Part D. Chapter 3: Individual Diet and Physical Activity Behavior Change
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/or body weight. As a component of behavioral weight-management programs, self-monitoring is typically coupled with goal setting and performance feedback. Goal setting involves specifying a target or recommended level for dietary intake, physical activity, and/or body weight. Self-monitoring provides information that allows the individual to judge whether targets have been met, and if not, to use the feedback from self-monitoring to adjust future actions so as to meet the target. A high frequency of self-monitoring is commonly associated with greater adherence to other weight management strategies and with greater success in lifestyle programs for weight management.81
The goal of this systematic review was to determine whether self-monitoring of diet and/or weight is associated with body weight outcomes. This review included studies examining the effect of self-weighing or self-monitoring of diet, such as counting calories and/or monitoring foods consumed. Although 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 maintenances interventions, it is important to understand its effect on body weight outcomes.
Question 6: What is the relationship between use of diet and weight self-monitoring strategies and body weight outcomes in adults and youth?
Source of evidence: NEL systematic review
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, incorporating goal setting and performance feedback, improves weight-loss outcomes. 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. DGAC Grade: Limited
Self-monitoring coupled with goal setting and performance feedback can be used to enhance outcomes in weight management programs and should be incorporated into these programs for weight management.
Review of the Evidence
Twenty studies (4 RCTs,82-85 15 prospective cohort studies,86-100 and 1 retrospective cohort study101) examined the relationship between diet and weight self-monitoring strategies and body weight outcomes in adults and youth. The study durations ranged from 3 months to 3.25 years. The study samples predominantly included women. Five studies were exclusively in women, one study was in pregnant women,88 and one study was in children.83 Sixteen studies were conducted in the United States84-87, 89-100 and four were international (one each from the United Kingdom, Australia, Netherlands, and Japan).82, 83, 88, 101
Three RCTs showed that weight management interventions, delivered through mail or email which included self-monitoring of diet, weight, or both, coupled with behavioral change strategies, such as goal setting, personalized feedback, shaping, stimulus control, and problem solving, resulted in significantly greater weight losses than did interventions that did not emphasize self-monitoring.82, 84, 85 One weight loss maintenance study in children found no effect for self-monitoring through Short Message Service on BMI.83
Sixteen cohort studies in adults found higher frequency or greater adherence to diet and weight self-monitoring was associated with favorable body weight outcomes.86-101 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.88 The women in the intervention arm lost more weight 6 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, Internet-based or mobile applications, and found that no specific method was superior to others.87, 93, 94, 98
The limitations of the evidence were that study participants were predominately overweight or obese, educated, Caucasian, females between the ages of 30 to 60 years, thus limiting generalizability to broader population groups.
For additional details on this body of evidence, visit: http://NEL.gov/topic.cfm?cat=3374