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BestFIT Sequential Multiple Assignment Randomized Trial Results: A SMART Approach to Developing Individualized Weight

Nancy E Sherwood1, A Lauren Crain2, Elisabeth M Seburg2

  • 1Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

Annals of Behavioral Medicine : a Publication of the Society of Behavioral Medicine
|August 20, 2021
PubMed
Summary
This summary is machine-generated.

Adaptive behavioral weight loss treatment (SBT) shows promise. Early identification of suboptimal responders and switching to portion-controlled meals (PCM) may enhance weight loss outcomes in obesity treatment.

Keywords:
AdultsInterventionObesityWeight loss

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Area of Science:

  • Obesity research
  • Behavioral medicine
  • Clinical trial methodology

Background:

  • Standard behavioral weight loss treatment (SBT) achieves clinically significant weight loss in only 30-60% of individuals.
  • Adaptive interventions, tailored to individual progress, could improve treatment efficacy.
  • The BestFIT trial investigated optimizing SBT through adaptive strategies.

Purpose of the Study:

  • To determine the optimal timing for identifying individuals not responding well to SBT.
  • To compare switching to portion-controlled meals (PCM) versus acceptance-based treatment (ABT) for suboptimal responders.
  • To evaluate adaptive intervention strategies within a Sequential Multiple Assignment Randomized Trial (SMART) framework.

Main Methods:

  • The BestFIT trial enrolled 468 adults with obesity starting SBT.
  • Participants were randomized for treatment response assessment at Session 3 (Early TRA) or Session 7 (Late TRA).
  • Suboptimal responders were re-randomized to PCM or ABT; responders continued SBT. Weight change was assessed at 6 and 18 months.

Main Results:

  • Portion-controlled meals (PCM) showed a trend towards greater weight loss at 6 months compared to acceptance-based treatment (ABT) (p = .09).
  • No significant difference in weight loss was observed between PCM and ABT at 18 months.
  • Early treatment response assessment (TRA) combined with PCM led to greater weight loss than late assessment with PCM (p = .03).

Conclusions:

  • Adaptive intervention strategies, such as early identification of suboptimal responders and switching to PCM, warrant further investigation for obesity treatment.
  • The Sequential Multiple Assignment Randomized Trial (SMART) methodology is valuable for developing and optimizing adaptive weight loss interventions.
  • Future research should focus on refining adaptive sequences to potentially outperform standard behavioral weight loss treatment.