Addressing Rural Health Disparities by Optimizing "High Touch" Intervention Components in Digital Obesity Treatment

Over 130 million individuals in the US have overweight and obesity, and rural communities experience significantly higher rates of obesity and related chronic diseases. Fortunately, weight losses of as little as 5-7% can ameliorate obesity-associated co-morbidities. Although lifestyle interventions successfully produce weight loss of this magnitude, the reach and availability of weight management programs is limited in rural areas. Digital interventions offer an attractive alternative for delivering lifestyle programs to rural populations. However, in-person behavioral obesity treatment programs achieve better weight losses than digital programs, likely because in-person programs typically include personnel-intensive “high touch” treatment components. Some studies indicate that having a human “behind the curtain” of a digital program, through emailed feedback or with the addition of online group sessions, can significantly increase weight loss. Thus, to reduce obesity- associated health disparities experienced by rural populations, it is time to move the field forward by identifying the specific constellation of human-delivered digital treatment components that produce the strongest weight loss outcomes. Therefore, the aims of this study are to increase the public health impact of digital obesity treatment for rural populations by simultaneously investigating 3 “high touch” intervention components. We will conduct a highly efficient 2 x 2 x 2 factorial experiment using the MOST framework with participants residing in non-urban areas recruited online from across the United States. Participants (N=616; 22% racial/ethnic minority; 40% male) will be randomized to: (1) weekly facilitated synchronous group video sessions (yes vs. no); (2) type of self-monitoring feedback received (counselor-crafted vs. pre-scripted); and (3) individual coaching calls (yes vs. no). Based on the results of the experiment, we will identify an optimized program in which each component (or combination of components) contributes meaningfully (≥1.5 kg at 6- months) to enhanced weight loss. We will investigate potential mediators (e.g., accountability, social support, self-regulation, motivation, and problem solving), as well as possible mediators (e.g., sex/gender, race/ethnicity, age), to explore their impact on weight loss outcomes. We will also examine treatment delivery costs for each component and conduct exploratory analyses of weight trajectories 6-months post-treatment (i.e., at 12 months) to elucidate the extended impact of the specific components on weight control. Ultimately, this research will set the stage for confirming the most promising digital behavioral weight loss intervention for dissemination without geographic borders to reduce obesity rates among rural residents and provide essential evidence to inform policy decisions on optimal dissemination.