Dori M. Steinberg

The efficacy of a daily self‐weighing weight loss intervention using smart scales and e‐mail

To examine the impact of a weight loss intervention that focused on daily self‐weighing for self‐monitoring as compared to a delayed control group among 91 overweight adults.

Daily Text Messaging for Weight Control Among Racial and Ethnic Minority Women: Randomized Controlled Pilot Study

Background Daily self-monitoring of diet and physical activity behaviors is a strong predictor of weight loss success. Text messaging holds promise as a viable self-monitoring modality, particularly among racial/ethnic minority populations. Objective This pilot study evaluated the feasibility of a text messaging intervention for weight loss among predominantly black women. Methods Fifty obese women were randomized to either a 6-month intervention using a fully automated system that included daily text messages for self-monitoring tailored behavioral goals (eg, 10,000 steps per day, no sugary drinks) along with brief feedback and tips (n=26) or to an education control arm (n=24). Weight was objectively measured at baseline and at 6 months. Adherence was defined as the proportion of text messages received in response to self-monitoring prompts. Results The average daily text messaging adherence rate was 49% (SD 27.9) with 85% (22/26) texting self-monitored behavioral goals 2 or more days per week. Approximately 70% (16/23) strongly agreed that daily texting was easy and helpful and 76% (16/21) felt the frequency of texting was appropriate. At 6 months, the intervention arm lost a mean of 1.27 kg (SD 6.51), and the control arm gained a mean of 1.14 kg (SD 2.53; mean difference –2.41 kg, 95% CI –5.22 to 0.39; P=.09). There was a trend toward greater text messaging adherence being associated with greater percent weight loss (r=–.36; P=.08), but this did not reach statistical significance. There was no significant association between goal attainment and text messaging adherence and no significant predictors of adherence. Conclusions Given the increasing penetration of mobile devices, text messaging may be a useful self-monitoring tool for weight control, particularly among populations most in need of intervention. Trial Registration Clinicaltrials.gov: NCT00939081; http://clinicaltrials.gov/show/NCT00939081 (Archived by WebCite at http://www.webcitation.org/6KiIIcnk1).

Electronic health (eHealth) interventions for weight management among racial/ethnic minority adults: a systematic review

Electronic health (eHealth) interventions have demonstrated efficacy for weight management. However, little is known about their efficacy among racial/ethnic minority populations, in whom there is a disproportionate prevalence of obesity. This systematic review evaluated the efficacy of eHealth weight management interventions among overweight and obese racial/ethnic minority adults. We required that trial samples be comprised of at least 50% racial/ethnic minorities or report outcomes by race/ethnicity. We searched five electronic databases for trials conducted through June 2012. Six papers met our eligibility criteria. These studies provide suggestive evidence that eHealth interventions can produce low magnitude, short‐term weight loss among racial/ethnic minorities. Trials were methodologically sound, with high retention and participant engagement. There was no evidence detailing the efficacy of mobile health approaches, although this area is promising given high utilization rates of mobile devices among racial/ethnic minorities. More evidence, particularly from longer‐term trials, is necessary to demonstrate that eHealth intervention approaches can produce clinically meaningful (≥5% of initial body weight) weight loss among racial/ethnic minority populations.

Daily Self-Weighing and Adverse Psychological Outcomes: A Randomized Controlled Trial

BACKGROUND Despite evidence that daily self-weighing is an effective strategy for weight control, concerns remain regarding the potential for negative psychological consequences. PURPOSE The goal of the study was to examine the impact of a daily self-weighing weight-loss intervention on relevant psychological constructs. DESIGN A 6-month RCT. SETTING/PARTICIPANTS The study sample (N=91) included overweight men and women in the Chapel Hill NC area. INTERVENTION Between February and August 2011, participants were randomly assigned to a daily self-weighing intervention or delayed-intervention control group. The 6-month intervention included daily self-weighing for self-regulation of diet and exercise behaviors using an e-scale that transmitted weights to a study website. Weekly e-mailed lessons and tailored feedback on daily self-weighing adherence and weight-loss progress were provided. MAIN OUTCOME MEASURES Self-weighing frequency was measured throughout the study using e-scales. Weight was measured in-clinic at baseline, 3 months, and 6 months. Psychological outcomes were assessed via self-report at the same time points. RESULTS In 2012, using linear mixed models and generalized estimating equation models, there were no significant differences between groups in depressive symptoms, anorectic cognitions, disinhibition, susceptibility to hunger, and binge eating. At 6 months, there was a significant group X time interaction for body dissatisfaction (p=0.007) and dietary restraint (p<0.001), with the intervention group reporting lower body dissatisfaction and greater dietary restraint compared to controls. CONCLUSIONS Results indicate that a weight-loss intervention that focuses on daily self-weighing does not cause adverse psychological outcomes. This suggests that daily self-weighing is an effective and safe weight-control strategy among overweight adults attempting to lose weight. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT01369004.

Weighing every day matters: Daily weighing improves weight loss and adoption of weight control behaviors

BACKGROUND Daily weighing is emerging as the recommended self-weighing frequency for weight loss. This is likely because it improves adoption of weight control behaviors. OBJECTIVE To examine whether weighing every day is associated with greater adoption of weight control behaviors compared with less frequent weighing. DESIGN Longitudinal analysis of a previously conducted 6-month randomized controlled trial. PARTICIPANTS/SETTING Overweight men and women in Chapel Hill, NC, participated in the intervention arm (N=47). INTERVENTION The intervention focused on daily weighing for weight loss using an e-scale that transmitted weights to a study website, along with weekly e-mailed lessons and tailored feedback on daily weighing adherence and weight loss progress. MAIN OUTCOME MEASURES We gathered objective data on self-weighing frequency from the e-scales. At baseline and 6 months, weight change was measured in the clinic and weight control behaviors (total items=37), dietary strategies, and calorie expenditure from physical activity were assessed via questionnaires. Calorie intake was assessed using an online 24-hour recall tool. STATISTICAL ANALYSES We used χ(2) tests to examine variation in discrete weight control behaviors and linear regression models to examine differences in weight, dietary strategies, and calorie intake and expenditure by self-weighing frequency. RESULTS Fifty-one percent of participants weighed every day (n=24) over 6 months. The average self-weighing frequency among those weighing less than daily (n=23) was 5.4±1.2 days per week. Daily weighers lost significantly more weight compared with those weighing less than daily (mean difference=-6.1 kg; 95% CI -10.2 to -2.1; P=0.004). The total number of weight control behaviors adopted was greater among daily weighers (17.6±7.6 vs 11.2±6.4; P=0.004). There were no differences by self-weighing frequency in dietary strategies, calorie intake, or calorie expenditure. CONCLUSIONS Weighing every day led to greater adoption of weight control behaviors and produced greater weight loss compared with weighing most days of the week. This further implicates daily weighing as an effective weight loss tool.

Adherence to Self-Monitoring via Interactive Voice Response Technology in an eHealth Intervention Targeting Weight Gain Prevention Among Black Women: Randomized Controlled Trial

Background eHealth interventions are effective for weight control and have the potential for broad reach. Little is known about the use of interactive voice response (IVR) technology for self-monitoring in weight control interventions, particularly among populations disproportionately affected by obesity. Objective This analysis sought to examine patterns and predictors of IVR self-monitoring adherence and the association between adherence and weight change among low-income black women enrolled in a weight gain prevention intervention. Methods The Shape Program was a randomized controlled trial comparing a 12-month eHealth behavioral weight gain prevention intervention to usual care among overweight and obese black women in the primary care setting. Intervention participants (n=91) used IVR technology to self-monitor behavior change goals (eg, no sugary drinks, 10,000 steps per day) via weekly IVR calls. Weight data were collected in clinic at baseline, 6, and 12 months. Self-monitoring data was stored in a study database and adherence was operationalized as the percent of weeks with a successful IVR call. Results Over 12 months, the average IVR completion rate was 71.6% (SD 28.1) and 52% (47/91) had an IVR completion rate ≥80%. At 12 months, IVR call completion was significantly correlated with weight loss (r =−.22; P=.04) and participants with an IVR completion rate ≥80% had significantly greater weight loss compared to those with an IVR completion rate <80% (−1.97 kg, SE 0.67 vs 0.48 kg, SE 0.69; P=.01). Similar outcomes were found for change in body mass index (BMI; mean difference −0.94 kg, 95% CI −1.64 to −0.24; P=.009). Older, more educated participants were more likely to achieve high IVR call completion. Participants reported positive attitudes toward IVR self-monitoring. Conclusions Adherence to IVR self-monitoring was high among socioeconomically disadvantaged black women enrolled in a weight gain prevention intervention. Higher adherence to IVR self-monitoring was also associated with greater weight change. IVR is an effective and useful tool to promote self-monitoring and has the potential for widespread use and long-term sustainability. Trial Registration Clinicaltrials.gov NCT00938535; http://www.clinicaltrials.gov/ct2/show/NCT00938535 (Archived by WebCite at http://www.webcitation.org/6P1FFNJRs).

Mobile health devices: will patients actually use them?

Although mobile health (mHealth) devices offer a unique opportunity to capture patient health data remotely, it is unclear whether patients will consistently use multiple devices simultaneously and/or if chronic disease affects adherence. Three healthy and three chronically ill participants were recruited to provide data on 11 health indicators via four devices and a diet app. The healthy participants averaged overall weekly use of 76%, compared to 16% for those with chronic illnesses. Device adherence declined across all participants during the study. Patients with chronic illnesses, with arguably the most to benefit from advanced (or increased) monitoring, may be less likely to adopt and use these devices compared to healthy individuals. Results suggest device fatigue may be a significant problem. Use of mobile technologies may have the potential to transform care delivery across populations and within individuals over time. However, devices may need to be tailored to meet the specific patient needs.

The DASH Diet, 20 Years Later

This year marks the 20th anniversary of the publication showing the blood pressure–lowering effects of the Dietary Approaches to Stop Hypertension (DASH) diet.1 The DASH diet is considered an important advance in nutritional science. It emphasizes foods rich in protein, fiber, potassium, magnesium, and calcium, such as fruits and vegetables, beans, nuts, whole grains, and low-fat dairy. It also limits foods high in saturated fat and sugar.1 DASH is not a reduced-sodium diet, but its effect is enhanced by also lowering sodium intake.1 Since the creation of DASH 20 years ago, numerous trials have demonstrated that it consistently lowers blood pressure across a diverse range of patients with hypertension and prehypertension.

mHealth interventions for weight loss: a guide for achieving treatment fidelity

UNLABELLED mHealth interventions have shown promise for helping people sustain healthy behaviors such as weight loss. However, few have assessed treatment fidelity, that is, the accurate delivery, receipt, and enactment of the intervention. Treatment fidelity is critical because the valid interpretation and translation of intervention studies depend on treatment fidelity assessments. We describe strategies used to assess treatment fidelity in mobile health (mHealth) interventions aimed at sustaining healthy behaviors in weight loss. We reviewed treatment fidelity recommendations for mHealth-based behavioral interventions and described how these recommendations were applied in three recent weight loss studies. We illustrate how treatment fidelity can be supported during study design, training of providers, treatment delivery, receipt of treatment, and enactment of treatment skills. Pre-planned strategies to ensure the treatment fidelity of mHealth interventions will help counter doubts concerning valid conclusions about their effectiveness and allow investigators and clinicians to implement robustly efficacious mobile health programs. TRIAL REGISTRATION NUMBER 1F31 NR012599.

Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention

Background While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes. Purpose “Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes. Methods Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm. Results The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes. Conclusions This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement.