Jessica L. Unick

Background: Over 70% of US adults are overweight or have obesity. Internet-delivered weight loss (IDWL) treatment overcomes many common barriers to in-person weight loss (WL) programs; yet, IDWLs underperform compared to in-person treatment. Yoga is a novel intervention that targets physical and psychological health and can be delivered virtually, increasing translation potential. Yoga has been understudied as an intervention to address barriers to WL despite favorable effects in other health disciplines. Preliminary studies suggest yoga to improve self-regulation and reduce lapses from dietary recommendations, 2 factors integral to long-term WL success. Objective: The aim of the study is to conduct the first fully powered randomized controlled trial to test the added effect of yoga to IDWL treatment on weight (primary outcome), dietary lapses, potential lapse triggers, and self-regulation mediator variables (secondary outcomes). Methods: Adults that are overweight or have obesity will be recruited to participate in a 12-month IDWL program. Following a 3-month assessment, eligible participants will be randomized to (1) a yoga intervention, including 14 weeks of group-based, virtual Iyengar yoga delivered twice weekly, followed by 22 weeks of yoga delivered once per week, and then 6 months of no contact, or (2) a contact-matched wellness comparison condition. Assessments will take place at baseline, 3 months, 6 months, 12 months, and 18 months. Several questionnaires, ecological momentary assessments, and objectively measured weight and accelerometry data will be collected. This trial is registered on ClinicalTrials.gov (NCT06166225). Results: This randomized trial was funded with an original project period of July 2023-June 2028. Enrollment began in February 2024 and is ongoing with the expectation of closing enrollment in June 2026. Conclusions: This trial will examine the combined effect of yoga and WL treatment among individuals with overweight or obesity and will be the first fully powered trial to assess the combination of virtually delivered yoga and WL beyond 6 months. Findings will inform whether yoga could be considered a valuable intervention component for improving IDWL treatment.

Background: Cancer survivors face long-term health challenges posttreatment. Physical activity (PA) can help manage cancer-related side effects and offer additional health benefits, yet up to 80% of survivors do not meet PA guidelines. Effective and translatable PA interventions are needed. Objective: This randomized trial assessed the feasibility, acceptability, and preliminary efficacy of a 12-week automated Internet program for increasing moderate-to-vigorous physical activity (MVPA) among cancer survivors. A secondary aim examined the effect of the intervention on physical and mental well-being. Methods: Inactive (P<.001). Energize! increased self-reported (92.7 min/wk), bouted (35.4 min/wk), and total (46.3 min/wk) MVPA at 3 months (Cohen d=0.74‐0.94), and these changes were partially maintained at 6 months. Increases in MVPA were smaller among Newsletter participants (d=0.28‐0.47). Group differences in health-related outcomes were minimal and mixed, favoring Energize! over Newsletter for vitality (d=0.63) and somatization (d=0.76) at 3 months, and for depression (d=0.59) and anxiety (d=0.51) at 6 months. Conclusions: The automated Energize! Program is feasible, acceptable, and associated with positive changes in MVPA, yet future studies are needed to improve MVPA long-term. Findings suggest that self-guided PA programs may be beneficial for increasing MVPA among cancer survivors.

BACKGROUND Cancer survivors often face long-term health challenges after treatment. Physical activity (PA) can help manage cancer-related side effects and offer additional health benefits, yet up to 80% of survivors do not meet PA guidelines. OBJECTIVE To assess the feasibility, acceptability, and preliminary effects of a 12-week automated Internet program for increasing moderate-to-vigorous PA (MVPA) among cancer survivors. METHODS The study included 46 adults (age: 55.2±8.3 years, BMI: 33.0±7.6 kg/m²; 91.3% female, 80.4% non-Hispanic White), randomized to the Energize! Exercise Program or Newsletter control condition. The Energize! Program involved weekly behaviorally-based video lessons, homework assignments, exercise planning and reporting, and progressive PA goals (75 to 200 min/week). Automated, personalized feedback was provided. The newsletter group received bi-monthly PA education newsletters (total of 6). Assessments occurred at baseline, 3 months (post-intervention), and 6 months (following a 3-month no-contact follow-up). Measures included self-reported PA, accelerometer-derived total and ‘bouted’ MVPA (≥10 minutes bouts), and health-related outcomes (e.g., quality-of-life, fatigue, psychological distress). RESULTS Retention rates (>94%) and compliance to the Energize! program (73-86%) were excellent. Energize! increased self-reported (92.7 min/week), bouted (35.4 min/week), and total (46.3 min/wk) MVPA at 3 months (Cohen’s d=0.74-0.94), and these changes were partially maintained at 6 months. Increases in MVPA were smaller among Newsletter participants (Cohen’s d=0.28-0.47). Group differences in health-related outcomes were minimal and mixed. CONCLUSIONS The automated Energize! Program is feasible, acceptable, and associated with positive changes in MVPA, yet future studies are needed to improve MVPA long-term. Findings suggest that self-guided PA programs may be beneficial for increasing MVPA among cancer survivors. CLINICALTRIAL Clinicaltrials.gov: NCT1850077

Introduction: Given the numerous health benefits associated with regular physical activity (PA), effective, affordable, and scalable PA interventions are needed to address the high prevalence of inactivity among adults within the United States. The purpose of this study was to evaluate the feasibility, acceptability, and preliminary efficacy of an Internet-delivered program for increasing moderate-to-vigorous PA (MVPA) among inactive adults. Methods: Participants (n = 55; age: 53.5 ± 10.2 yr, body mass index: 32.0 ± 6.1 kg·m⁻², 56.4% female, 83.6% non-Hispanic White) were randomized to the Energize! exercise program, a 12-wk, fully automated program for increasing MVPA, or a newsletter control condition. Each week, Energize! participants completed behaviorally based video lessons, submitted an exercise plan, reported their exercise minutes, and completed a homework assignment. The PA goal progressed from 75 to 200 min·wk⁻¹ and automated, personalized feedback was provided. Control participants received PA education newsletters twice per month (six in total). Assessments of psychosocial PA constructs and MVPA (self-report, accelerometer-derived total MVPA, and accelerometer-derived bouted MVPA (>10 min bouts)) occurred at baseline, 3 months (post-intervention), and 6 months (following a 3-month no-contact follow-up). Results: Retention was 85.5% and 81.8% at 3 and 6 months, respectively. On average, Energize! participants submitted an exercise plan in 76.4% of weeks, watched 84.5% of video lessons, and completed 75.0% of homework assignments. Program satisfaction was higher in Energize! than the control group (all P < 0.001). A significant interaction effect favoring Energize! was observed from baseline to 3 months for bouted MVPA (P = 0.01) and total MVPA (P = 0.01). No significant differences between groups were observed for changes from baseline to 6 months. At both 3 and 6 months, medium to large effect sizes were observed for most psychosocial PA variables (Cohen’s d = 0.57–1.08). Conclusion: This fully automated program was feasible, acceptable, and effective at increasing MVPA in the short-term, but effects were diminished once the intervention was removed.

Importance: Weight loss (WL) during the first month of a behavioral program is associated with longer-term WL. Testing of translatable and adaptive obesity programs is needed.Objective: To compare brief, extended, and no telephone coaching for individuals with suboptimal response (ie, 1-month WL P < .001). Similarly, the proportion of participants achieving 5% or greater WL at 4 months was greater in the extended coaching group (89 participants [65.9%]) and brief coaching group (77 participants [58.5%]) vs control group (46 participants [36.5%]) (P < .001). At 12 months, a similar pattern was observed for achievement of 5% WL or greater (extended coaching, 63 participants [48.1%]; brief coaching, 58 participants [45.9%]; control, 38 participants [32.8%]; P = .03). Percent WL at 12 months was significantly higher in extended coaching vs control (mean [SD] WL for extended coaching, −5.5% [6.7%]; mean [SD] WL for control, −3.9% [7.4%]; P = .03) but not for brief coaching (mean [SD] WL, −4.9% [6.1%]).Both the brief and extended coaching groups watched more lessons and self-monitored on more days compared with the control group. The cost per additional kilogram of WL, beyond that of the control group, was $50.09 for brief coaching and $92.65 for extended coaching.Conclusions and Relevance: In this randomized clinical trial testing an adaptive intervention, the provision of coaching for individuals with suboptimal response improved WL and was cost-effective; further testing in clinical settings (eg, health care systems) is warranted.Trial Registration: ClinicalTrials.gov Identifier: NCT03867981

Objectives: Given that low early (4 weeks) weight loss (WL) predicts longer-term WL, the purpose of this study was to identify factors associated with poor early WL. Methods: We had 438 adults with overweight/obesity participating in an Internet-delivered behavioral WL program provide weights at baseline and 4 weeks. Participants were stratified by percent WL at 4 weeks: LOW: < 2% WL, MEDIUM: 2 to < 4% WL, HIGH: ≥ 4% WL and groups were compared on baseline variables (demographics, physical activity, and psychosocial measures) and 4-week intervention adherence. Results: Respectively, 37.4%, 40.9%, and 21.7% of participants had LOW, MEDIUM, and HIGH early WL. LOW was more likely to be female compared to HIGH and less likely to be non-Hispanic white compared to MEDIUM and HIGH (p's Conclusion: Findings can inform future adaptive interventions that tailor treatment based upon early WL to improve WL outcomes for more individuals.

Objective: There is substantial inter‐individual variability in response to weight loss interventions and emerging evidence suggests that weight loss during the early weeks of an intervention may be predictive of longer‐term weight loss. This secondary analysis of data from a commercial program therefore examined 1) the associations between early weight loss (i.e., week 4) with final visit weight loss and duration on the program, and 2) other predictors of lower weight loss at final visit.Methods: Client charts of adults with overweight or obesity (N = 748) were analyzed. Clients were stratified into categories of weight loss at the week 4 (< and ≥2%, 3% and 4%) and final visits (< and ≥5% and 10%). Multivariate logistic regression was used to assess predictors of p < 0.01) compared with those who did not meet the 2% threshold.Conclusions: Lower 4‐week weight loss was identified as a strong predictor of not losing a clinically relevant amount of weight. These results may be useful for the early identification of individuals who can be targeted for additional counseling and support to aid in attaining weight loss goals.

Background: Dietary lapses can hinder weight loss and yoga can improve self‐regulation, which may protect against lapses. This study examined the effect of yoga on dietary lapses, potential lapse triggers (e.g., affective states, cravings, dietary temptations), and reasons for initiating eating following weight loss treatment.Methods: Sixty women with overweight/obesity (34.3 ± 3.9 kg/m²) were randomized to a 12 week yoga intervention (2x/week; YOGA) or contact‐matched control (cooking/nutrition classes; CON) following a 12‐week behavioral weight loss program. Participants responded to smartphone surveys (5x/day) over a 10‐day period at baseline, 12, and 24 weeks to assess lapses and triggers.Results: At 24 weeks, YOGA and CON differed on several types of lapses (i.e., less eating past full, eating more than usual, loss of control when eating, self‐identified overeating, difficulty stopping eating in YOGA), and YOGA was less likely to eat to feel better or in response to stress (ps < 0.05). YOGA also reported less stress and anxiety and more positive affect (ps < 0.01); dietary temptations and cravings did not differ from CON.Conclusion: Yoga resulted in fewer dietary lapses and improved affect among women with overweight/obesity following weight loss. While preliminary, findings suggest that yoga should be considered as a potential component of weight loss treatment to target dietary lapses.

Objective: The aims of this study were as follows: 1) examine weight changes in older adults (mean age = 76 years) with type 2 diabetes and overweight or obesity during the COVID‐19 shutdown; and 2) compare the behavioral and psychosocial effects of the shutdown in those who had large weight losses (>5%), those who had small weight losses (2%‐5%), those who remained weight stable (±2%), or those who gained weight (>2%).Methods: Look AHEAD (Action for Health in Diabetes) participants (N = 2544) were surveyed during the COVID‐19 shutdown (2020), and they self‐reported their current weight, reasons for weight change, weight‐related behaviors, psychosocial measures, and negative and positive effects of the pandemic on their lives.Results: Comparing self‐reported weight during the COVID‐19 shutdown with earlier measured weight, Look AHEAD participants lost, on average, 2.2 kg during the COVID‐19 shutdown: 47% lost >2%, and only 18% gained >2% (p < 0.0001). Decreases in physical activity and increases in screen time were reported frequently in all weight‐change categories. Similarly, there were few differences among the categories on standardized psychosocial measures or self‐reported effects of the shutdown on participants' lives. However, when differences were seen, the most negative impact was in those who gained weight.Conclusions: Although weight loss appeared more common than weight gain during the shutdown, the weight‐change groups did not differ on most psychosocial and behavioral variables.