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Self-Monitoring as a Mediator of Weight Loss in the SMART Randomized Clinical Trial

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Abstract

Background

Integral components of behavioral weight-loss treatment include self-monitoring of diet and physical activity along with feedback to participants regarding their behaviors. While providing feedback has been associated with weight loss, no studies have examined the impact of feedback frequency on weight loss or the mediating role of self-monitoring adherence in this relationship.

Purpose

This study examined the effect of participant feedback frequency on weight loss and determined if this effect was mediated by adherence to self-monitoring in a behavioral weight-loss trial conducted in the USA.

Method

Participants (N = 210) were randomly assigned to one of three self-monitoring methods with either no-daily feedback messages or daily feedback messages: (1) paper diary (PD), no-daily feedback; (2) personal digital assistant (PDA), no-daily feedback; and (3) PDA, daily tailored feedback messages (PDA + FB). The Sobel test via bootstrapping examined the direct effect of feedback frequency on weight loss and the indirect effect through self-monitoring adherence.

Results

Receiving daily feedback messages significantly increased participants' self-monitoring adherence. A significant effect of feedback frequency on weight loss was noted; however, after adjusting for self-monitoring adherence, the effect of feedback frequency on weight loss was no longer significant. Feedback frequency had a significant indirect effect on weight loss through self-monitoring adherence.

Conclusion

Self-monitoring adherence mediated the effect of feedback frequency on weight loss. Increasing the frequency with which participants receive feedback could enhance self-monitoring adherence, a critical component of behavioral weight-loss treatment.

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References

  1. World Health Organization. Obesity and overweight fact sheet. WHO website. http://www.who.int/mediacentre/factsheets/fs311/en/. Accessed June 15, 2011.

  2. Burke LE, Warziski M, Styn MA, Music E, Hudson AG, Sereika SM. A randomized clinical trial of a standard versus vegetarian diet for weight loss: the impact of treatment preference. Int J Obes. 2008;32:166–76.

    Article  CAS  Google Scholar 

  3. Carels RA, Young KM, Wott CB, et al. Weight bias and weight loss treatment outcomes in treatment-seeking adults. Ann Behav Med. 2009;37(3):350–5.

    Article  PubMed  Google Scholar 

  4. Franz MJ, Vanwormer JJ, Crain AL, et al. Weight-loss outcomes: a systematic review and meta-analysis of weight-loss clinical trials with a minimum 1-year follow-up. J Am Diet Assoc. 2007;107(10):1755–67.

    Article  PubMed  Google Scholar 

  5. Stolley MR, Fitzgibbon ML, Schiffer L, et al. Obesity Reduction Black Intervention Trial (ORBIT): six-month results. Obesity. 2008;17:100–6.

    Article  PubMed  Google Scholar 

  6. Foster GD, Makris AP, Bailer BA. Behavioral treatment of obesity. Am J Clin Nutr. 2005;82(Supp(1)):230S–5S.

    PubMed  CAS  Google Scholar 

  7. Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28(1):151–70.

    Article  PubMed  Google Scholar 

  8. Patterson R. The new focus: integrating behavioral science into disease management. In: Patterson R, editor. Changing patient behavior: improving outcomes in health and disease management. San Francisco: Jossey-Bass; 2001. p. 1–21.

    Google Scholar 

  9. Krukowski RA, Harvey-Berino J, Ashikaga T, Thomas CS, Micco N. Internet-based weight control: the relationship between web features and weight loss. Telemed J E Health. 2008;14(8):775–82.

    Article  PubMed  Google Scholar 

  10. Tate DF, Jackvony EH, Wing RR. Effects of Internet behavioral counseling on weight loss in adults at risk for type 2 diabetes: a randomized trial. JAMA. 2003;289(14):1833–6.

    Article  PubMed  Google Scholar 

  11. Haapala I, Barengo NC, Biggs S, Surakka L, Manninen P. Weight loss by mobile phone: a 1-year effectiveness study. Public Health Nutr. 2009;12(12):2382–91.

    Article  PubMed  Google Scholar 

  12. Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001;285(9):1172–7.

    Article  PubMed  CAS  Google Scholar 

  13. Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. New Engl J Med. 2005;353(20):2111–20.

    Article  PubMed  CAS  Google Scholar 

  14. Burke LE, Wang J, Sevick MA. Self-monitoring in weight loss: a systematic review of the literature. J Am Diet Assoc. 2011;111:92–102.

    Article  PubMed  Google Scholar 

  15. Lubans D, Morgan P, Collins C, Warren J, Callister R. Exploring the mechanisms of weight loss in the SHED-IT intervention for overweight men: a mediation analysis. Int J Behav Nutr Phys Act. 2009;6(1):76.

    Article  PubMed  Google Scholar 

  16. Webber KH, Tate DF, Ward DS, Bowling JM. Motivation and its relationship to adherence to self-monitoring and weight loss in a 16-week Internet behavioral weight loss intervention. J Nutr Educ Behav. 2010;42(3):161–7.

    Article  PubMed  Google Scholar 

  17. Burke LE, Styn MA, Glanz K, et al. SMART trial: a randomized clinical trial of self-monitoring in behavioral weight management—design and baseline findings. Contemp Clin Trials. 2009;30(6):540–51.

    Article  PubMed  Google Scholar 

  18. Burke LE, Conroy MB, Sereika SM, et al. The effect of electronic self-monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial. Obesity. 2011;19(2):338–44.

    Article  PubMed  Google Scholar 

  19. Wadden TA, Berkowitz RI, Sarwer DB, Prus-Wisniewski R, Steinberg C. Benefits of lifestyle modification in the pharmacologic treatment of obesity: a randomized trial. Arch Intern Med. 2001;161(2):218–27.

    Article  PubMed  CAS  Google Scholar 

  20. Wing RR. Behavioral approaches to the treatment of obesity. In: Bray GA, Bourchard C, James WPT, editors. Handbook of obesity. New York: Marcel Dekker; 1998. p. 855–77.

    Google Scholar 

  21. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behav Res Methods Instrum Comput. 2004;36(4):717–31.

    Article  PubMed  Google Scholar 

  22. Kraemer HC, Wilson GT, Fairburn CG, Agras WS. Mediators and moderators of treatment effects in randomized clinical trials. Arch Gen Psychiatry. 2002;59(10):877–83.

    Article  PubMed  Google Scholar 

  23. Andrade AM, Coutinho SR, Silva MN, et al. The effect of physical activity on weight loss is mediated by eating self-regulation. Patient Educ Couns. 2010;79(3):320–6.

    Article  PubMed  Google Scholar 

  24. Teixeira PJ, Silva MN, Coutinho SR, et al. Mediators of weight loss and weight loss maintenance in middle-aged women. Obesity. 2010;18(4):725–35.

    Article  PubMed  Google Scholar 

  25. Silva MN, Markland D, Carraca EV, et al. Exercise autonomous motivation predicts 3-yr weight loss in women. Med Sci Sports Exerc. 2011;43(4):728–37.

    Article  PubMed  Google Scholar 

  26. Perri MG, Nezu AM, McKelvey WF, Shermer RL, Renjilian DA, Viegener BJ. Relapse prevention training and problem-solving therapy in the long-term management of obesity. J Consult Clin Psychol. 2001;69(4):722–6.

    Article  PubMed  CAS  Google Scholar 

  27. Coons MJ, Roehrig M, Spring B. The potential of virtual reality technologies to improve adherence to weight loss behaviors. J Diabetes Sci Technol. 2011;5(2):340–4.

    PubMed  Google Scholar 

  28. Gerber BS, Stolley MR, Thompson AL, Sharp LK, Fitzgibbon ML. Mobile phone text messaging to promote healthy behaviors and weight loss maintenance: a feasibility study. Health Informatics J. 2009;15(1):17–25.

    Article  PubMed  Google Scholar 

  29. Fjeldsoe BS, Marshall AL, Miller YD. Behavior change interventions delivered by mobile telephone short-message service. Am J Prev Med. 2009;36(2):165–73.

    Article  PubMed  Google Scholar 

  30. Hurling R, Catt M, Boni MD, et al. Using internet and mobile phone technology to deliver an automated physical activity program: randomized controlled trial. J Med Internet Res. 2007;9(2):e7.

    Article  PubMed  Google Scholar 

  31. Tate DF, Jackvony EH, Wing RR. A randomized trial comparing human e-mail counseling, computer-automated tailored counseling, and no counseling in an Internet weight loss program. Arch Intern Med. 2006;166:1620–5.

    Article  PubMed  Google Scholar 

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Acknowledgments

Thank you to the participants of the SMART trial for their time; the Data Manager, Edvin Music, MSIS; and the Project Director, Mindi Styn, PhD. Funding/support was received from the National Institutes of Health grants #RO1-DK71817 and K24 Award, NR010742; Data Management Core of the Center for Research in Chronic Disorders, NIH-NINR #P30-NR03924; the General Clinical Research Center, NIH-NCRR-GCRC #5MO1-RR00056; and the Clinical Translational Research Center, NIH/NCRR/CTSA Grant UL1 RR024153 at the University of Pittsburgh. Trial registration at clinicaltrials.gov identifier is NCT00277771.

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Authors and Affiliations

  1. Duquesne University School of Nursing, 524 Fisher Hall, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA

    Melanie Warziski Turk

  2. Center of Biostatistics and Bioinformatics, University of Mississippi Medical Center, Arthur C. Guyton Research Complex, G-559, 2500 North State St., Jackson, MS, 39216, USA

    Okan U. Elci

  3. University of Texas Health Science Center at Houston School of Nursing, 6901 Bertner Avenue, Room 614, Houston, TX, 77030, USA

    Jing Wang

  4. University of Pittsburgh School of Nursing and Graduate School of Public Health, 360 Victoria Bldg., Pittsburgh, PA, 15261, USA

    Susan M. Sereika

  5. University of Pittsburgh School of Medicine, 3811 O’Hara St., Pittsburgh, PA, 15213, USA

    Linda J. Ewing

  6. Community Guide Branch, Office of Surveillance, Epidemiology and Laboratory Services, Epidemiology and Analysis Program Office, Centers for Disease Control and Prevention, 1600 Clifton Road, MS E-69, Atlanta, GA, 30329, USA

    Sushama D. Acharya

  7. Schools of Nursing and Medicine, University of Pennsylvania, 423 Guardian Drive, 801 Blockley Hall, Philadelphia, PA, 19104, USA

    Karen Glanz

  8. University of Pittsburgh School of Nursing and Graduate School of Public Health, 415 Victoria Bldg., Pittsburgh, PA, 15261, USA

    Lora E. Burke

Authors
  1. Melanie Warziski Turk
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  2. Okan U. Elci
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  3. Jing Wang
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  4. Susan M. Sereika
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  5. Linda J. Ewing
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  6. Sushama D. Acharya
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  7. Karen Glanz
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  8. Lora E. Burke
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Corresponding author

Correspondence to Melanie Warziski Turk.

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Turk, M.W., Elci, O.U., Wang, J. et al. Self-Monitoring as a Mediator of Weight Loss in the SMART Randomized Clinical Trial. Int.J. Behav. Med. 20, 556–561 (2013). https://doi.org/10.1007/s12529-012-9259-9

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  • DOI: https://doi.org/10.1007/s12529-012-9259-9

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