Self-Monitoring in Weight Loss: A Systematic Review of the Literature
01 Jan 2011-Journal of The American Dietetic Association (NIH Public Access)-Vol. 111, Iss: 1, pp 92-102
TL;DR: A significant association between self-monitoring and weight loss was consistently found; however, the level of evidence was weak and the most significant limitations of the reviewed studies were the homogenous samples and reliance on self-report.
Abstract: Self-monitoring is the centerpiece of behavioral weight loss intervention programs This article presents a systematic review of the literature on three components of self-monitoring in behavioral weight loss studies: diet, exercise, and self-weighing This review included articles that were published between 1993 and 2009 that reported on the relationship between weight loss and these self-monitoring strategies Of the 22 studies identified, 15 focused on dietary self-monitoring, one on self-monitoring exercise, and six on self-weighing A wide array of methods was used to perform self-monitoring; the paper diary was used most often Adherence to self-monitoring was reported most frequently as the number of diaries completed or the frequency of log-ins or reported weights The use of technology, which included the Internet, personal digital assistants, and electronic digital scales were reported in five studies Descriptive designs were used in the earlier studies whereas more recent reports involved prospective studies and randomized trials that examined the effect of self-monitoring on weight loss A significant association between self-monitoring and weight loss was consistently found; however, the level of evidence was weak because of methodologic limitations The most significant limitations of the reviewed studies were the homogenous samples and reliance on self-report In all but two studies, the samples were predominantly white and women This review highlights the need for studies in more diverse populations, for objective measures of adherence to self-monitoring, and for studies that establish the required dose of self-monitoring for successful outcomes
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TL;DR: The MMM app, a self-monitoring weight management intervention delivered by a smartphone app, is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted.
Abstract: Background: There is growing interest in the use of information communication technologies to treat obesity. An intervention delivered by smartphone could be a convenient, potentially cost-effective, and wide-reaching weight management strategy. Although there have been studies of texting-based interventions and smartphone applications (apps) used as adjuncts to other treatments, there are currently no randomized controlled trials (RCT) of a stand-alone smartphone application for weight loss that focuses primarily on self-monitoring of diet and physical activity. Objective: The aim of this pilot study was to collect acceptability and feasibility outcomes of a self-monitoring weight management intervention delivered by a smartphone app, compared to a website and paper diary. Methods: A sample of 128 overweight volunteers were randomized to receive a weight management intervention delivered by smartphone app, website, or paper diary. The smartphone app intervention, My Meal Mate (MMM), was developed by the research team using an evidence-based behavioral approach. The app incorporates goal setting, self-monitoring of diet and activity, and feedback via weekly text message. The website group used an existing commercially available slimming website from a company called Weight Loss Resources who also provided the paper diaries. The comparator groups delivered a similar self-monitoring intervention to the app, but by different modes of delivery. Participants were recruited by email, intranet, newsletters, and posters from large local employers. Trial duration was 6 months. The intervention and comparator groups were self-directed with no ongoing human input from the research team. The only face-to-face components were at baseline enrollment and brief follow-up sessions at 6 weeks and 6 months to take anthropometric measures and administer questionnaires. Results: Trial retention was 40/43 (93%) in the smartphone group, 19/42 (55%) in the website group, and 20/43 (53%) in the diary group at 6 months. Adherence was statistically significantly higher in the smartphone group with a mean of 92 days (SD 67) of dietary recording compared with 35 days (SD 44) in the website group and 29 days (SD 39) in the diary group ( P <.001). Self-monitoring declined over time in all groups. In an intention-to-treat analysis using baseline observation carried forward for missing data, mean weight change at 6 months was -4.6 kg (95% CI –6.2 to –3.0) in the smartphone app group, –2.9 kg (95% CI –4.7 to –1.1) in the diary group, and –1.3 kg (95% CI –2.7 to 0.1) in the website group. BMI change at 6 months was –1.6 kg/m 2 (95% CI –2.2 to –1.1) in the smartphone group, –1.0 kg/m 2 (95% CI –1.6 to –0.4) in the diary group, and –0.5 kg/m 2 (95% CI –0.9 to 0.0) in the website group. Change in body fat was –1.3% (95% CI –1.7 to –0.8) in the smartphone group, –0.9% (95% CI –1.5 to –0.4) in the diary group, and –0.5% (95% CI –0.9 to 0.0) in the website group. Conclusions: The MMM app is an acceptable and feasible weight loss intervention and a full RCT of this approach is warranted. Trial Registration: ClinicalTrials.gov NCT01744535; http://clinicaltrials.gov/ct2/show/NCT01744535 (Archived by WebCite at http://www.webcitation.org/6FEtc3PVB) [J Med Internet Res 2013;15(4):e32]
591 citations
Cites background from "Self-Monitoring in Weight Loss: A S..."
...Adherence to self-monitoring is an important process outcome because it has been consistently linked to weight loss [39]....
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TL;DR: A synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus are presented.
Abstract: Cardiovascular disease risk factor control as primary prevention in patients with type 2 diabetes mellitus has changed substantially in the past few years. The purpose of this scientific statement is to review the current literature and key clinical trials pertaining to blood pressure and blood glucose control, cholesterol management, aspirin therapy, and lifestyle modification. We present a synthesis of the recent literature, new guidelines, and clinical targets, including screening for kidney and subclinical cardiovascular disease for the contemporary management of patients with type 2 diabetes mellitus.
461 citations
TL;DR: In this 72-week trial in participants with obesity, 5 mg, 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight.
Abstract: BACKGROUND
Obesity is a chronic disease that results in substantial global morbidity and mortality. The efficacy and safety of tirzepatide, a novel glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, in people with obesity are not known.
METHODS
In this phase 3 double-blind, randomized, controlled trial, we assigned 2539 adults with a body-mass index (BMI; the weight in kilograms divided by the square of the height in meters) of 30 or more, or 27 or more and at least one weight-related complication, excluding diabetes, in a 1:1:1:1 ratio to receive once-weekly, subcutaneous tirzepatide (5 mg, 10 mg, or 15 mg) or placebo for 72 weeks, including a 20-week dose-escalation period. Coprimary end points were the percentage change in weight from baseline and a weight reduction of 5% or more. The treatment-regimen estimand assessed effects regardless of treatment discontinuation in the intention-to-treat population.
RESULTS
At baseline, the mean body weight was 104.8 kg, the mean BMI was 38.0, and 94.5% of participants had a BMI of 30 or higher. The mean percentage change in weight at week 72 was -15.0% (95% confidence interval [CI], -15.9 to -14.2) with 5-mg weekly doses of tirzepatide, -19.5% (95% CI, -20.4 to -18.5) with 10-mg doses, and -20.9% (95% CI, -21.8 to -19.9) with 15-mg doses and -3.1% (95% CI, -4.3 to -1.9) with placebo (P<0.001 for all comparisons with placebo). The percentage of participants who had weight reduction of 5% or more was 85% (95% CI, 82 to 89), 89% (95% CI, 86 to 92), and 91% (95% CI, 88 to 94) with 5 mg, 10 mg, and 15 mg of tirzepatide, respectively, and 35% (95% CI, 30 to 39) with placebo; 50% (95% CI, 46 to 54) and 57% (95% CI, 53 to 61) of participants in the 10-mg and 15-mg groups had a reduction in body weight of 20% or more, as compared with 3% (95% CI, 1 to 5) in the placebo group (P<0.001 for all comparisons with placebo). Improvements in all prespecified cardiometabolic measures were observed with tirzepatide. The most common adverse events with tirzepatide were gastrointestinal, and most were mild to moderate in severity, occurring primarily during dose escalation. Adverse events caused treatment discontinuation in 4.3%, 7.1%, 6.2%, and 2.6% of participants receiving 5-mg, 10-mg, and 15-mg tirzepatide doses and placebo, respectively.
CONCLUSIONS
In this 72-week trial in participants with obesity, 5 mg, 10 mg, or 15 mg of tirzepatide once weekly provided substantial and sustained reductions in body weight. (Supported by Eli Lilly; SURMOUNT-1 ClinicalTrials.gov number, NCT04184622.).
441 citations
TL;DR: Findings point to potential benefits of mobile monitoring methods during behavioral weight loss trials as well as ways to predict which self-monitoring method works best for an individual to increase adherence.
351 citations
TL;DR: Most of the new technologies in dietary assessment were seen to have overlapping methodological features with the conventional methods predominantly used for nutritional epidemiology.
Abstract: Introduction: The use of innovative technologies is deemed to improve dietary assessment in various research settings. However, their relative merits in nutritional epidemiological studies, which require accurate quantitative estimates of the usual intake at individual level, still need to be evaluated.
Objective: To report on the inventory of available innovative technologies for dietary assessment and to critically evaluate their strengths and weaknesses as compared with the conventional methodologies (i.e. Food Frequency Questionnaires, food records, 24-hour dietary recalls) used in epidemiological studies.
Methods: A list of currently available technologies was identified from English-language journals, using PubMed and Web of Science. The search criteria were principally based on the date of publication (between 1995 and 2011) and pre-defined search keywords.
Results: Six main groups of innovative technologies were identified ('Personal Digital Assistant-', 'Mobile-phone-', 'Interactive computer-', 'Web-', 'Camera- and tape-recorder-' and 'Scan- and sensor-based' technologies). Compared with the conventional food records, Personal Digital Assistant and mobile phone devices seem to improve the recording through the possibility for 'real-time' recording at eating events, but their validity to estimate individual dietary intakes was low to moderate. In 24-hour dietary recalls, there is still limited knowledge regarding the accuracy of fully automated approaches; and methodological problems, such as the inaccuracy in self-reported portion sizes might be more critical than in interview-based applications. In contrast, measurement errors in innovative web-based and in conventional paper-based Food Frequency Questionnaires are most likely similar, suggesting that the underlying methodology is unchanged by the technology.
Conclusions: Most of the new technologies in dietary assessment were seen to have overlapping methodological features with the conventional methods predominantly used for nutritional epidemiology. Their main potential to enhance dietary assessment is through more cost- and time-effective, less laborious ways of data collection and higher subject acceptance, though their integration in epidemiological studies would need additional considerations, such as the study objectives, the target population and the financial resources available. However, even in innovative technologies, the inherent individual bias related to self-reported dietary intake will not be resolved. More research is therefore crucial to investigate the validity of innovative dietary assessment technologies.
350 citations
References
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TL;DR: An Explanation and Elaboration of the PRISMA Statement is presented and updated guidelines for the reporting of systematic reviews and meta-analyses are presented.
Abstract: Systematic reviews and meta-analyses are essential to summarize evidence relating to efficacy and safety of health care interventions accurately and reliably. The clarity and transparency of these reports, however, is not optimal. Poor reporting of systematic reviews diminishes their value to clinicians, policy makers, and other users.
Since the development of the QUOROM (QUality Of Reporting Of Meta-analysis) Statement—a reporting guideline published in 1999—there have been several conceptual, methodological, and practical advances regarding the conduct and reporting of systematic reviews and meta-analyses. Also, reviews of published systematic reviews have found that key information about these studies is often poorly reported. Realizing these issues, an international group that included experienced authors and methodologists developed PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) as an evolution of the original QUOROM guideline for systematic reviews and meta-analyses of evaluations of health care interventions.
The PRISMA Statement consists of a 27-item checklist and a four-phase flow diagram. The checklist includes items deemed essential for transparent reporting of a systematic review. In this Explanation and Elaboration document, we explain the meaning and rationale for each checklist item. For each item, we include an example of good reporting and, where possible, references to relevant empirical studies and methodological literature. The PRISMA Statement, this document, and the associated Web site (http://www.prisma-statement.org/) should be helpful resources to improve reporting of systematic reviews and meta-analyses.
25,711 citations
"Self-Monitoring in Weight Loss: A S..." refers methods in this paper
...The Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (13) guided the systematic review....
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TL;DR: Examination of health promotion and disease prevention from the perspective of social cognitive theory finds the areas of overlap with some of the most widely applied psychosocial models of health are identified.
Abstract: This article examines health promotion and disease prevention from the perspective of social cognitive theory. The areas of overlap with some of the most widely applied psychosocial models of health are identified. The models of health promotion and disease prevention have undergone several generational changes. We have shifted from trying to scare people into health, to rewarding them into health, to equipping them with self-regulatory skills to manage their health habits, to shoring up their habit changes with dependable social supports. These transformations have evolved a multifaceted approach that addresses the reciprocal interplay between self-regulatory and environmental determinants of health behavior. Social cognitive theory addresses the socio structural determinants of health as well as the personal determinants. A comprehensive approach to health promotion requires changing the practices of social systems that have widespread detrimental effects on health rather than solely changing t...
2,716 citations
"Self-Monitoring in Weight Loss: A S..." refers background in this paper
...In order to change behaviors, individuals need to pay adequate attention to their own actions, as well as the conditions under which they occur and their immediate and long-term effects (5)....
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TL;DR: In this paper, the authors evaluated whether a structured Internet behavioral weight loss program produces greater initial weight loss and changes in waist circumference than a weight loss education Web site and found that participants who were given a structured behavioral treatment program with weekly contact and individualized feedback had better weight loss compared with those given links to educational Web sites.
Abstract: ContextRapid increases in access to the Internet have made it a viable mode
for public health intervention. No controlled studies have evaluated this
resource for weight loss.ObjectiveTo determine whether a structured Internet behavioral weight loss program
produces greater initial weight loss and changes in waist circumference than
a weight loss education Web site.DesignRandomized, controlled trial conducted from April to December 1999.Setting and ParticipantsNinety-one healthy, overweight adult hospital employees aged 18 to 60
years with a body mass index of 25 to 36 kg/m2. Analyses were performed
for the 65 who had complete follow-up data.InterventionsParticipants were randomly assigned to a 6-month weight loss program
of either Internet education (education; n = 32 with complete data) or Internet
behavior therapy (behavior therapy; n = 33 with complete data). All participants
were given 1 face-to-face group weight loss session and access to a Web site
with organized links to Internet weight loss resources. Participants in the
behavior therapy group received additional behavioral procedures, including
a sequence of 24 weekly behavioral lessons via e-mail, weekly online submission
of self-monitoring diaries with individualized therapist feedback via e-mail,
and an online bulletin board.Main Outcome MeasuresBody weight and waist circumference, measured at 0, 3, and 6 months,
compared the 2 intervention groups.ResultsRepeated-measures analyses showed that the behavior therapy group lost
more weight than the education group (P = .005).
The behavior therapy group lost a mean (SD) of 4.0 (2.8) kg by 3 months and
4.1 (4.5) kg by 6 months. Weight loss in the education group was 1.7 (2.7)
kg at 3 months and 1.6 (3.3) kg by 6 months. More participants in the behavior
therapy than education group achieved the 5% weight loss goal (45% vs 22%; P = .05) by 6 months. Changes in waist circumference were
also greater in the behavior therapy group than in the education group at
both 3 months (P = .001) and 6 months (P = .005).ConclusionsParticipants who were given a structured behavioral treatment program
with weekly contact and individualized feedback had better weight loss compared
with those given links to educational Web sites. Thus, the Internet and e-mail
appear to be viable methods for delivery of structured behavioral weight loss
programs.
949 citations
"Self-Monitoring in Weight Loss: A S..." refers background or result in this paper
...In 2001, Tate and colleagues reported that the number of diaries submitted to a behavioral weight loss program delivered via the Internet was significantly related to weight loss (16)....
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...Studies that used the Internet reported the number of diaries submitted without specifying the degree of completeness (16)....
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...Similar to what has been reported in the literature (16), there was a gradual decline in self-monitoring adherence, which worsened when the treatment sessions decreased in frequency....
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...Measures of adherence reported in the literature included the number of diaries submitted (15,16,33), therapists’ ratings of the completeness of diaries (12,22,24), scores on a survey of self-monitoring (10,25,31), or the number of self-reported weights over a specified period (17,18,32)....
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...Tate and colleagues conducted two studies that used a structured Internet program and found that the total number of submitted diaries was significantly related to weight loss (16,33)....
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TL;DR: This study used a newly developed paper diary that could objectively record when patients made diary entries in order to compare patients' reported and actual compliance with diary keeping, and used an electronic diary designed to enhance compliance inorder to assess what compliance rates might be achieved.
Abstract: Doctors often ask patients to recall recent health experiences, such as pain, fatigue, and quality of life1 Research has shown, however, that recall is unreliable and rife with inaccuracies and biases2 Recognition of recall's shortcomings has led to the use of diaries, which are intended to capture experiences close to the time of occurrence, thus limiting recall bias and producing more accurate data3
The rationale for using diaries would be undermined if patients failed to complete diaries according to protocol In this study we used a newly developed paper diary that could objectively record when patients made diary entries in order to compare patients' reported and actual compliance with diary keeping For comparison, we also used an electronic diary designed to enhance compliance in order to assess what compliance rates might be achieved
We recruited 80 adults with chronic pain (pain for ≥3 hours a day and rated ≥4 on a 10 point scale) and assigned 40 to keeping a paper …
786 citations
TL;DR: As compared with receiving quarterly newsletters, a self-regulation program based on daily weighing improved maintenance of weight loss, particularly when delivered face-to-face or over the Internet.
Abstract: Background Since many successful dieters regain the weight they lose, programs that teach maintenance skills are needed. We developed a maintenance program based on self-regulation theory and tested the efficacy of delivering the program face to face or over the Internet. Methods We randomly assigned 314 participants who had lost a mean of 19.3 kg of body weight in the previous 2 years to one of three groups: a control group, which received quarterly newsletters (105 participants), a group that received face-to-face intervention (105), and a group that received Internet-based intervention (104). The content of the programs in the two intervention groups was the same, emphasizing daily self-weighing and self-regulation, as was the frequency of contact with the groups. The primary outcome was weight gain over a period of 18 months. Results The mean (±SD) weight gain was 2.5±6.7 kg in the face-to-face group, 4.7±8.6 kg in the Internet group, and 4.9±6.5 kg in the control group, with a significant difference ...
781 citations
"Self-Monitoring in Weight Loss: A S..." refers background in this paper
...Self-Monitoring Weight Most recently, researchers have advocated weight self-monitoring in order to increase participants’ awareness of their weight and its relation to energy intake and expenditure (18,31,32)....
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...Measures of adherence reported in the literature included the number of diaries submitted (15,16,33), therapists’ ratings of the completeness of diaries (12,22,24), scores on a survey of self-monitoring (10,25,31), or the number of self-reported weights over a specified period (17,18,32)....
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...Fifteen studies focused on dietary self-monitoring (12,15,16,19,20,22–26,28–30,33,34), one included self-monitoring of exercise (27), and six focused on self-monitoring of weight (10,17,18,21,31,32)....
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...(32) examined the effect of self-weighing among three groups: face-to-face, Internetbased, and a control in an 18-month trial focused on prevention of weight regain....
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...Two additional trials focused on self-weighing in a self-regulation framework (17,32)....
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