WW Improving Nutrition Study: A Randomized Controlled Trial

Weight (lb); % body weight loss defined as baseline to 6-month weight change divided by baseline weight multiplied by 100.

Proportion of participants that achieve at least 3% body weight loss at 6 months

Proportion of participants that achieve at least 5% body weight loss at 6 months

Proportion of participants that achieve at least 10% body weight loss at 6 months

Measured using the Impact of Weight on Quality of Life - Lite (IWQOL).

The IWQOL-Lite is a reliable and valid brief measure of quality of life in people with obesity. There are 31 items rated on a Likert scale 5-Always True to 1-Never True. Items are broken into subscales for physical function, self-esteem, sexual life, public distress, and work. Subscale scores and total score range from 0-100, with higher scores reflecting better levels of functioning.

Measured using a Hunger Visual Analog scale (VAS) which includes a question that asks participants to rate how hungry they felt over the past week on a horizontal line with endpoints of "Not at all hungry" (0) to "Extremely hungry" (100). VAS are scored by measuring in where the participant places their tick mark on the horizontal line with endpoints of 0-100. Higher scores indicate greater feelings of hunger.

Measured using the Food-craving Inventory (FCI-II). The FCI-II is a validated 33-item self-report measure that assesses the subjective experience of food craving across 33 different foods. The FCI-II assesses the frequency of cravings for a specified food with a five-point Likert scale (1, never; 2, rarely; 3, sometimes; 4, often; 5, always) and consists of 5 factors: high fats, sweets, carbohydrates/starches, fast food fats, \& fruits and vegetables, that constitute the total food craving inventory score which averages all 33 items. Scores can range between 1 and 5, with higher scores indicating greater frequency of cravings.

Measured using the Global Physical Activity Questionnaire (GPAQ). The GPAQ collects information on physical activity participation in the following domains: activity at work, travel to- and from- places, recreational activities, and sedentary behavior. From these inputs, the minutes per week spent in moderate activity, vigorous activity, moderate and vigorous activity, and sedentary behavior can be calculated.

Measured using the World Health Organization Well-being Index-5 (WHO-5). The WHO-5 consists of five statements rated by study participants with a Likert Scale: All of the time=5, Most of the time=4, More than half of the time=3, Less than half of the time=2, Some of the time=1, At no time=0. The total raw score, ranging from 0 to 25, is multiplied by 4 to give the final score with 0 representing the worst imaginable well-being and 100 representing the best imaginable well-being.

Measured using the Perceived Stress Scale (PSS). The 10-item PSS measures the extent to which a participant's life is unpredictable, uncontrollable, and overloading. It was designed for use in older adolescents and adults, and is considered to have adequate internal reliability and construct validity. Each question asks about how the participant has felt or thought in the past month and uses a 5-point Likert scale (0=never, 4=very often). Scores are calculated by summing responses, creating a possible score range of 0-40, with higher scores indicating greater perceived stress.

Measured with the Self-Reported Behavioral Automaticity Index. The self-reported behavioral automaticity index (SRBAI) captures habitual patterns of behavior. Each behavior of interest is assessed by 4 items rated on a Likert scale 1-strongly disagree to 7-strongly agree.

Scores are calculated for each behavior by taking an average of the response values, creating a possible score range between 1 and 7. Higher scores indicate greater habit strength for the behavior being measured.

The AMED score includes seven "healthy" components: a. fruits, b. vegetables, c. fish, d. legumes, e. nuts, f. whole grains, and g. ratio of monounsaturated fat to saturated fat), and two additional components: h. red and processed meat, and i. alcohol consumption.

Each component, except alcohol, will be categorized into quintiles (Q) and positive scores to the seven healthy components will be assigned as follows: (Q1=1, Q2=2, Q3=3, Q4=4, Q5=5). Reverse scores to red and processed meat will be assigned as follows: (Q5=1, Q4=2, Q3=3, Q2=4, Q1=5).

For alcohol consumption (g/d), points will be assigned as follows: 5-15=5, 0-5 or 15-25=4, 0 or 25-30=3, 30-35=2, and ≥35=1 for women and 10-30=5, 0-10 or 30-40=4, 0 or 40-45=3, 45-50=2, and ≥50=1 for men.

Macro- and micro-nutrient intakes will be measured with the validated Automated Self-Administered 24-hour (ASA24®) Dietary Assessment Tool. Participants will be asked to complete three recalls at each timepoint. Participants will be asked to complete three recalls at each timepoint.

[Time Frame; Baseline and 6-months] Measured using the measured with the Automated Self-Administered Dietary Assessment Tool 24-hour dietary recalls (ASA 24)

Measured with the sleep assessment module from the validated Automated Self-Administered 24-hour (ASA24®) Dietary Assessment Tool

Measured with the Automated Self-Administered Dietary Assessment Tool 24-hour dietary recalls (ASA24®).