Mary Ann Sevick

Self-Monitoring in Weight Loss: A Systematic Review of the Literature

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.

Measuring Adherence to Behavioral and Medical Interventions

Measuring adherence to medical and behavioral interventions is important to clinicians and researchers since inadequate adherence can reduce the effectiveness of an intervention. Unfortunately, there is no gold standard for measuring adherence across health behaviors. Adherence needs to be defined situationally with parameters of acceptable adherence carefully delineated and appropriate to the health behavior being studied. Additionally, measurement methods must be valid, reliable, and sensitive to change; this paper reviews these criteria. Methods used to measure adherence to dietary interventions include 24-hour recalls, food diaries, and food frequency questionnaires. Direct and indirect calorimetry, doubly labeled water, and a variety of self-report methods can be used to measure adherence in physical activity interventions. Adherence to pharmacological interventions is assessed using self-report methods, biochemical measures, medication counts, and the automated pharmacy database review strategy. The strengths and weaknesses of these methods for measuring adherence to dietary, physical activity, and pharmacological interventions are reviewed. Control Clin Trials 2000;21:188S-194S

Cost-Effectiveness of Lifestyle and Structured Exercise Interventions in Sedentary Adults: Results of Project ACTIVE

BACKGROUND Project ACTIVE was a randomized clinical trial comparing two physical activity interventions, lifestyle and traditional structured exercise. The two interventions were evaluated and compared in terms of cost effectiveness and ability to enhance physical activity among sedentary adults. DESIGN This was a randomized clinical trial. SETTING/ PARTICIPANTS The study included 235 sedentary but healthy community-dwelling adults. INTERVENTION A center-based lifestyle intervention that consisted of behavioral skills training was compared to a structured exercise intervention that included supervised, center-based exercise. MAIN OUTCOME MEASURES The main outcome measures of interest included cost, cardiorespiratory fitness, and physical activity. RESULTS Both interventions were effective in increasing physical activity and fitness. At 6 months, the costs of the lifestyle and structured interventions were, respectively,

Using mHealth Technology to Enhance Self-Monitoring for Weight Loss A Randomized Trial

46.53 and

The Effect of Electronic Self-Monitoring on Weight Loss and Dietary Intake: A Randomized Behavioral Weight Loss Trial

190.24 per participant per month. At 24 months these costs were

Factors Related to Sleep Disturbance in Older Adults Experiencing Knee Pain or Knee Pain with Radiographic Evidence of Knee Osteoarthritis

17.15 and

Active Care Management Supported by Home Telemonitoring in Veterans with Type 2 Diabetes: (The DiaTel Randomized Controlled Trial)

49.31 per participant per month. At both 6 months and 24 months, the lifestyle intervention was more cost-effective than the structured intervention for most outcomes measures. CONCLUSIONS A behaviorally-based lifestyle intervention approach in which participants are taught behavioral skills to increase their physical activity by integrating moderate-intensity physical activity into their daily lives is more cost-effective than a structured exercise program in improving physical activity and cardiorespiratory health. This study represents one of the first attempts to compare the efficiency of intervention alternatives for improving physical activity among healthy, sedentary adults.

SMART trial: A randomized clinical trial of self-monitoring in behavioral weight management-design and baseline findings

BACKGROUND Self-monitoring for weight loss has traditionally been performed with paper diaries. Technologic advances could reduce the burden of self-monitoring and provide feedback to enhance adherence. PURPOSE To determine if self-monitoring diet using a PDA only or the PDA with daily tailored feedback (PDA+feedback [FB]), was superior to using a paper diary on weight loss and maintenance. DESIGN The Self-Monitoring and Recording Using Technology (SMART) Trial was a 24-month randomized clinical trial; participants were randomly assigned to one of three self-monitoring groups. SETTING/PARTICIPANTS From 2006 to 2008, a total of 210 overweight/obese adults (84.8% female, 78.1% white) were recruited from the community. Data were analyzed in 2011. INTERVENTION Participants received standard behavioral treatment for weight loss that included dietary and physical activity goals, encouraged the use of self-monitoring, and was delivered in group sessions. MAIN OUTCOME MEASURES Percentage weight change at 24 months, adherence to self-monitoring over time. RESULTS Study retention was 85.6%. The mean percentage weight loss at 24 months was not different among groups (paper diary: -1.94%, 95% CI = -3.88, 0.01; PDA: -1.38%, 95% CI= -3.38, 0.62; PDA+FB: -2.32%, 95% CI= -4.29, -0.35); only the PDA+FB group (p=0.02) demonstrated a significant loss. For adherence to self-monitoring, there was a time-by-treatment group interaction between the combined PDA groups and the paper diary group (p=0.03) but no difference between PDA and PDA+FB groups (p=0.49). Across all groups, weight loss was greater for those who were adherent ≥60% versus <30% of the time (p<0.001). CONCLUSIONS PDA+FB use resulted in a small weight loss at 24 months; PDA use resulted in greater adherence to dietary self-monitoring over time. However, for sustained weight loss, adherence to self-monitoring is more important than the method used to self-monitor. A daily feedback message delivered remotely enhanced adherence and improved weight loss, which suggests that technology can play a role in improving weight loss. TRIAL REGISTRATION This study is registered at clinicaltrials.gov NCT00277771.

Medication nonadherence: A diagnosable and treatable medical condition.

Technology may improve self‐monitoring adherence and dietary changes in weight loss treatment. Our study aimed to investigate whether using a personal digital assistant (PDA) with dietary and exercise software, with and without a feedback message, compared to using a paper diary/record (PR), results in greater weight loss and improved self‐monitoring adherence. Healthy adults (N = 210) with a mean BMI of 34.01 kg/m2 were randomized to one of three self‐monitoring approaches: PR (n = 72), PDA with self‐monitoring software (n = 68), or PDA with self‐monitoring software and daily feedback messages (PDA+FB, n = 70). All participants received standard behavioral treatment. Self‐monitoring adherence and change in body weight, waist circumference, and diet were assessed at 6 months; retention was 91%. All participants had a significant weight loss (P < 0.01) but weight loss did not differ among groups. A higher proportion of PDA+FB participants (63%) achieved ≥5% weight loss in comparison to the PR group (46%) (P < 0.05) and PDA group (49%) (P = 0.09). Median percent self‐monitoring adherence over the 6 months was higher in the PDA groups (PDA 80%; PDA+FB 90%) than in the PR group (55%) (P < 0.01). Waist circumference decreased more in the PDA groups than the PR group (P = 0.02). Similarly, the PDA groups reduced energy and saturated fat intake more than the PR group (P < 0.05). Self‐monitoring adherence was greater in the PDA groups with the greatest weight change observed in the PDA+FB group.

Patients with Complex Chronic Diseases: Perspectives on Supporting Self-Management

OBJECTIVES: To describe the types and frequencies of sleep complaints and the biopsychosocial factors associated with sleep disturbance in a large community sample of older adults experiencing knee pain or knee pain with radiographic evidence of knee osteoarthritis (OA).