NCT05861973

Brief Summary

The SMARTer trial will be a three-arm, randomized controlled non-inferiority trial that compares the optimized, adaptive SMARTer intervention, fixed DPP, and Self-Guided (Control). The trial will address whether a scalable, stepped-care intervention can stand up to gold-standard DPP by achieving comparable weight loss at a lower cost. Alongside evaluation of clinical non-inferiority, a comprehensive economic evaluation will inform relative affordability. Cost information is important to inform treatment policy and change standard of care, but is sorely lacking for behavioral interventions. The SMARTer intervention reduces costs by initially offering minimal intervention to all and stepping up to offer more costly treatment components only to non-responders who fail to attain the target weight loss. A rigorous economic evaluation planned and designed alongside the SMARTer trial will provide an accurate, robust head-to-head comparison of costs, cost-effectiveness, and projected lifetime health care costs between the three arms.

Trial Health

77
On Track

Trial Health Score

Automated assessment based on enrollment pace, timeline, and geographic reach

Enrollment
492

participants targeted

Target at P75+ for not_applicable obesity

Timeline
18mo left

Started Jun 2024

Typical duration for not_applicable obesity

Geographic Reach
1 country

1 active site

Status
recruiting

Health score is calculated from publicly available data and should be used for screening purposes only.

Trial Relationships

Click on a node to explore related trials.

Study Timeline

Key milestones and dates

Study Progress56%
Jun 2024Oct 2027

First Submitted

Initial submission to the registry

May 8, 2023

Completed
9 days until next milestone

First Posted

Study publicly available on registry

May 17, 2023

Completed
1.1 years until next milestone

Study Start

First participant enrolled

June 25, 2024

Completed
2.8 years until next milestone

Primary Completion

Last participant's last visit for primary outcome

April 30, 2027

Expected
6 months until next milestone

Study Completion

Last participant's last visit for all outcomes

October 31, 2027

Last Updated

April 15, 2026

Status Verified

April 1, 2026

Enrollment Period

2.8 years

First QC Date

May 8, 2023

Last Update Submit

April 10, 2026

Conditions

Keywords

stepped careadaptive interventionnon-inferiority trialbehavioral obesity treatment

Outcome Measures

Primary Outcomes (2)

  • Weight - percent change

    Participant percent change in weight (kg) from baseline to 6-months.

    Baseline to 6-months

  • Weight - difference in kg

    Participant change in weight (kg) from baseline to 6-months.

    Baseline to 6-months

Secondary Outcomes (1)

  • Cost

    12-months

Other Outcomes (11)

  • Weight Maintenance - percent change

    Baseline to 12-months

  • Weight Maintenance - difference in kg

    Baseline to 12-months

  • Moderating effect of food insecurity on percent weight loss at 6 months

    Baseline to 6-months

  • +8 more other outcomes

Study Arms (3)

Adaptive SMARTer intervention (SMARTer)

EXPERIMENTAL

Smartphone application, diet and activity goals, online lessons, brief remote sessions with a Health Promotionist. Data from a wifi scale will be monitored. Individuals losing less than .5 lb per week will be stepped up to also be given meal replacement products. Will have physical measures taken at baseline, 3 months, 6 months, 9 months, and 12 months.

Behavioral: Adaptive SMARTer intervention (SMARTer)

Diabetes Prevention Program (DPP)

EXPERIMENTAL

Fixed intervention using participant program manual, diet and activity logs, hour long remote sessions with a Health Promotionist. Will have physical measures taken at baseline, 3 months, 6 months, 9 months, and 12 months.

Behavioral: Diabetes Prevention Program (DPP)

Self-Guided Treatment (Self-Guided)

ACTIVE COMPARATOR

Provides paper and internet resources tailored to geographic area, educating on leading a healthier lifestyle, including information on wellness and physical activity. Will have physical measures taken at baseline, 3 months, 6 months, 9 months, and 12 months.

Behavioral: Self-Guided Treatment (Self-Guided)

Interventions

In accordance with the Center for Disease Control curriculum, participants will receive a participant log for tracking physical activity, food intake, and weight, a paper participant guide with worksheets, logs, and psycho-educational materials, and 16 hour long remote sessions with a Health Promotionist.

Diabetes Prevention Program (DPP)

Participants will receive calorie, fat, and physical activity goals, a Smartphone application for self-monitoring their diet, activity and weight, online educational readings, and brief bi-weekly remote health sessions with a Health Promotionist. They will also be loaned a Fitbit tracking device and a wireless Bluetooth scale for 12 months.

Adaptive SMARTer intervention (SMARTer)

Provides paper and internet resources tailored to geographic area, educating on leading a healthier lifestyle, including information on wellness and physical activity. Will have physical measures taken at baseline, 3 months, 6 months, 9 months, and 12 months.

Self-Guided Treatment (Self-Guided)

Eligibility Criteria

Age18 Years+
Sexall
Healthy VolunteersNo
Age GroupsAdult (18-64), Older Adult (65+)

You may qualify if:

  • Over 18 years old
  • BMI of ≥25, weight \<396 lbs
  • Must own a Smartphone, and be willing to install the SMARTer app
  • Not enrolled in a formal weight loss program

You may not qualify if:

  • Cerebrovascular accident or myocardial infarction within six months of enrollment
  • Diabetes treated with insulin
  • Pregnancy, lactation or intended pregnancy
  • Active suicidal ideation
  • Anorexia or bulimia
  • Requiring an assistive device for mobility
  • Taking weight loss medications, such as GLP-1 agonists

Contact the study team to confirm eligibility.

Sponsors & Collaborators

Study Sites (1)

Florida State University

Tallahassee, Florida, 32306, United States

RECRUITING

MeSH Terms

Conditions

Obesity

Condition Hierarchy (Ancestors)

OverweightOvernutritionNutrition DisordersNutritional and Metabolic DiseasesBody WeightSigns and SymptomsPathological Conditions, Signs and Symptoms

Study Officials

  • Bonnie Spring, PhD

    Florida State University

    PRINCIPAL INVESTIGATOR

Central Study Contacts

Keri A Gladhill, PhD

CONTACT

Study Design

Study Type
interventional
Phase
not applicable
Allocation
RANDOMIZED
Masking
SINGLE
Who Masked
OUTCOMES ASSESSOR
Purpose
TREATMENT
Intervention Model
PARALLEL
Model Details: This is a randomized control trial with 3 parallel intervention arms. One arm will be the SMARTer active treatment group, one the active DPP treatment group, and the other a Self-Guided control group. Assessors will be blinded to study condition, and intervention will be behavioral.
Sponsor Type
OTHER
Responsible Party
PRINCIPAL INVESTIGATOR
PI Title
Krafft Professor of Behavioral Sciences and Social Medicine and Director of Florida Blue Center for Rural Health Research & Policy

Study Record Dates

First Submitted

May 8, 2023

First Posted

May 17, 2023

Study Start

June 25, 2024

Primary Completion (Estimated)

April 30, 2027

Study Completion (Estimated)

October 31, 2027

Last Updated

April 15, 2026

Record last verified: 2026-04

Data Sharing

IPD Sharing
Will not share

Locations