Self Monitoring for Weight Loss

Self-regulation theory states that:

Self monitoring leads to self-evaluation and self-reinforcement for progress made so far toward a goal. An ongoing process of self-monitoring creates motivation to continue behaviours that help us achieve a goal.

When it comes to weight management it is practically a given that you'll be tracking your progress in some way. You may be tracking your food, weighing yourself, monitoring your emotional eating, or triumphantly recording PB's in the gym.  But, does it work? Is it even helpful?

This weekend I pulled an interesting paper from my 'read sometime' file. It's a 2011 systematic review (1) of the evidence base for the effectiveness of self-monitoring in weight loss. The review looked at 22 studies which investigated food monitoring, exercise monitoring, weight monitoring or some combination of these.  Eight of the studies were Randomised Controlled Trials (RCT's). 

Food Monitoring

Fifteen of the reviewed studies focused on dietary self-monitoring and six of those were RCT's which utilised some form of food diary.

All of these studies found a significant association between keeping a food diary and weight loss, whether the method was a paper or electronic diary, or a combination of the two.

There is some disagreement as to whether paper diaries or apps are more effective, with some studies reporting no difference between them and other studies reporting increased compliance with digital diaries. One study reported that participants found a phone app to be more socially acceptable for food tracking.

Degree of food diary completeness was also associated with degree of weight loss. In studies that reported it, weekly weight loss was higher on weeks that participants were more engaged with their food diaries.

Timing of self-monitoring for eating was also important, with immediate monitoring being more effective for weight loss than relying on memory recall.

Exercise Monitoring

Disappointingly, although five trials included exercise self-monitoring, only one of the trials (it was a small RCT) reported the impact of exercise monitoring as a separate outcome.

This study found that more consistent self-monitoring was associated with more exercise, fewer difficulties with exercise and greater weight loss.

Weight Monitoring

Six studies focused on self-weighing and two of these were RCT's. In general the self-weighing studies were large with excellent retention rates.

A weight gain prevention trial for overweight individuals found that daily weighing was associated with weight loss (which was not a goal of the intervention), but that any frequency less than that was associated with weight gain. Even weekly weigh ins were associated with slight weight gain over time. Another trial showed that increased daily weighing after weightloss was associated with less weight regain.  

For weight loss, again more frequent weighing was associated with larger losses over time, although unlike the weight maintenance trial, a weight loss effect was seen with daily, weekly and monthly weigh ins. The general consensus was to weigh 'at least weekly'.

One of the trials suggested that weight self-monitoring may become more important over time, showing similar weight loss at 20 weeks between a group that weighed daily throughout the trial, and one that did not weigh at all until the 11th week. At week 20, as with the other trials, frequency of weighing was associated with weight loss, no matter when the participants started weighing themselves. 

A more recent review and meta-analysis suggested that daily or weekly self-weighing is an effective adjunct to a behavioural weight loss program, but that self-weighing is not an effective stand-alone strategy (4).

Conclusions

Self-monitoring was associated with weight loss success. It seems that the critical factor is compliance and completeness, rather than method of monitoring, although that is not the whole story: one study increased compliance by changing from a paper diary to a simplified checklist, which increased compliance but did not increase results. Perhaps a degree of personal engagement is necessary?

I went looking for more info on the effectiveness of apps vs. paper and found a pilot RCT (2) which tested a self-monitoring app for weight loss (goal setting, diet, activity and feedback via text message) against a web-based or paper-based version. That study found greater retention and adherence in the smartphone app (40 of 43 participants completed the study, average 92 days of recording) compared to the website (19/42, 35 days) or paper diary (20/43, 29 days). Another study (3) evaluated apps and suggested that there is a need for evidence-based apps that include behavioural strategies such as stress reduction, problem solving and social networking. 

The review did have a few limitations. The 22 studies reviewed were chosen for their quality of evidence from more than 90 possible studies, however, in spite of the stringent inclusion criteria, the trials were predominantly focused on white women and were inconsistent in design. In particular there was no consistent method for recording adherence to, or completeness of, self-monitoring. And of course, with all forms of self-report there is problem of accidental or deliberate inaccuracies. A particularly sneaky study used a paper diary with a sensor that relayed back to researchers exactly when the diary was opened. This study found such things as back-filling, and submitting of data for days when the diary was not opened at all. In general though, the evidence in favour of self-monitoring while losing weight, and maintaining weight loss, is very strong. Most reviews will at least mention studies that contradict their findings, but in this case, there really weren't any.

Personally, I have found self-monitoring to be a crucial part of maintaining a 20kg weight loss over nearly 20 years now. It hasn't always been tracking the things mentioned above. At times I have tracked weight, exercise and food. and at other times I put that aside and self-monitored other things like how food makes me feel, my emotions, my body image or turned my attention to hunger and fullness signals or level of daily activity.

I still move between the two, having times when I track and weigh things, or keep a food journal and times when I just make healthy choices and don't think about it too hard. I don't think it's healthy to be shackled to your scales or the cronometer app, but when you are just starting out, or getting back on track, self-monitoring can help you see where you are at and what actions lead toward your goals.

Let me know what you think! What type of self-monitoring, if any, do you use for keeping your health (or your life) moving along in the right direction? Do you think it helps, or is it just one more annoying task in your already busy life?

References

1. Burke, L. E., Wang, J., & Sevick, M. A. (2011). Self-Monitoring in Weight Loss: A Systematic Review of the Literature. Journal of the American Dietetic Association, 111(1), 92-102.

2. Carter, M. C., Burley, V. J., Nykjaer, C., & Cade, J. E. (2013). Adherence to a Smartphone Application for Weight Loss Compared to Website and Paper Diary: Pilot Randomized Controlled Trial. Journal of medical Internet research, 15(4).

3.Pagoto, S., Schneider, K., Jojic, M., DeBiasse, M., & Mann, D. (2013). Evidence-Based Strategies in Weight-Loss Mobile Apps. American Journal of Preventive Medicine, 45(5), 576-582.

4.Madigan, C. D., Daley, A. J., Lewis, A. L., Aveyard, P., & Jolly, K. (2015). Is self-weighing an effective tool for weight loss: a systematic literature review and meta-analysis. International Journal of Behavioral Nutrition and Physical Activity, 12.