Miro-randomized Trial for Optimizing a JITAI to Reduce Dietary Lapses in Obesity Treatment

"The Enhanced Education intervention option seeks to: 1) enhance understanding of personal health-behavior links, 2) improve health literacy by checking the adequacy of participant understanding, and 3) remind participant of important elements of Behavioral Obesity Treatment (BOT) dietary goals."

"This intervention option is based on a previously established self-efficacy intervention for weight loss, which is a multi-component intervention for increasing self-efficacy. To provide variety in this intervention option and limit time spent in a single intervention, components are split into independent modules that either prompt: 1) attainable intention setting related to dietary adherence (e.g., I will focus on eating mostly fruits/vegetables in my next meal/snack in order to take back control of my eating); 2) barrier identification for adhering to dietary goals along with a brief problem-solving exercise; 3) devising a small self-reward; OR 4) self-assessment of thoughts/behaviors that could interfere with dietary adherence in the next several hours with coping strategies (e.g., stimulus control, social support)."

"To provide variety in this intervention option and limit time spent in a single intervention, components are split into independent modules that either: 1) guide participants in identifying values related to weight control (e.g., longevity, quality of life, being a role model) and connect those values to their behavior in the current moment.; 2) use a collaborative non-judgmental approach to explore the consequences of letting barriers drive behavior (e.g., Take a moment to consider the effect on your longevity if you let your preference for sweets determine your behavior.); 3) prompt participants to identify reasons for change, thereby eliciting change talk; OR 4) engage participants in a brief self-assessment of motivation for dietary adherence (i.e., On a scale of 1-10, how important to you is it to stick to your dietary goals today)."

"There are 4 independent modules that prompt self-monitoring and self-awareness efforts: 1) advise participants to record everything that they eat before they eat it, with attention to eating in the subsequent few hours; 2) use the traffic light model to enhance awareness of dietary intake. This module provides the traffic light categories of foods (i.e., green=healthiest choices, yellow=sometimes choices, and red=rare choices), and asks participants to check-off foods that they intend to eat vs. stay away from in the next few hours; 3) advise participants to track portion sizes carefully and provide a portion size guide that is available to them until the following EMA survey; OR 4) provide a tutorial on noticing hunger/satiety cues and slowing down rate of eating, with an experiential exercise for use during their next eating episode."

"Participants will be notified that the JITAI algorithm has determined heightened lapse risk in the following 2-3 hours (i.e., We have detected that your risk of lapsing from your weight loss diet is higher than usual and may require attention.)."

The online BOT consists of: (a) 12 weekly multimedia lessons for training in behavioral weight loss skills; (b) online tools for self-monitoring weight, diet, and physical activity; and (c) weekly automated text-based feedback on progress to date. Participants are given a goal of losing 1-2lbs per week to achieve a total weight loss of ≥10% of initial body weight. Participants are prescribed a calorie goal of 1200-1800 kcal/day tailored on initial weight. Participants are given guidelines to follow a lowfat or Mediterranean diet to meet the prescribed calorie goal. Participants are given a physical activity goal tailored on initial activity level that gradually increases to 200 min/wk of activity, emphasizing brisk walking as the primary form of activity. They also receive a primer in self-monitoring weight, diet, and physical activity. Participants are instructed to self-monitor and follow the prescribed diet for the 6-month study period.