Skip to main content
Top
Published in: International Journal of Behavioral Medicine 4/2013

01-12-2013

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

Authors: Melanie Warziski Turk, Okan U. Elci, Jing Wang, Susan M. Sereika, Linda J. Ewing, Sushama D. Acharya, Karen Glanz, Lora E. Burke

Published in: International Journal of Behavioral Medicine | Issue 4/2013

Login to get access

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.
Literature
2.
go back to reference 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.CrossRef 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.CrossRef
3.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
4.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
5.
go back to reference Stolley MR, Fitzgibbon ML, Schiffer L, et al. Obesity Reduction Black Intervention Trial (ORBIT): six-month results. Obesity. 2008;17:100–6.PubMedCrossRef Stolley MR, Fitzgibbon ML, Schiffer L, et al. Obesity Reduction Black Intervention Trial (ORBIT): six-month results. Obesity. 2008;17:100–6.PubMedCrossRef
6.
go back to reference Foster GD, Makris AP, Bailer BA. Behavioral treatment of obesity. Am J Clin Nutr. 2005;82(Supp(1)):230S–5S.PubMed Foster GD, Makris AP, Bailer BA. Behavioral treatment of obesity. Am J Clin Nutr. 2005;82(Supp(1)):230S–5S.PubMed
7.
go back to reference Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28(1):151–70.PubMedCrossRef Wadden TA, Crerand CE, Brock J. Behavioral treatment of obesity. Psychiatr Clin North Am. 2005;28(1):151–70.PubMedCrossRef
8.
go back to reference 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. 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.
9.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
10.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
11.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
12.
go back to reference Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001;285(9):1172–7.PubMedCrossRef Tate DF, Wing RR, Winett RA. Using Internet technology to deliver a behavioral weight loss program. JAMA. 2001;285(9):1172–7.PubMedCrossRef
13.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
14.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
15.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
16.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
17.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
18.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
19.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
20.
go back to reference 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. 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.
21.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
22.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
23.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
24.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
25.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
26.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
27.
go back to reference 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 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
28.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
29.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
30.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
31.
go back to reference 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.PubMedCrossRef 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.PubMedCrossRef
Metadata
Title
Self-Monitoring as a Mediator of Weight Loss in the SMART Randomized Clinical Trial
Authors
Melanie Warziski Turk
Okan U. Elci
Jing Wang
Susan M. Sereika
Linda J. Ewing
Sushama D. Acharya
Karen Glanz
Lora E. Burke
Publication date
01-12-2013
Publisher
Springer US
Published in
International Journal of Behavioral Medicine / Issue 4/2013
Print ISSN: 1070-5503
Electronic ISSN: 1532-7558
DOI
https://doi.org/10.1007/s12529-012-9259-9

Other articles of this Issue 4/2013

International Journal of Behavioral Medicine 4/2013 Go to the issue