title: A mixed methods approach to improving recruitment and engagement of emerging adults in behavioural weight loss programs.
abstract: Emerging adults ages 18-25 are at high risk for obesity, but are markedly underrepresented in behavioural weight loss (BWL) programs and experience lower engagement and retention relative to older adults.
  
  
  
  To utilize a mixed methods approach to inform future efforts to effectively recruit and engage this high-risk population in BWL programs.
  
  
  
  We used a convergent parallel design in which quantitative and qualitative data were given equal priority. Study 1 (N= 137, age = 21.8 + 2.2, BMI = 30.1 + 4.7) was a quantitative survey, conducted online to reduce known barriers and minimize bias. Study 2 (N= 7 groups, age = 22.3 + 2.2, BMI = 31.5 + 4.6) was a qualitative study, consisting of in person focus groups to gain greater depth and identify contextual factors unable to be captured in Study 1.
  
  
  
  Weight loss was of interest, but weight itself was not a central motivation; an emphasis on overall lifestyle, self-improvement and fitness emerged as driving factors. Key barriers were time, motivation and money. Recruitment processes should be primarily online with messages tailored specifically to motivations and preferences of this age group. Preferences for a program were reduced intensity and brief, hybrid format with some in-person contact, individual level coaching, experiential learning and peer support. Key methods of promoting engagement and retention were autonomy and choice, money and creating an optimal default.
  
  
  
  An individually tailored lifestyle intervention that addresses a spectrum of health behaviours, promotes autonomy and emphasizes activity and fitness may facilitate recruitment and engagement in this population better than traditional BWL protocols.
authors.affiliation: Virginia Commonwealth University School of Medicine Richmond VA USA; Weight Control and Diabetes Research Center The Miriam Hospital Providence RI USA; Alpert Medical School of Brown University Providence RI USA.
authors.forename: J G
authors.initials: JG
authors.lastname: LaRose
authors.affiliation: Alpert Medical School of Brown University Providence RI USA; Centers for Behavioral and Preventive Medicine The Miriam Hospital Providence RI USA.
authors.forename: K M
authors.initials: KM
authors.lastname: Guthrie
authors.affiliation: Virginia Commonwealth University School of Medicine Richmond VA USA.
authors.forename: A
authors.initials: A
authors.lastname: Lanoye
authors.affiliation: Gillings Global School of Public Health University of North Carolina at Chapel Hill Chapel Hill NC USA; Lineberger Comprehensive Cancer Center University of North Carolina at Chapel Hill Chapel Hill NC USA.
authors.forename: D F
authors.initials: DF
authors.lastname: Tate
authors.affiliation: Weight Control and Diabetes Research Center The Miriam Hospital Providence RI USA.
authors.forename: E
authors.initials: E
authors.lastname: Robichaud
authors.affiliation: Virginia Commonwealth University School of Medicine Richmond VA USA.
authors.forename: L J
authors.initials: LJ
authors.lastname: Caccavale
authors.affiliation: Weight Control and Diabetes Research Center The Miriam Hospital Providence RI USA; Alpert Medical School of Brown University Providence RI USA.
authors.forename: R R
authors.initials: RR
authors.lastname: Wing
keywords: Behavioural weight loss; emerging adults; treatment development; young adults