Thank you for your interest in the study. The purpose of this study is to test a four-week program designed to help you feel better about your body and to prepare you to approach weight loss with a more positive body image.
Participation in the study would involve attending four group meetings lasting approximately 60 minutes. All of these meetings will be remote, through online video conferencing. Before the group meetings begin and after you have completed all four meetings, we will complete an assessment. We will send you a survey to complete before your first group meeting and again after your last group meeting with questionnaires about how you feel about your body and other factors that influence how you think about your body weight and shape. We will also help you download a secure Smartphone Application to your phone that will prompt you to answer questions about how you feel about your body 6 times daily during the 7 days prior to your first group meeting and during the 7 days after your last group meeting. We will also ask you to attend one additional group meeting within a month after your last group meeting. This meeting will also be conducted on the online platform and will include an interview with you and the other women in your group so we can ask you questions about how you felt about the intervention and to get your feedback. After completing the study procedures, you will receive resources and information to help begin your weight loss journey.
You will be compensated $25 for completing each assessment and the last group interview meeting. This is a total of $75. You will also receive $1 for every phone prompt you complete up to a total of $84.
Yes
No
Yes
No
Home Phone (if not applicable, put N/A):
Can we leave a message on your home phone?
Yes
No
Work Phone (if not applicable, put N/A):
Can we leave a message on your work phone?
Yes
No
Best phone number to use?
How did you hear about this study?
Flyer
Brochure
Facebook
Newspaper Advertisement
Other
What was your biological sex at birth?
Male
Female
Select which of the following best describes your gender identity:
Male
Female
Gender-Nonconforming
Non-Binary
Other
Do you consider yourself to be:
Straight/Heterosexual
Gay/Lesbian/Homosexual
Bisexual
Something else
Prefer not to report
By "something else" do you mean:
Queer
Pansexual
Asexual
Celibate
Unsure
Something else
In your own words, please describe what you mean by "something else"
Which of the following best describes your racial heritage? You may choose more than one.
American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Pacific Islander
White
Other
Which of the following best describes your ethnic heritage?
Hispanic or Latino
Not Hispanic or Latino
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What is your current weight in pounds?
What is your height in inches?
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Would you like to lose weight?
Yes
No
Are you currently trying to lose weight?
Yes
No
If you are thinking about joining a weight loss program, are you willing to wait or to agree not to join any formal weight loss programs during the two months you're enrolled in this study?
Yes
No
Have you lost weight recently?
Yes
No
If yes, how many pounds have you lost?
Have you ever had bariatric surgery or any other weight loss surgery?
Yes
No
Do you plan to have bariatric surgery or any other weight loss surgery?
Yes
No
When will the procedure take place?
Are you currently using any medications for weight loss?
Yes
No
Are you currently pregnant?
Yes
No
Are you currently breastfeeding?
Yes
No
Have you ever been diagnosed with an eating disorder?
Yes
No
Have you ever used extreme measures to control your weight such as use of laxatives, diuretics, self-induced vomiting, or extended periods of severe food restriction?
Yes
No
Do you have a physical disability or chronic condition that would impact your ability to exercise or lose weight?
Yes
No
Do you have any conditions that would make it challenging to sit through and pay attention to weekly classes or follow instructions?
Yes
No
Are you currently being treated for drug or alcohol abuse?
Yes
No
Is a doctor or health care provider currently treating you or prescribing medications for any psychological problems?
Yes
No
Have you ever been hospitalized for any psychological problems (Depression included)?
Yes
No
Was hospitalization within the last year?
Yes
No
Do you have a Smartphone?
Yes
No
Are you willing to allow us to download a Smartphone application onto your phone to collect data for the study?
Yes
No
Do you have a tablet, laptop computer or desktop computer that you could use to attend online group meetings?
Yes
No
Do you have internet service at your current residence?
Yes
No
Are you currently participating in any other research studies?
Yes
No
What does your participation in this study involve?
Are you able to attend weekly zoom meetings on Thursday from 5:30 to 6:30 pm EASTERN TIME starting in January?
Yes
No
Questions 1 to 12: please select the appropriate number. Remember that the questions only refer to the past four weeks....
1
2
3
4
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7
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9
10
11
12
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Would you like us to contact you about other studies at the Weight Control and Diabetes Research Center that you may be eligible for in the future?
Yes
No
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