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Background: 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.Purpose: 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).Method: 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.Results: 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).Conclusions: 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.Clinical Trial Information: ClinicalTrials.gov identifier; NCT02368002. [ABSTRACT FROM AUTHOR]

Although a considerable body of evidence supports telephone quit lines for smoking cessation, much less is known about the effectiveness of proactive Telephone Counseling with smokeless tobacco (ST) users. We conducted a randomized controlled trial comparing Telephone Counseling with the distribution of a self-help manual for ST cessation. We recruited 406 adult ST users throughout the state of Minnesota and randomized them to receive either: (a) a self-help manual (Manual only) or (b) a self-help manual plus proactive telephone-based cessation counseling (Telephone Counseling). The telephone-based treatment included up to four calls in support of quitting, and personalized various cognitive and behavioral strategies that are generally considered effective in tobacco cessation (such as setting a quit date, examining patterns of use, developing stress reduction skills, avoiding known triggers to use). Participants were surveyed by phone at 3 and 6 months to assess both point prevalence and continued abstinence. Prolonged abstinence from all tobacco was 6.8% and 30.9% (p<.001) at 3 months and 9.8% and 30.9% (p<.001) at 6 months in Manual only and Telephone Counseling, respectively. We found older age, lower dependency, and increased readiness predicted quitting success. Proactive telephone-based counseling is an effective strategy for improving cessation rates among ST users. Future research should determine the components contributing to the intervention success. [ABSTRACT FROM AUTHOR]

Background: Six months of loss followed by gradual regain to baseline is descriptive of most weight toss attempts. Purpose: This study sought to identify thoughts and feelings accompany-ing weight loss that might explain the phenomenon. Methods: Thoughts, feelings, and body weight were measured weekly for 6 months in 41 women receiving behavioral treatment for obesity. Results: Overall, the weight loss experience of these women was positive, requiring modest time and effort and being associated with more positive than negative thoughts and experiences. Over lime, however, positive but not negative reactions to the weight loss experience decreased, as did the strength of beliefs that the benefits of weight loss were worth the effort. In addition, we found no relation between the women's perception of effort and weight loss results. Conclusions: Inadequate long-term rewards for behaviors needed for weight control may be an important cause of frequent weight loss failures. [ABSTRACT FROM AUTHOR]