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Using mHealth Technology to Enhance Self-Monitoring for Weight Loss

A Randomized Trial
  • Lora E. Burke
    Correspondence
    Address correspondence to: Lora E. Burke, PhD, MPH, University of Pittsburgh School of Nursing, 3500 Victoria Street, 415 Victoria Building, Pittsburgh PA 15261
    Affiliations
    Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania

    Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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  • Mindi A. Styn
    Affiliations
    Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania

    Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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  • Susan M. Sereika
    Affiliations
    Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania

    Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania

    Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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  • Molly B. Conroy
    Affiliations
    Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania

    Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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  • Lei Ye
    Affiliations
    Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania

    Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, Pennsylvania
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  • Karen Glanz
    Affiliations
    School of Medicine and Nursing, Unviersity of Pennsylvania, Philadelphia, Pennsylvania
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  • Mary Ann Sevick
    Affiliations
    Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania

    Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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  • Linda J. Ewing
    Affiliations
    Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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      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.
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