Background

Although 73.1% of the adult US population struggle with overweight or obesity, weight loss programs are often costly and fail to meet people's individualized needs. The current study aimed to evaluate participant engagement in an individualized stepped-care weight management program. Enrolled participants (Age >=18; BMI >=25) completed online measures of biopsychosocial functioning. Retention and level of care were used to assess program engagement. Neighborhood area deprivation index (ADI), body mass index (BMI), Edmonton Obesity Staging System (EOSS), and demographic information were extracted from medical records and analyzed using chi-square tests. Participants (n = 137) averaged 47.62 years of age (+-11.24; range 23-76), a state ADI of 5.45 (+-1.33; range 2-9), national ADI of 23.26 (+-9.99; range 5-73), and EOSS of 1.44 (+-0.73). They primarily identified as White non-Hispanic (69.1%) and female (71.9%); 32.1% (n=34) met criteria for Class I Obesity (n=34), 28.3% for Overweight (n=30), 19.8% for Class II (n=21), and 19.8% (n=21) Class III. More participants who completed a clinic visit but were unresponsive to survey follow-ups had a higher obesity class than active participants or those who removed themselves from the program (χ² (6, n=106)=18.84; p=.004). Participants choosing more intensive care (e.g., medication management, surgery versus MHealth application, therapy) had higher EOSS (χ² (24, n=102)=66.89; p<.001) and state ADI (χ² (36, n=102)=60.55; p=.006). Increased biopsychosocial health risks were associated with engagement in more intensive levels of care, especially among those with higher neighborhood disadvantage. Future research should examine the benefits of accessible psychosocial interventions on weight management care.