{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,15]],"date-time":"2026-04-15T15:06:46Z","timestamp":1776265606626,"version":"3.50.1"},"reference-count":53,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T00:00:00Z","timestamp":1730937600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/100006110","name":"Academy of Nutrition and Dietetics Foundation","doi-asserted-by":"publisher","award":["Amy Joye Memorial Research Grant"],"award-info":[{"award-number":["Amy Joye Memorial Research Grant"]}],"id":[{"id":"10.13039\/100006110","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Obesity Science &amp;amp; Practice"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>Adaptive interventions may improve the potency and scalability of behavioral weight loss interventions, but the treatments\u2014or treatment combinations\u2014that should be offered are unknown. A two\u2010stage pilot sequential multiple assignment randomized trial was used to test the timing and dose of human support added to a core digital weight loss program.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>In stage 1, 99 adults with overweight\/obesity were randomized at baseline to a kick\u2010off with or without additional human support. In stage 2, \u201cearly non\u2010responders\u201d who had not achieved a 2% weight loss were re\u2010randomized after 4\u00a0weeks to either biweekly counseling (120\u00a0min over 8\u00a0weeks) or a one\u2010time check\u2010in (30\u00a0min) with a dietitian. \u201cEarly responders\u201d continued with the mHealth program alone. Feasibility and acceptability were assessed against pre\u2010specified criteria. Preliminary outcomes (weight loss, self\u2010monitoring and behavioral goal adherence) were explored.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study met\u00a0all feasibility and acceptability criteria. The rate of early response was 52.5%. Mean (SE) 3\u2010month percent weight losses were significantly greater in early responders (\u22126.63% (0.72)) than non\u2010responders (\u22121.70% (0.43), <jats:italic>p<\/jats:italic>\u00a0&lt;\u00a00.001). Outcomes were similar by first\u2010 and second\u2010line treatment though more counseling (27.3%) than check\u2010in (12.5%) participants achieved a 5% weight loss.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Identifying early responders may help optimize weight loss interventions, but more research is needed on rescue treatments for early non\u2010responders.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial Registration<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"http:\/\/ClinicalTrial.gov\">ClinicalTrial.gov<\/jats:ext-link>, NCT05929469.<\/jats:p><\/jats:sec>","DOI":"10.1002\/osp4.70018","type":"journal-article","created":{"date-parts":[[2024,11,7]],"date-time":"2024-11-07T09:00:59Z","timestamp":1730970059000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Results of a pilot sequential multiple assignment randomized trial 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North Carolina at Chapel Hill  Chapel Hill North Carolina USA"},{"name":"School of Medicine University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Erik A.","family":"Willis","sequence":"additional","affiliation":[{"name":"Center for Health Promotion and Disease Prevention University of North Carolina at Chapel Hill  Chapel Hill North Carolina USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amy A.","family":"Gorin","sequence":"additional","affiliation":[{"name":"Department of Psychological Sciences University of Connecticut  Storrs Connecticut USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4915-5308","authenticated-orcid":false,"given":"Deborah F.","family":"Tate","sequence":"additional","affiliation":[{"name":"Department of Nutrition Gillings School of Global Public Health University of North Carolina at Chapel Hill  Chapel Hill 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