Paving the way for SMART weight loss in college students.

Many established and emerging technologies represent attractive mediums for the implementation of behavioural weight loss interventions in college students due to their widespread reach, familiarity, and appeal among other advantageous characteristics. 1 However, surprisingly few studies have sought to evaluate technology-based behavioural weight loss interventions in college students. 2 In The Lancet Diabetes and Endocrinology, Job Godino and colleagues 3 not only help address this literature gap, but do so using an innovative, ambitious, and timely approach. The authors report a parallel-group, randomised, controlled trial that enrolled 404 overweight or obese college students from three universities in the USA. Participants were assigned to either a multi-component, adaptive, technology-based behavioural weight loss intervention (n=202, the SMART intervention) or general information about health and wellness (n=202, control group). At 24 months, the primary outcome—objectively measured weight at 24 months—was assessed in 341 (84%) participants and was not signifi cantly diff erent between the groups (–0·79 kg [95% CI –2·02 to 0·43], p=0·204). 3 However, at earlier timepoints, weight loss was greater in the intervention group compared with controls (6 months –1·33 kg [95% CI –2·36 to –0·30], p=0·011; at 12 months –1·33 kg [–2·30 to –0·35], p=0·008). Their use of an adaptive intervention and the long duration of the study contrast with previous technology-based weight loss studies in college students, which have employed less adaptable, short-term interventions. 4,5 They also creatively attempted to leverage the power of existing social ties 6 by using a popular social networking framework (Facebook) to direct the focus of social support towards participants' weight loss-related behaviours. Additionally, their use of researcher-designed, theory-based, smartphone apps (GoalGetter app for setting, tracking, and sharing progress towards weight-related goals; TrendSetter app for self-monitoring and sharing weight, physical activity, and diet; and BeHealthy app for delivering and sharing weight-related challenges) is a study strength given that many commercially available weight loss apps generally incorporate little or no evidence-based content. 7 The comprehensive intervention approach used resulted in a mean 1 year weight reduction of 1 kg and an impressive 2 year retention rate of 80%, especially considering the remote delivery of the intervention and the age group of the sample. The study represented a novel way to engage an age group (young adults aged <40 years) that is typically diffi cult to retain in weight loss interventions 8 and was eff ective in stimulating short-term, modest, weight losses. In addition to revealing …