July 2, 2019

In the United States, young adults (aged 18‐35 years) are experiencing the greatest rates of weight gain, paired with increased cancer risk and increasing rates of cardiovascular disease and diabetes. The public health burden among young adults due to obesity is only expected to grow in the future, driving an urgent need for effective weight‐related interventions.

One attempt to respond to this looming health crisis was the “Early Adult Reduction of weight through LifestYle” (EARLY) program — a National Institutes of Health‐funded cooperative agreement of seven randomized controlled weight management trials with 17 different treatment interventions. EARLY was composed of coordinated but diverse intervention studies: Three studies focused on weight loss; two studies focused on weight gain prevention; and two studies focused on other outcomes in special populations, including preventing weight gain during smoking cessation attempts and supporting mothers during gestational weight gain and subsequent postpartum weight loss. All EARLY interventions were delivered using technology, including the Internet, cell phones, mobile apps and exercise tracking devices.

A recent study led by researchers at the University of North Carolina at Chapel Hill Gillings School of Global Public Health made use of this unique opportunity to increase understanding of the behavioral strategies used in weight‐related interventions. Researchers deconstructed the individual behavioral change techniques (BCTs) used in each EARLY intervention in order to learn how often and in which combinations specific techniques were employed.

The full article, titled “Deconstructing Weight Management Interventions for Young Adults: Looking Inside the Black Box of the EARLY Consortium Trials,” was published online May 28 in the journal Obesity.

Dr. Leslie Lytle

Dr. Leslie Lytle

Dr. Deborah Tate

Dr. Deborah Tate

Leslie Lytle, PhD, and Deborah Tate, PhD, both dual professors of nutrition and health behavior at the UNC Gillings School, were co-authors on the paper. Tate also is director of UNC’s Communication for Health Applications and Interventions Core.

“Weight management interventions are notoriously complex,” said Lytle. “Often, we put as many strategies into our behavior change interventions as our resources allow, hoping that something will work. That approach is inefficient, however. As a field, we need to start identifying the most important ‘active ingredients’ that will help people change their health behaviors.”

The researchers used a novel approach to estimate which standardized behavioral change techniques — such as self-monitoring, social support, feedback on behavior and goal-setting —received greater emphasis across the 17 EARLY interventions. They adapted this approach from the Resources for Enhancing Alzheimer’s Caregiver Health (REACH) study consortium, which successfully deconstructed interventions for caregivers of family members with Alzheimer disease or related dementia. This is the first study to determine the relative emphasis of BCTs.

While all of the EARLY studies targeted young adults, their approaches varied from intensive face‐to‐face interventions to entirely technology‐based approaches, and the interventions varied in the BCTs they used. Considering the 15 most used BCTs, a “common EARLY intervention” emerges.

Participants in EARLY were encouraged to self‐monitor their behavior and were provided with feedback on their behaviors and how they were working in terms of weight outcomes. They were instructed on how to perform behaviors, given information about the health consequences of obesity, provided with social support by the program and/or from other participants, and prompted (primarily through the use of technology) to continue working toward their goals. They were taught about cues in their environment or cued via text message/app and encouraged to set both behavioral and weight goals, with more specific action planning and problem solving support provided as needed.

While this common set of 15 BCTs was used across the interventions, the delivery methods and dose of the interventions varied, as well as the additional BCTs that were used by specific interventions. On average, an additional unique set of 14 BCTs was used in each study, bringing the total to 29 behavioral change techniques per intervention — this number illustrates the complexity of effective approaches to weight management.

Future work is needed, the researchers concluded, to determine whether a smaller set of techniques might be as (or more) effective and more easily disseminated.

Contact the Gillings School of Global Public Health communications team at sphcomm@listserv.unc.edu.

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