Conclusion Statement
Moderate evidence, primarily in overweight adult women living in the United States, indicates that self-monitoring of diet, weight or both in the context of a behavioral weight management intervention generally improves weight loss outcomes.
2015 DGAC Grade: Moderate
Limited but consistent evidence suggests that higher frequency or greater adherence to self-monitoring of diet, weight or both in the context of a behavioral weight management program is associated with better weight-loss outcomes.
2015 DGAC Grade: Limited
Technical Abstract
Background
In the context of comprehensive behavioral lifestyle interventions for weight management, self-monitoring refers to the process by which an individual observes and records specific information reflecting his or her dietary intake, physical activity, and body weight. Selfmonitoring provides information that allows an individual to judge whether goals have been met, and if not, to adjust future actions so as to meet the target. The goal of this systematic review was to determine whether self-monitoring of diet and weight is associated with body weight outcomes. This review included studies examining the effect of self-weighing or selfmonitoring of diet, such as counting calories and monitoring foods consumed. While paper diaries are the traditional method for self-monitoring, new technological approaches are emerging such as the use of websites, smart phone apps and interactive voice response phone calls. Because self-monitoring is often a component of weight loss and weight maintenance interventions, it is important to understand its effect on weight outcomes
Conclusion statement
Moderate evidence, primarily in overweight adult women living in the United States, indicates that self-monitoring of diet, weight or both in the context of a behavioral weight management intervention generally improves weight loss outcomes.
2015 DGAC Grade: Moderate
Limited but consistent evidence suggests that higher frequency or greater adherence to selfmonitoring of diet, weight or both in the context of a behavioral weight management program is associated with better weight-loss outcomes.
2015 DGAC Grade: Limited
Methods
Literature searches were conducted using PubMed, Embase and Cochrane databases to identify studies published in English in peer-reviewed journals from January 2010 to August 2014 for diet self-monitoring (based on the end date of the 2010 DGAC review) and from January 2004 to August 2014 for body weight monitoring (not included in the 2010 DGAC review). Included studies met the following inclusion and exclusion criteria established a priori to the review: randomized controlled trials (RCTs), crossover trials, cohort studies and posthoc analysis of RCTs; human subjects aged two years and older who were healthy or at elevated chronic disease risk; and studies conducted in high or very highly developed countries (2012 Human Development Index). The intervention or exposure was selfmonitoring of diet and weight. The outcome was measures of weight outcomes including obesity, overweight, body mass index (BMI), waist circumference, body weight, percent body fat change, weight-for-age, length and stature-for-age, weight for stature, BMI-for-age and BMI Z-score.
Data from each included article were extracted and risk of bias was assessed by two Systematic Reviews of the Individual Diet and Physical Activity Behavior Change Subcommittee, 2015 DGAC 87 Archived from www.NEL.gov on March 21, 2017 abstractors. The evidence was qualitatively synthesized, a conclusion statement was developed and the strength of the evidence (grade) was assessed using pre-established criteria including evaluation of the quality and risk of bias, quantity, consistency, magnitude of effect and generalizability of available evidence.
Findings
- A total of 20 studies were reviewed to examine the relationship between the use of diet and weight self-monitoring on body weight. This review included four RCTs, 15 prospective cohort studies and one retrospective cohort study
- Three RCTs showed that weight management interventions that included selfmonitoring of diet, weight or both, coupled with behavioral change strategies, resulted in significantly greater weight loss than controls that did not emphasize selfmonitoring. One weight loss maintenance study in children found no effect for selfmonitoring via Short Message Service (SMS) on BMI.
- Sixteen cohort studies (15 prospective, one retrospective study) in adults found higher frequency or greater adherence to diet and weight self-monitoring was associated with favorable body weight outcomes:
- One study with overweight pregnant women provided a four-session behavior change program with a gestational weight gain chart and a recommendation for regular self-weighing. The women in the intervention arm lost more weight six weeks after delivery compared to a control group that received one brief education session.
- Four studies assessed different methods of self-monitoring, including paper diaries and Internet-based or mobile applications, and found that no specific method was superior to others
- Study participants were predominately overweight, educated, white females between the ages of 30 years and 60 years. Additional research is needed among males, and subjects below the age of 30 years and above the age of 60 years.
Limitations
- Studies often used different approaches for self-monitoring and often monitored different behaviors. Study interventions differed between weight loss interventions and weight maintenance interventions. Also, study durations varied from 12 weeks to 3.25 years.
- In seven studies, the impact of self-monitoring was conducted as secondary analysis of pooled intervention data
- In all studies reviewed, self-monitoring was assessed as part of a weight loss or weight maintenance intervention, making it difficult to separate the effects of selfmonitoring from other intervention components
- The interaction between frequency of self-monitoring and motivation is unclear.