Improving Self-Monitoring in Weight Loss With Technology

The prevalence of obesity, a major chronic health problem that is an independent risk factor
for coronary heart disease (CHD), continues to increase at an alarming rate. Although weight
control research has significantly improved short-term treatment success, long-term weight
loss maintenance has lagged behind. Research has demonstrated a consistent relationship
between self-monitoring eating and physical activity habits and success in weight loss as
well as in maintenance of weight loss. However, the methods primarily used for
self-monitoring continue to be the paper diary (PD), which is time consuming and burdensome.
Moreover, PDs do not permit immediate external feedback to support and motivate the
individual. Emerging technologies could improve self-monitoring and weight loss treatment.
However, the use of these technological advances, such as a personal digital assistant
(PDA), has not been studied in weight loss treatment. The primary aim of this behavioral
weight loss treatment study is to determine if self-monitoring of daily eating and physical
activity habits using a PDA, with or without a tailored feedback intervention, is superior
to using a PD in terms of promoting and maintaining short- and long-term weight loss.
Secondary aims include comparing the effect of treatment group assignment on adherence to
self-monitoring and on risk factors for CHD (lipids, glucose, insulin, C-reactive protein).
We propose to enroll 198 subjects and randomize them to one of three treatment groups that
will use different methods to self-monitor eating and physical activity habits: (1) use of
the traditional PD with delayed written feedback, (2) use of a PDA with limited feedback on
daily targets, or (3) use of a PDA with limited feedback on daily targets plus receive
daily, subject-tailored feedback messages via the PDA. The proposed study includes prolonged
(24 months) supervision of self-management with three important components: self-monitoring,
feedback, and ongoing contact. Subjects will complete assessments at baseline, 6, 12, 18,
and 24 months. This innovative study will provide information on the efficacy of combining
technological advances with proven behavioral strategies.

Inclusion Criteria:

1. age 18 to 59 years

2. BMI ≥ 27 and ≤ 43

3. willing to be randomized to one of the three treatment conditions

4. successful completion of screening

- Note that although residing in Western Pennsylvania is not an explicit
eligibility criterion, participants are asked to travel to the University of
Pittsburgh frequently.

Exclusion Criteria:

1. presence of an eating disorder

2. current serious illness or unstable condition requiring physician-supervised diet and
exercise including a glucose level above 125 at baseline

3. physical limitations precluding ability to exercise

4. pregnant or planning to become pregnant in the next 24 mos

5. under current treatment for a psychological disorder

6. reported alcohol intake of 4 drinks/day or more

7. current or recent (past 6 mos) participation in a weight-loss program or use of
weight-loss medication

8. planning an extended vacation, absence, or relocation within the next 24 mos