Using mHealth technology to enhance self-monitoring for weight loss: a randomized trial.
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.


OBJECTIVE
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.


METHODS
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.


METHODS
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.


METHODS
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.


METHODS
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.


BACKGROUND
This study is registered at clinicaltrials.gov NCT00277771.
Department of Health and Community Systems, University of Pittsburgh School of Nursing, Pittsburgh, Pennsylvania 15261, USA. lbu100@pitt.edu
Lora E
LE
Burke
Mindi A
MA
Styn
Susan M
SM
Sereika
Molly B
MB
Conroy
Lei
L
Ye
Karen
K
Glanz
Mary Ann
MA
Sevick
Linda J
LJ
Ewing
D000328:Adult; D034201:Computers, Handheld; D004032:Diet; D002149:Energy Intake; D015444:Exercise; D030141:Feedback, Psychological; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010414:Pennsylvania; D012648:Self Care / Q000295:instrumentation*; D057566:Self Report; D015431:Weight Loss / Q000502:physiology*