Innovative approaches to weight loss in a high‐risk population: The small changes and lasting effects (SCALE) trial

Objective To evaluate the efficacy of a small change behavioral weight loss intervention with or without a positive affect/self‐affirmation (PA/SA) component on weight loss at 12 months. Methods Black and Hispanic adults (N = 405) with body mass index 25‐50 kg/m2 selected one of ten small change eating strategies and a physical activity goal, randomly with/without PA/SA. Participants were followed by community health workers at set intervals (weekly in months 1‐3; biweekly in months 4‐9; once monthly in months 10‐12). Results There was no difference in weight loss at 12 months between participants in the small change approach alone (1.1%) versus the small change PA/SA intervention (1.2%). During treatment, 9% of participants lost at least 7% of their initial body weight. Participants who reported more interval life events had a lower likelihood of losing weight (P