An Adaptive Telephone Coaching Intervention for Patients in an Online Weight Loss Program

Importance Weight loss (WL) during the first month of a behavioral program is associated with longer-term WL. Testing of translatable and adaptive obesity programs is needed. Objective To compare brief, extended, and no telephone coaching for individuals with suboptimal response (ie, 1-month WL lt;4%) within an online WL program. Design, Setting, and Participants This randomized clinical trial with enrollment between March 2019 and April 2022 (data collection completed May 2023) was conducted at an academic research center in the US. Eligible participants included adults aged 18 to 70 years with daily access to internet and a body mass index between 25 and 45. Interventions All participants received an automated online WL program (4 months) and WL maintenance program (8 months), consisting of video lessons, self-monitoring, and personalized feedback. Participants were randomized, such that individuals with suboptimal response received either brief telephone coaching (3 calls during weeks 5-8), extended telephone coaching (12 calls during weeks 5-16), or no coaching (control). Coaching included education, problem solving, and goal setting, and promoted engagement with the online program. Main Outcomes and Measures The primary outcomes were percent weight change and proportion of participants achieving 5% or greater WL at 4 and 12 months. A priori hypotheses for WL were that WL for extended coaching would be greater than for brief coaching, and both extended and brief coaching would be greater than no coaching (control). A longitudinal mixed-effects model with participant-specific intercept was used to examine intervention effects on percent WL at 4 and 12 months. Secondary analyses focused on program engagement and cost/kilogram of WL. Results The study included a total of 437 participants who reported WL at 1 month (mean SD age, 50. 8 11. 4 years; mean SD BMI, 34. 6 5. 0; 305 female 69. 8% and 132 male 30. 2%) with 148 randomized to extended coaching, 143 assigned to brief coaching, and 146 assigned to the control group. Of all participants, 346 (79. 2%) were considered to have a suboptimal response. WL at 4 months was significantly greater in the extended coaching group (mean SD WL, −7. 0% 5. 1%) and brief coaching group (mean SD WL, −6. 2% 4. 7%) vs the control group (mean SD WL, −4. 5% 4. 7%) (P lt;. 001). Similarly, the proportion of participants achieving 5% or greater WL at 4 months was greater in the extended coaching group (89 participants 65. 9%) and brief coaching group (77 participants 58. 5%) vs control group (46 participants 36. 5%) (P lt;. 001). At 12 months, a similar pattern was observed for achievement of 5% WL or greater (extended coaching, 63 participants 48. 1%; brief coaching, 58 participants 45. 9%; control, 38 participants 32. 8%; P =. 03). Percent WL at 12 months was significantly higher in extended coaching vs control (mean SD WL for extended coaching, −5. 5% 6. 7%; mean SD WL for control, −3. 9% 7. 4%; P =. 03) but not for brief coaching (mean SD WL, −4. 9% 6. 1%). Both the brief and extended coaching groups watched more lessons and self-monitored on more days compared with the control group. The cost per additional kilogram of WL, beyond that of the control group, was 50. 09 for brief coaching and 92. 65 for extended coaching. Conclusions and Relevance In this randomized clinical trial testing an adaptive intervention, the provision of coaching for individuals with suboptimal response improved WL and was cost-effective; further testing in clinical settings (eg, health care systems) is warranted. Trial Registration ClinicalTrials. gov Identifier: NCT03867981