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Peer-reviewedCC BY 4.0PLOS One

Intensive longitudinal assessment of stress and stress-related concepts across a weight loss program: Protocol for a longitudinal ecological momentary assessment study

  • Chelsea L. Kracht1
  • Ann M. Davis2
  • Udayan Apte3
  • Madigan Snodgrass
  • Taylor Y. Collier
  • Jeffery J. Honas
  • John M. Jakicic
  1. 1Department of Internal Medicine, University of Kansas Medical Center, Kansas City, Kansas, United States of America
  2. 2Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas, United States of America
  3. 3Center for Children’s Healthy Lifestyles & Nutrition, Children’s Mercy Hospital, Kansas City, Missouri, United States of America
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Abstract

Background: Fluctuations in daily stress and the inability to cope with this stress (i.e., coping) can negatively impact behavior and potentially weight loss. Longitudinal studies using ecological momentary assessment (EMA) of psychological factors and behavior may inform interventions that can be adapted in real-time to modify stress and stress-related factors to enhance weight loss. This study’s purpose is to examine variability in stress and stress-related concepts and weight loss during a behavioral weight loss program with the intent of this informing future interventions. Methods: Individuals with obesity (body mass index: ≥ 30 kg/m2) who are newly enrolled in an existing community-based behavioral weight loss programs will be recruited. Participants will complete four visits, to coincide with before program (week-0), early program (6-weeks), program mid-point (3-months), and program end (6-months). Each visit will include height, weight, and questionnaires related to chronic stress and coping, and weight-related behaviors. Participants will then complete at least 14-days of EMA, including one morning survey, four signal-contingent surveys during fixed 3-hour windows, and one night-time survey daily via a smartphone application. During these 14-days, participants will also complete device-based measures for physical activity and sleep and waking saliva collection to evaluate cortisol. The primary exposure is the difference (i.e., variability) in signal-contingent survey stress, coping, and affect at baseline. The primary outcome is weight change across 6-months. This study received initial startup in March 2024, and was registered in Clinical Trials in October 2024. The study began recruitment in March 2025 and anticipate completion in early 2027. Discussion: Findings may inform justification for the pursuit of an ecological momentary intervention focused on improving stress while engaging in a behavioral weight loss intervention to support behavior change and potentially weight loss. Trial registration: ClinicalTrials.gov NCT06668259

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Cite

BibTeXRIS
BibTeX
@article{kracht2026intensive,
  title = {{Intensive longitudinal assessment of stress and stress-related concepts across a weight loss program: Protocol for a longitudinal ecological momentary assessment study}},
  author = {Chelsea L. Kracht and Ann M. Davis and Udayan Apte and Madigan Snodgrass and Taylor Y. Collier and Jeffery J. Honas and John M. Jakicic},
  journal = {PLOS One},
  year = {2026},
  month = sep,
  doi = {10.1371/journal.pone.0357572},
  url = {https://doi.org/10.1371/journal.pone.0357572},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Intensive longitudinal assessment of stress and stress-related concepts across a weight loss program: Protocol for a longitudinal ecological momentary assessment study
AU  - Chelsea L. Kracht
AU  - Ann M. Davis
AU  - Udayan Apte
AU  - Madigan Snodgrass
AU  - Taylor Y. Collier
AU  - Jeffery J. Honas
AU  - John M. Jakicic
PY  - 2026
DA  - 2026/09/10
JO  - PLOS One
DO  - 10.1371/journal.pone.0357572
UR  - https://doi.org/10.1371/journal.pone.0357572
AB  - Background: Fluctuations in daily stress and the inability to cope with this stress (i.e., coping) can negatively impact behavior and potentially weight loss. Longitudinal studies using ecological momentary assessment (EMA) of psychological factors and behavior may inform interventions that can be adapted in real-time to modify stress and stress-related factors to enhance weight loss. This study’s purpose is to examine variability in stress and stress-related concepts and weight loss during a behavioral weight loss program with the intent of this informing future interventions. Methods: Individuals with obesity (body mass index: ≥ 30 kg/m2) who are newly enrolled in an existing community-based behavioral weight loss programs will be recruited. Participants will complete four visits, to coincide with before program (week-0), early program (6-weeks), program mid-point (3-months), and program end (6-months). Each visit will include height, weight, and questionnaires related to chronic stress and coping, and weight-related behaviors. Participants will then complete at least 14-days of EMA, including one morning survey, four signal-contingent surveys during fixed 3-hour windows, and one night-time survey daily via a smartphone application. During these 14-days, participants will also complete device-based measures for physical activity and sleep and waking saliva collection to evaluate cortisol. The primary exposure is the difference (i.e., variability) in signal-contingent survey stress, coping, and affect at baseline. The primary outcome is weight change across 6-months. This study received initial startup in March 2024, and was registered in Clinical Trials in October 2024. The study began recruitment in March 2025 and anticipate completion in early 2027. Discussion: Findings may inform justification for the pursuit of an ecological momentary intervention focused on improving stress while engaging in a behavioral weight loss intervention to support behavior change and potentially weight loss. Trial registration: ClinicalTrials.gov NCT06668259
SN  - 1932-6203
ER  -