Please select the eligibility criteria that correspond to the clinical trial below.
Title: SMART Weight Loss Management
Brief Summary: The overall objective of this study is to use an innovative experimental approach, the SMART (Sequential Multiple Assignment Randomized Trial), to determine the best way to sequence the delivery of mHealth tools and traditional treatment components in a stepped program of obesity treatments. The SMART approach is a highly efficient strategy for identifying and constructing efficacious adaptive interventions: it accommodates sequential decision-making based on the participant's response to early weight loss treatment components. The proposed treatment package begins with the least expensive components, and for participants identified as treatment non-responders, provides sequential step-up of additional treatment components. By sequentially delivering treatment components based on participant response, SMART permits achievement of the target outcome, weight loss, with least resource consumption and participant burden.


Options:
A: Inclusion Criteria:

1. Currently own and regularly use a smartphone
2. Age ≥18 years;
3. BMI \> 27 and \< 43; and
4. Successful completion of a 5-day electronic diary of food intake during a run-in period.

Exclusion Criteria:

1. Presence of an unstable condition requiring physician-supervised diet and exercise (e.g., recent myocardial infarction);
2. Physical limitations precluding ability to engage in moderate-intensity physical activity;
3. Pregnancy or intention to become pregnant during study;
4. Current treatment for a serious mental illness (e.g. schizophrenia);
5. Reported alcohol intake \> 4 drinks/day;
6. Participation in a formal weight loss program, loss of ≥ 5% weight in past 6 month, or current use of weight loss medication;
7. History of bariatric surgery in \<5 years,
8. Planned extended vacations, absences, or relocation during study;
9. A score \>16 on the Center for Epidemiologic Studies Depression Scale (CES-D);
10. Score \>32 on the Eating Habits Checklist, an eating disorder scale administered at baseline. For those who have an elevated BDI score (\>22) or EHC (\>32), we offer referral for counseling.
B: Inclusion Criteria:

* At least 1 visit in the previous 12 months to an adult medicine, internal medicine, or family practice provider at a participating community health center
* BMI between 30.0-45.0 kg/m2 and weight ≤ 320 pounds
* Diagnosis of hypertension or diabetes

Exclusion Criteria:

* Current pregnancy
* Pregnancy in previous 12 months
* Heart attack/stroke in previous 2 years
* Active cancer diagnosis
* Current participation in another weight loss study
C: Inclusion Criteria:

* Age 18 to 35 years
* Intending to be available for a 24 month intervention
* Full-time student enrollment at one of the designated San Diego college or university campuses: UCSD, SDSU, and CSU San Marcos
* Facebook user or willingness to begin using Facebook
* Owns personal computer
* Owns mobile phone and uses text messaging
* Willing to attend required research measurement visits in San Diego over the 2 year RCT
* Participants must meet overweight and obesity criteria: 25 \< BMI \<35 kg/m2
* English-speaking
* Able to ambulate unassisted

Exclusion Criteria:

* Those unable to provide informed consent
* Those with a BMI of \<25 kg/m2 or \>35 kg/m2
* Those who have a household member on the study staff
* Those with any comorbidities of obesity who require immediate sub-specialist referral including pseudo-tumor cerebri, sleep apnea/hypoventilation syndrome, orthopedic problems, and meeting American Diabetes Association criteria for diabetes
* Cardiovascular event within the last 6 months
* Systolic BP at screening of \>160 mmHg OR diastolic BP \> 100 mmHg
* Current treatment for malignancy other than non-melanoma skin cancer
* Psychiatric or medical condition that prohibit compliance with study protocol, prescribed dietary changes and/or moderate physical activity
* Current treatment for eating disorder
* Taking medications that alter weight
* Regular use of systemic steroids
* Currently pregnant, gave birth within the last 6 months, currently lactating or breastfeeding within the last 3 months or intending to get pregnant over the next two years
* Enrolled in or planning to enroll in another weight loss program
* Past or planned (within the next 24 months) weight loss surgery
* Current participation in a commercial weight loss program
* Investigator discretion
* Non-English speaking
* Not able to ambulate unassisted
D: Inclusion Criteria:

* 18 through 60 years old
* BMI between 27 - 45 kg/m2
* \< 350 lbs
* Weight stable (no loss or gain \>25 lbs. for the past 6 months)
* Interested in losing weight and not enrolled in a formal weight loss program or taking medications or supplements that may cause weight change
* Own a Smartphone and be willing to install the SMART App
* Reside in the Chicago area for the duration of their participation (12 months)

Exclusion Criteria:

* Unstable medical conditions (uncontrolled hypertension, diabetes - uncontrolled or treated with insulin, uncontrolled hypothyroidism, unstable angina pectoris, transient ischemic attack, cancer undergoing active treatment, cerebrovascular accident or myocardial infarction within the past six months, or Crohn's disease)
* Pregnancy, lactation, or intended pregnancy
* Active suicidal ideation, anorexia, bulimia, binge eating disorder, current substance abuse or dependence (besides nicotine dependence)
* Require assistive device for mobility or current condition that may limit or prevent participation in moderate activity
* Use of pacemaker or other electrical implanted device
* History of bariatric (or LapBand) surgery, or considering or currently on a wait-list for bariatric or LapBand surgery
* May not live with a current or past SMART study participant

Answer: D