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Background We adapted an interactive obesity treatment approach (iOTA) derived from the Diabetes Prevention Program, incorporating short message service (SMS) messaging to supplement in-person health coaching. Treatment was delivered in Community Mental Health Center (CMHC) and the Clubhouse settings. Here, we describe the results of the 12-week feasibility test. We hypothesized that illness severity and iOTA engagement would be associated with weight change. Methods Treatment Adaptation: Individuals with SMI between the ages of 16 and 75 underwent 12 weeks of treatment consisting of monthly 1:1 in-person visits for participants seen in the CMHC setting and monthly group sessions for participants seen in the Clubhouse setting. All participants received SMS-based health tips 5 days per week that were directly related to their goals. Participants were prompted once a week to respond via text with their weight and progress towards goals. Treatment adaptations included increased frequency of in-person meetings, weekly phone check-ins as needed, and incorporation of evidence-based psychological approaches to address barriers to behavior change (cognitive behavioral therapy, interpersonal therapy and dialectic behavior therapy). Defining Criteria for Illness Severity & Engagement: We evaluated factors hypothesized to be associated with change in weight, including illness severity and treatment engagement. "Severe" psychiatric symptoms were defined as baseline Clinical Global Impression (CGI) Severity score of >5. Criterion engagement was defined as text messaging response rate of >80% over the first 4 weeks of treatment. Disordered eating, assessed with the Loss of Control Over Eating Scores (LOCES), was also evaluated. Analytic Approach: Repeated measures ANCOVA was used to test for the effect of time on weight change, including 2-level factors for membership in included/excluded participant group and treatment setting, as well as an exploratory covariate representing score on the LOCES. Finally, we evaluated whether treatment setting had an effect on weight change over time. Significance was set at p<0.05 using a two-tailed test. Results A total of 26 participants were recruited for the study (24% schizophrenia, 68% mood disorder). The mean age of the population was 48.5 years (SD=15.67); 60% were white and 60% female. Eight participants met the exclusion criteria under evaluation (CGI >5 and response rate <80%). A significant interaction was observed between included/excluded participant group and time (F[1,23]=17.98, p<0.0001), explained by participants with lower symptom severity and criterion level engagement exhibiting a significant decrease in weight (F[1,16]=22.54, p<0.0001). Participants with high symptom severity and low treatment engagement had a trend-level increase in weight (F[1,7]=4.33, p=0.08). Next, we tested the interactive effect of time and treatment setting on weight change and found no significant interaction (F[1,23]=2.22, p=0.15). Finally, no significant interaction between time and baseline LOCES score on weight change was detected (F[1,22]=0.02, p=0.90). Discussion These results demonstrate the feasibility of delivering an adapted iOTA to SMI patients receiving care in CMHC and Clubhouse settings and suggest testable criteria for defining sufficient treatment engagement and psychiatric symptom severity. These data are relevant to future study design considerations and support the use of specific exclusion criteria for treatment engagement and psychiatric symptom control. More comprehensive symptom assessments may be needed to understand the effect of eating disorder symptoms on weight change outcomes in this populations. [ABSTRACT FROM AUTHOR]