an m-health app for physical activity, we use artificial intelligence (AI) techniques of multi-armed bandits. Results from our user study (n=53) indicate that there is some evidence that motivation can be increased using the AI-based personalization of social comparison. The detected effects achieved small-to-moderate effect sizes, illustrating the real-world implications of the intervention for enhancing motivation and physical activity. In addition to design implications for social comparison features in social apps, this paper identified the personalization paradox, the conflict between user modeling and adaptation, as a key design challenge of personalized applications for behavior change. Additionally, we propose research directions to mitigate this Personalization Paradox

Secondary data analysis from a randomized trial examining the effects of small financial incentives on intrinsic and extrinsic motivation for weight loss

The purpose of this study was to examine whether (a) an obesity treatment involving financial incentives yields higher levels of extrinsic motivation for weight management compared to an identical intervention without incentives, (b) extrinsic motivation for weight management mediates, or accounts for, the difference in weight loss outcomes between the two interventions, and (c) there is any evidence that financial incentives and associated extrinsic motivation “crowd out” intrinsic motivation for weight control. Participants (N = 153, 80.4% female; body mass index [BMI] = 33.2 ± 5.9) were randomly assigned to a 3-month Web-based behavioral weight loss program (WBWL) or the same program plus small financial incentives delivered consistent with behavioral economics and behavior change theories (WBWL + $). Weight was objectively assessed at baseline, post-treatment (month 3), and after a 9-month no-treatment follow-up phase (month 12). Intrinsic and extrinsic motivation for weight management were assessed at months 3 and 12 using a modified version of the Treatment Self-Regulation Questionnaire (TSRQ), with questions added to specifically target extrinsic motivation related to incentives. Compared to WBWL alone, WBWL +$ had better weight loss and higher levels of both extrinsic and intrinsic motivation for weight management (p-values ≤ .02). Moreover, during the no-treatment follow-up phase, the trajectories of weight regain did not significantly differ between WBWL and WBWL + $ (p = .58). Extrinsic motivation was not a significant mediator of treatment outcomes. These results suggest that modest financial incentives delivered consistent with behavioral economics and behavior change theories do not undermine intrinsic motivation for weight management during obesity treatment; in fact, they yield higher levels of both extrinsic and intrinsic motivation. Additional research is needed to better understand the mechanisms by which incentives improve outcomes in health behavior change interventions. Clinicaltrials.gov number: NCT01560130

An Acceptance-Based Behavioral Intervention for Weight Loss: A Pilot Study

On average, participants in behavioral weight-loss interventions lose 8 kilograms (kg) at 6. months, but there is marked variability in outcomes with some participants losing little or no weight. Individuals with difficulties with internal disinhibition (i.e., eating in response to emotions or thoughts) typically lose less weight in such programs and may require an innovative, specialized approach. This pilot study examined the preliminary acceptability and efficacy of a 24-week acceptance-based behavioral intervention for weight loss among overweight and obese adults reporting difficulty with eating in response to emotions and thoughts. Participants were 21 overweight or obese men and women (mean age = 52.2 ± 7.6. years; baseline mean body mass index = 32.8 ± 3.4). Eighty-six percent completed the 6-month program and a 3-month follow-up assessment. Ratings of program satisfaction averaged 4.9 on a five-point scale. Multilevel modeling analyses indicated participants lost an average of 12.0. kg (SE= 1.4) after 6. months of treatment and 12.1. kg (SE= 1.9) at 3-month follow-up, thus exceeding the weight losses typically seen in behavioral treatment programs. Decreases in internal disinhibition and weight-related experiential avoidance were found at 6- and 3-months follow-up. Greater decreases in weight-related experiential avoidance were associated with greater weight loss at the end of the program (r= .64, p= .002), suggesting a potential mechanism of action. Although there have been a few preliminary studies using acceptance-based approaches for obesity, this is the first study to specifically target emotional overeaters, a subgroup that might be particularly responsive to this new approach. Our findings provide initial support for the feasibility, efficacy, and acceptability of this approach for this subgroup of participants. Further study with longer follow-up, a more diverse sample, and comparison to a standard behavioral program is clearly warranted. © 2011

Feasibility of online behavioral clinical trials: The future of weight management randomized clinical trials?

Abstract Objective Behavioral weight management trials are traditionally conducted in‐person. The COVID‐19 shutdown halted in‐person operations, forcing investigators to develop new methods for remote treatment and assessment delivery without additional funding for website development or remote equipment. This study examined the feasibility and acceptability of remote procedures from an ongoing weight management trial impacted by COVID‐19. Methods Using a quasi‐experimental longitudinal design, in‐person (pre‐COVID) and remote (COVID) treatment and assessment procedures were used. Attendance at in‐person versus remote (videoconference) treatment sessions was compared. Acceptability of treatment modalities (in‐person vs. remote) was examined via self‐report. Validity and reliability were assessed on bathroom scales. Attendance at remote (videoconference + mailed, scales) versus in‐person assessment sessions was compared. Finally, exploratory analyses were conducted to determine whether participant characteristics moderated the effects. Results Remote treatment attendance was significantly better than in‐person. Overall, there was no significant difference in modality preference. However, Hispanic (vs. non‐Hispanic) individuals had greater preference for remote options and attended more remote treatment sessions. Bathroom scales demonstrated excellent validity and reliability. Adherence to remote and in‐person assessment sessions was similar. Conclusions COVID‐19 has provided an opportunity to rethink how we conduct research. Results herein establish an evidence‐base to support a paradigm shift to remote clinical trial procedures. Such a shift may enhance diversity in clinical trials