title: A novel stepped-care approach to weight loss: The role of self-monitoring and health literacy in treatment outcomes.
abstract: The aims of the current study were twofold: 1) examine the effectiveness of an innovative three-step, stepped-care behavioral weight loss treatment, and 2) examine factors that contribute to poor weight loss outcomes and the need for more intensive treatment.
  
  
  
  The total sample for the study consisted of 53 individuals (87% female) with MBMI=35.6, SDBMI=6.4. A three-step, stepped-care treatment approach was implemented over six months. Step 1 included the Diabetes Prevention Program manual adapted for self-administration augmented with monitoring technology shown to facilitate weight loss and participant accountability and engagement. Participants who were unsuccessful at achieving established weight loss goals received stepped-up treatments in 2-month increments beginning at month 2. The stepped progression included the addition of meal replacement at Step 2 and individual counseling concurrent with meal replacement at Step 3.
  
  
  
  Un-stepped and once stepped participants lost a clinically significant amount of weight (i.e., >5%), while twice stepped participants lost an insignificant amount of weight. Twice stepped participants were significantly lower in health literacy and self-monitoring frequency.
  
  
  
  In this investigation, approximately 60% of the participants were able to lose a clinically significant amount of weight utilizing a minimally intensive intervention with little additional support. Regular self-monitoring and high health literacy proved to be significant correlates of success.
authors.affiliation: East Carolina University, United States. Electronic address: carelsr14@ecu.edu.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Carels
authors.affiliation: East Carolina University, United States.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Selensky
authors.affiliation: East Carolina University, United States.
authors.forename: James
authors.initials: J
authors.lastname: Rossi
authors.affiliation: East Carolina University, United States.
authors.forename: Chelsey
authors.initials: C
authors.lastname: Solar
authors.affiliation: East Carolina University, United States.
authors.forename: Reid
authors.initials: R
authors.lastname: Hlavka
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D004059:Diffusion of Innovation; D005260:Female; D005500:Follow-Up Studies; D057220:Health Literacy / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009765:Obesity / Q000523:psychology / Q000628:therapy*; D012648:Self Care / Q000523:psychology; D016896:Treatment Outcome; D015431:Weight Loss