Interactive Obesity Treatment Approach for Obesity Prevention in Adults With Early Serious Mental Illness: iOTA-SMI (iOTA-eSMI)

December 8, 2021 updated by: Washington University School of Medicine

Adaptation of an Evidence-based Interactive Obesity Treatment Approach (iOTA) for Obesity Prevention in Early Serious Mental Illness: iOTA-eSMI

Using a design-for-dissemination approach, this application proposes to use combined methods to adapt and pilot test an interactive obesity treatment approach (iOTA) for obesity prevention in early serious mental illness (eSMI) that uses text messaging to provide between-visit support. Derived from the lifestyle intervention used in the Diabetes Prevention Program, the parent iOTA targets diet, activity and adherence using web-based and health coach support.

Study Overview

Detailed Description

Most obesity and related complications in serious mental illness (SMI) occur in the context of chronic psychiatric illness, but there are few treatments that work. Behavioral interventions face challenges with long-term effectiveness, implementation and sustainability. Medications have modest effectiveness at best, and/or pose serious side effect risks. This study focuses on prevention of chronic obesity by adapting and pilot testing a prevention-focused, interactive obesity treatment approach (iOTA) for use in persons with early-phase SMI (eSMI) experiencing initial weight gain, overweight or early-stage obesity. The intervention will be adapted from the most studied, effective iOTA, derived from the Diabetes Prevention Program. The parent iOTA uses health coaches who extend their sustainable reach with scalable, inexpensive, semi-automated text messaging. Using a formal evaluation process and a specific implementation science framework, planned adaptations for this application will address mechanisms to improve health-related awareness, insight and self-efficacy skills.

Aim 1: Evaluate barriers and facilitators for intervention engagement, effectiveness and implementation, and identify needed adaptations of the prior iOTA for use in obesity attenuation in eSMI.

Aim 2: Adapt the prior iOTA for use in obesity attenuation in eSMI, aiming to maximize acceptability, engagement, sustainable reach and target engagement for eSMI.

Aim 3: Conduct a randomized pilot and feasibility study of iOTA-eSMI in a diverse sample of adults aged 18-45 with eSMI and initial weight gain, overweight or early class I obesity, comparing iOTA-eSMI to a health education condition.

Study Type

Interventional

Enrollment (Anticipated)

60

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Contact

Study Contact Backup

Study Locations

    • Florida
      • Miami, Florida, United States, 33126
        • Recruiting
        • South Florida Behavioral Health Network
        • Contact:
        • Principal Investigator:
          • John W Newcomer, MD
    • Missouri
      • Saint Louis, Missouri, United States, 63110
        • Recruiting
        • Washington University in St. Louis Medical School
        • Contact:
        • Contact:

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

18 years to 60 years (ADULT)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Description

Inclusion Criteria:

  • Age 18-60 years
  • At-risk weight defined as greater than 7 percent weight gain in the prior 2 years, overweight as evidenced by BMI 25-29.9, OR class I obesity as evidenced by BMI 30-32.49
  • Serious Mental Illness diagnosis
  • Receiving case management services
  • University of California, San Diego Brief Assessment of Capacity to Consent score less than 14
  • Not taking weight loss medications or participating in another behavioral weight loss intervention
  • Mild to moderate psychiatric symptom severity as measured by the Clinical Global Impression Severity scale
  • Willing and able to provide written informed consent

Exclusion criteria:

  • Taking weight loss medications or participating in another behavioral weight loss intervention
  • University of California, San Diego Brief Assessment of Capacity to Consent score greater than or equal to 14
  • Acute suicidality at time of screening
  • Unwilling or unable to provide written informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: TREATMENT
  • Allocation: RANDOMIZED
  • Interventional Model: PARALLEL
  • Masking: NONE

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
ACTIVE_COMPARATOR: iOTA text messaging intervention
There will be a 6 month "active" treatment phase consisting of monthly meetings with a study health coach to develop reasonable health goals and interactive text messaging to provide daily support and self-monitoring of behavior change goals between in-person visits. Participants may receive phone calls between visits from their health coach for additional support if needed. Following the active treatment phase, participants will receive daily health-related text messages for another 3 months.
Over 6 months, participants in the iOTA arm will have monthly in-person visits with a health coach who will work with the participant to set goals for the upcoming month related to healthy eating and activity. The participant will receive daily text message health tips related to their goals, and will be prompted once a week to respond with a text indicating their weight and how they are doing with their goals. Following the 6-month active treatment phase, participants will receive text messages only for another 3 months.
Other Names:
  • iOTA
PLACEBO_COMPARATOR: Health Education text messaging intervention
There will be a 6 month "active" treatment phase consisting of monthly in-person visits with a health coach to learn about healthy eating and activity behaviors, including developing readiness for health behavior change. Participants will not set specific health goals, but will receive weekly text messages about general health tips related to their in-person visits. Following the active treatment phase, participants will receive daily health-related text messages for another 3 months.
Over 6 months, participants in the Health Ed arm will also have monthly in-person visits with a health coach who will provide education on energy balance and problem-solving. Specific goals will not be set, but the health coach will assist participants in problem-solving any challenges. Participants will receive a weekly automated motivational text message health tip from the study related to what they learned in their health coaching sessions. Following the 6-month active treatment phase, participants will receive text messages only for another 3 months.
Other Names:
  • Health Ed

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Body Mass Index
Time Frame: Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
weight in kilograms/height in meters squared
Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Change in Self Efficacy for Healthy Eating and Exercise
Time Frame: Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
This questionnaire includes 32 questions in two domains of self efficacy: 1) healthy eating and 2) exercise. Respondents are asked to recall how confident they have felt in doing positive health behaviors since the last study visit. Responses are on a likert scale of 1 - 5 (1 - 2 = I know I cannot do; 3 - 4 = Maybe I can; 5 = I know I can).
Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
Change in Psychophysical Skills & Insight
Time Frame: Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
This questionnaire includes 10 questions, with three separate subscales (Self-determination, Cognitive control and Interoceptive Awareness). Respondents are asked to rate their own skills since the last study visit. Responses are on a likert scale of 1-5 (1 = never, 2 = rarely, 3 = sometimes, 4 = often, 5 = always). Scores are generated for each subscale, as well as a total score. Higher scores indicate greater degree of psychophysical awareness & skills.
Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks

Other Outcome Measures

Outcome Measure
Measure Description
Time Frame
Percentage response rate to text prompts
Time Frame: Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
Treatment engagement
Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
Intervention feasibility, usability and acceptability as measured by the Contextual Technology Adaptation Questionnaire
Time Frame: Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks
This questionnaire includes 35 questions, with five separate subscales (feedback on: the overall iOTA program, automatic text messages, personalized text messages, in-person visits and between-session phone check-ins). Respondents are asked to rate feasibility, acceptability and usability of the text messaging portion of the intervention since the last study visit. Responses are on a likert scale of 1-3 (1 = not at all/negative; 2 = moderate/neutral; 3 = always/positive). Scores are generated for each subscale, as well as a total score. Higher scores indicate more positive experiences.
Baseline, 4, 8, 12, 16, 20, 24 and 36 weeks

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (ACTUAL)

July 15, 2020

Primary Completion (ANTICIPATED)

March 31, 2022

Study Completion (ANTICIPATED)

May 31, 2022

Study Registration Dates

First Submitted

June 4, 2019

First Submitted That Met QC Criteria

June 7, 2019

First Posted (ACTUAL)

June 10, 2019

Study Record Updates

Last Update Posted (ACTUAL)

December 29, 2021

Last Update Submitted That Met QC Criteria

December 8, 2021

Last Verified

December 1, 2021

More Information

Terms related to this study

Other Study ID Numbers

  • 201911123

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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