Adapting a small change behavioral weight management program for college students: formative evaluation and iterative...

Offering behavioral weight management interventions in college health centers may improve cardiometabolic health for hard-to-reach emerging adult populations.

This paper outlines the iterative process undertaken, guided by the Adaptome framework, to adapt an evidence-based small changes approach to weight gain prevention to target weight loss and to improve the fit for delivery to college students via health centers.

Initial intervention adaptations were completed following in-depth interviews with college students and health center staff. The program was iteratively tested in a series of single-arm pilot trials to reach pre-identified benchmarks for retention (≥70%), adherence (≥75%), and clinical effectiveness (≥3% weight loss). Focus groups were held following each iteration to inform intervention adaptations.

Interview themes (n = 23) that highlighted environmental and developmental barriers to student weight management and strategies to promote engagement informed initial adaptations. Four cohorts (∼7 participants each) were run, with adaptations following each cohort made based on participant feedback and benchmark achievement. Major changes included transitioning to hybrid delivery, providing personalized feedback with autonomy supportive coaching, refining the self-monitoring approach, providing frequent text messages, and refining small change goals and instructional content to enhance feasibility and improve weight loss. The result was a final treatment package that exceeded pre-specified benchmarks with cohort 4 called HealthyU.

Emerging adult college students benefit from facilitator and group interaction, community building, additional touchpoints via text message, and autonomy-supportive structured guidance. Future directions include testing the HealthyU intervention against a control using a more generalizable sample to determine preliminary effectiveness.