Characterizing and Predicting Early Weight Loss as a Marker of Success in Technology-Based Weight Loss Interventions for Rural Populations

<strong>Background:</strong>&nbsp;<br />Obesity&nbsp;remains&nbsp;a significant public health burden in the United States, with disproportionately higher prevalence in rural populations due to limited access to healthcare and lifestyle interventions. Technology-based behavioral interventions have&nbsp;emerged&nbsp;as scalable solutions; however, predictors of early weight loss and their association with longer-term outcomes are not well established. This study aimed to characterize baseline factors associated with early weight loss,&nbsp;identify&nbsp;predictors of&nbsp;early response, and evaluate early weight loss as a predictor of clinically significant weight loss.&nbsp; <strong>Methods:</strong>&nbsp;<br />This secondary analysis included&nbsp;participants from four technology-based lifestyle interventions conducted in rural settings&nbsp;with study durations ranging from&nbsp;12 weeks-26 weeks. Early weight loss was defined as &ge;2% at&nbsp;6 weeks&nbsp;or &ge;2.5% at&nbsp;8 weeks, and clinically significant weight loss as &ge;5% at 12 or&nbsp;16 weeks. Baseline variables included dietary quality (REAPS), physical function, anthropometrics,&nbsp;energy expenditure, and sociodemographic characteristics.&nbsp;Participants&nbsp;who&nbsp;achieved&nbsp;weight loss thresholds were grouped together. Weight loss success groups and non-responders were compared&nbsp;using unpaired t-tests. Predictors were&nbsp;identified&nbsp;using univariate and multivariate logistic regression models constructed via purposeful selection and constrained by statistical power.&nbsp; <strong>Results:</strong>&nbsp;<br />A total of&nbsp;111 participants&nbsp;were included in the analysis&nbsp;(Early Weight&nbsp;Loss&nbsp;Responders: 53, Clinically Significant Weight Loss&nbsp;Responders.&nbsp;Mean age was&nbsp;66.3&nbsp;&plusmn;&nbsp;13.7&nbsp;(78.4% female) with mean BMI of&nbsp;38.0 &plusmn; 6.0.&nbsp;There were&nbsp;differences&nbsp;in baseline characteristics between responder groups.&nbsp;At baseline, participants&nbsp;achieving&nbsp;early weight loss&nbsp;demonstrated&nbsp;significantly&nbsp;higher dietary&nbsp;quality&nbsp;(p&nbsp;= 0.02),&nbsp;longer six-minute walk (p =&nbsp;0.01),&nbsp;greater&nbsp;BMI&nbsp;(p=0.007), waist circumference&nbsp;(p=0.02), and&nbsp;resting energy&nbsp;expenditure&nbsp;(p=0.03)&nbsp;compared to non-responders.&nbsp;Participants with depression had&nbsp;lower&nbsp;odds&nbsp;of achieving early weight loss (OR =0.46&nbsp;[0.11-0.88]), while&nbsp;participants who reported higher dietary quality had&nbsp;significantly&nbsp;greater odds of achieving early weight loss&nbsp;(OR&nbsp;=&nbsp;1.12 [1.02-1.31].&nbsp;Early weight loss was a strong predictor of clinically significant weight loss, with adjusted models&nbsp;demonstrating&nbsp;over 30-fold increased odds&nbsp;(p&nbsp;&lt;0.001)&nbsp;of achieving &ge;5% weight loss among early&nbsp;responders.&nbsp;&nbsp; <strong>Conclusion:</strong>&nbsp;<br />Early weight loss&nbsp;predicts&nbsp;clinically significant weight loss in technology-based interventions for&nbsp;rural populations. These findings&nbsp;also&nbsp;highlight the importance of dietary quality and psychosocial factors in early intervention success and support the use of early weight loss&nbsp;thresholds as actionable clinical checkpoints to inform personalized treatment strategies and&nbsp;optimize&nbsp;long-term outcomes.&nbsp; <br /><br />