Cited by 295Mobile Health and mHealth ApplicationsObesity, Physical Activity, DietNutrition, Health and Food Behavior

Using mHealth Technology to Enhance Self-Monitoring for Weight Loss

Open access
Burke, Lora E., Styn, Mindi A., Sereika, Susan M., Conroy, Molly B., Ye, Lei, Glanz, Karen, Sevick, Mary Ann, Ewing, Linda J.·2012·American Journal of Preventive Medicine

Abstract

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+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 RCCT; participants were randomly assigned to one of three self-monitoring groups. Setting/participants From 2006 to 2008, 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 which 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.

AI snapshot

Written from the paper’s full text.

TL;DR

In a 24-month randomized trial of 210 overweight/obese adults, PDA-based self-monitoring with daily tailored feedback produced a small significant 24-month weight loss, while PDA use without feedback improved adherence to dietary self-monitoring more than paper diaries. Across groups, greater self-monitoring adherence was associated with greater weight loss, suggesting adherence matters more than self-monitoring method.

Key findings

  • Mean percentage weight loss at 24 months did not differ 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 PDA+FB showed significant within-group loss (p=0.02).
  • Adherence to self-monitoring showed a time-by-treatment interaction between the combined PDA groups and the paper diary group (p=0.03), with no PDA vs PDA+FB difference (p=0.49); more PDA participants were adherent ≥60% than paper diary participants (PDA vs paper p=0.03; PDA+FB vs paper p=0.01).
  • Across all groups, weight loss was greater for those adherent ≥60% versus <30% (p<0.001); at 18 months, 19%–20% of PDA groups remained adherent ≥30% compared with 8% of the paper diary group.
  • Study retention was 85.6% in the abstract and 85.7% at 24 months in the results.

Methods

  • 24-month RCT; 210 overweight/obese adults recruited from the community in 2006–2008 (84.8% female, 78.1% white); randomized to paper diary, PDA, or PDA+FB; all received standard behavioral weight loss treatment in group sessions.
  • Primary outcome: percentage weight change at 24 months; secondary outcome: adherence to dietary self-monitoring, defined as percentage of days recording adequate calories, with nonadherence assumed if a diary was not submitted.
  • Analysis: intent-to-treat; linear mixed modeling with linear contrasts, ANOVA, and generalized estimating equations; missing weight observations handled by assuming a 0.3 kg/month increase; SAS 9.1; two-sided significance at 0.05.

Limitations

  • Stated: male representation was disappointing; recruitment strategies targeting men were implemented, but many eligible men did not complete screening. The paper also states that the impact of more-proximal feedback needs further investigation and that the novel design makes comparisons challenging.
  • Stated/design: adherence to self-monitoring was limited to 18 months because there was only one contact in the final 6 months.
  • Evident: the sample was predominantly female (84.8%) and white (78.1%), limiting generalizability; adherence relied on self-monitoring records, and missing weight data were imputed rather than fully observed.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1016/j.amepre.2012.03.016

Cites

35 of 35 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 13 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    The PDA+FB group had a mean percentage weight loss of −2.32% at 24 months (95% CI −4.29, −0.35).

    “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.”
    Quote in the paperSubstantial claim
  • Findingown data

    Only the PDA+FB group demonstrated a significant weight loss at 24 months (p=0.02).

    “A significant within-group difference in weight over time was found for the PDA+FB group (p=0.02) with an average 2.32% weight loss but not for the other two groups (paper diary: – 1.94%, PDA: –1.38%).”
    Quote in the paperNot a substantial claim
  • Findingown data

    Across all groups, weight loss was greater for those who were adherent ≥60% of the time versus <30% of the time (p<0.001).

    “Across all groups, weight loss was greater for those who were adherent ≥60% versus <30% of the time, p<0.001.”
    Quote in the paperSubstantial claim
  • Findingown data

    The mean percentage weight loss at 24 months was not different among the paper diary, PDA, and PDA+FB groups.

    “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.”
    Quote in the paperSubstantial claim
  • Findingown data

    There was no difference in adherence to self-monitoring between the PDA and PDA+FB groups (p=0.49).

    “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).”
    Quote in the paperNot a substantial claim
  • May combine two claims. 13
  • The quote only partly states this claim. 1
  • Classified as probably not a substantial claim. 8
  • May combine two claims.

    Findingown data

    Of those who lost ≥5% of baseline body weight at 6 months, 19% retained that weight loss at 24 months with no differences among the groups.

    “Overall, 52% (n=110) lost ≥5% of baseline body weight at 6 months; of that group, 19% retained that weight loss at 24 months with no differences among the groups.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationown data

    A daily feedback message delivered remotely enhanced adherence and improved weight loss.

    “A daily feedback message delivered remotely enhanced adherence and improved weight loss, which suggests that technology can play a role in improving weight loss.”
    • Also stated in: § Conclusion · boosted
      “In addition, the current results demonstrate that a daily feedback message delivered remotely enhanced adherence and improved weight loss, which has major implications for the potential use of technology such as smartphones in improving weight loss treatment.”
    Quote in the paperSubstantial claim
  • The quote only partly states this claim.

    Study design and conductown data

    Study retention at 24 months was 85.6%.

    “Study retention was 85.6%.”
    • Also stated in: § Results · plain
      “Retention at 24 months was 85.7% with no differential attrition (see Figure 1).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Interpretationown data

    At 18 months, the weight losses in the PDA groups were similar between those who were in the upper two categories of adherence (>60% and 30%-59%), suggesting that those who were using a PDA were able to maintain the weight loss at a lower level of self-monitoring adherence after engaging in this behavior for several months.

    “Also, at 18 months, the weight losses in the PDA groups were similar between those who were in the upper two categories of adherence (>60% and 30%–59%), suggesting that those who were using a PDA were able to maintain the weight loss at a lower level of self-monitoring adherence after engaging in this behavior for several months.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Evidence has continued to build, demonstrating a consistent relationship between self-monitoring and weight loss and weight loss maintenance.

    “Since then, the evidence has continued to build, demonstrating a consistent relationship between self-monitoring and weight loss7 and weight loss maintenance.8”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [7] Burke, 2011, Self-monitoring in weight loss: a systematic review of the literature, J Am Diet Assoc source

      Not checked in the free run.

    • cites [8] Wing, 2005, Long-term weight loss maintenance, Am J Clin Nutr source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductreasoning

    The sample size of 210 was chosen to have at least 0.80 power for two-sided hypothesis testing via linear contrasts from a linear mixed model at a significance level of 0.05 when comparing changes in weight at 6, 12, 18 and 24 months relative to baseline between the combined PDA groups and the paper diary group at a standardized mean difference (d) of 0.48 and between the PDA group and the PDA+FB组

    “The sample size of 210 was chosen to have at least 0.80 power for two-sided hypothesis testing via linear contrasts from a linear mixed model at a significance level of 0.05 when comparing changes in weight at 6, 12, 18 and 24 months relative to baseline between (1) the combined PDA groups (PDA, PDA+FB) and the paper diary group at a standardized mean difference (d) of 0.48 and (2) the PDA group”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim. May combine two claims.

    Study design and conductown data

    Participants were randomly assigned, with equal allocation via a computer-implemented minimization algorithm that stratified on gender and race.

    “For each cohort, participants were randomly assigned, with equal allocation via a computer-implemented minimization algorithm that stratified on gender and race, to either the Paper Diary, PDA, or PDA+FB group.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Weight was measured on a digital scale by study staff at each assessment.

    “At each assessment, the participants’ weight was measured on a digital scale by study staff.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Immediate positive reinforcement for a desired behavior leads to increases in the behavior; the more proximal the reinforcer to the desired behavior, the more likely it will be to increase the desired behavior.

    “A wealth of empirical evidence demonstrates that immediate positive reinforcement for a desired behavior leads to increases in the behavior; the more proximal the reinforcer to the desired behavior, the more likely it will be to increase the desired behavior.13”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [13] Powers, 1976

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Completers had a lower baseline BMI than noncompleters (33.74 vs 35.62, p=0.04).

    “Completers also had a lower baseline BMI (33.74 (4.44) vs 35.62 (4.47), p=0.04).”
    Quote in the paperNot a substantial claim
  • May combine two claims.

    Premisecitation

    Two studies that focused on self-monitoring methods reported an association between self-monitoring and weight loss; however, neither reported group differences in weight loss.

    “Two studies that focused on self-monitoring methods reported an association between self-monitoring and weight loss; however, neither reported group differences in weight loss.25, 26”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [25] Helsel, 2007, Comparison of techniques for self-monitoring eating and exercise behaviors on weight loss in a correspondence-based intervention, J Am Diet Assoc source

      Not checked in the free run.

    • cites [26] Yon, 2007, Personal digital assistants are comparable to traditional diaries for dietary self-monitoring during a weight loss program, J Behav Med source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    Completers were older than noncompleters (47.66 vs 41.77 years, p<0.001).

    “Completers were older than noncompleters (47.66 (8.38) years vs 41.77(10.95) years, p<0.001), which may have been influenced by three pregnancy-related withdrawals.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim.

    Study design and conductnone given

    After participants were trained in their assigned self-monitoring method, session materials were identical for the groups.

    “After participants were trained in their assigned self-monitoring method, session materials were identical for the groups.”
    Quote in the paperSubstantial claim
  • Probably not a substantial claim: may not pass S2 (checkable).

    Premisecitation

    The rapid advancement and adoption of wireless devices provide numerous opportunities for the incorporation of mHealth interventions for the delivery of feedback to individuals engaged in weight loss treatment.

    “The rapid advancement and adoption of wireless devices provide numerous opportunities for the incorporation of mHealth interventions for the delivery of feedback to individuals engaged in weight loss treatment.14, 15”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [14] Patrick, 2008, Health and the mobile phone, Am J Prev Med source

      Not checked in the free run.

    • cites [15] Tufano, 2005, Mobile eHealth interventions for obesity: a timely opportunity to leverage convergence trends, J Med Internet Res source

      Not checked in the free run.

    • Rests on an assumption: Paper diaries are time-consuming and tedious to complete.
    • Rests on an assumption: Paper diaries limit the timeliness of supportive and motivational feedback delivered by the interventionist due to the lag time between receipt of the paper diary and delivery of feedback to the participant.
  • May combine two claims.

    Interpretationown data

    Method of self-monitoring was notably related to self-monitoring adherence, and that, in turn, was related to weight loss maintenance.

    “when subgroups by level of adherence were examined, method of self-monitoring was notably related to self-monitoring adherence, and that, in turn, was related to weight loss maintenance (Table 1).”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationown data

    The use of technology-based tools markedly improved self-monitoring adherence in a larger number and those participants lost more weight and also sustained the loss.

    “The results of this 2-year trial underscore the fact that adherence to self-monitoring is more important than the method chosen to self-monitor; however, the use of technology-based tools markedly improved self-monitoring adherence in a larger number and those participants lost more weight and also sustained the loss.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Study design and conductown data

    The treatment groups did not differ by sociodemographic or baseline anthropometric measures.

    “The treatment groups did not differ by sociodemographic or baseline anthropometric measures.”
    Quote in the paperSubstantial claim
  • Classified as probably not a substantial claim.

    Study design and conductnone given

    Intent-to-treat principle was used, where subjects were analyzed as randomized.

    “Intent-to-treat principle was used, where subjects were analyzed as randomized.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Interpretationown data

    More participants in the PDA groups achieved ≥60% adherence; those individuals lost more weight and maintained most of it.

    “Moreover, more participants in the PDA groups achieved ≥60% adherence; those individuals lost more weight and maintained most of it.”
    Quote in the paperSubstantial claim
  • May combine two claims.

    Premisecitation

    Two studies have shown enhanced adherence with PDA use; however, the observation period was limited to 1 month.

    “Two studies have shown enhanced adherence with PDA use; however, the observation period was limited to 1 month.27, 28”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [27] Beasley, 2008, Evaluation of a PDA-based dietary assessment and intervention program: a randomized controlled trial, J Am Coll Nutr source

      Not checked in the free run.

    • cites [28] Glanz, 2006, Improving dietary self-monitoring and adherence with hand-held computers: a pilot study, Am J Health Promot source

      Not checked in the free run.

20 of 20
  • The paper relies on this without support.

    Paper diaries are time-consuming and tedious to complete.

    “The most frequently used method to self-monitor diet is the paper diary, which can be timeconsuming and tedious to complete.”
  • The paper relies on this without support.

    Paper diaries limit the timeliness of supportive and motivational feedback delivered by the interventionist due to the lag time between receipt of the paper diary and delivery of feedback to the participant.

    “Paper diaries also limit the timeliness of supportive and motivational feedback delivered by the interventionist due to the lag time between receipt of the paper diary and delivery of feedback to the participant.”
  • The paper relies on this without support.

    No other study has examined the effect of mobile technology with or without feedback on weight loss and adherence to self-monitoring during a 2-year behavioral treatment study.

    “No other study has examined the effect mobile technology with or without feedback on weight loss and adherence to self-monitoring during a 2-year behavioral treatment study.”
3 of 3

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Greater improvement in health behaviors is produced by intensive behavioral treatments that incorporate multiple counseling sessions, each lasting ≥10 minutes.

    “Greater improvement in health behaviors is produced by intensive behavioral treatments, that is, those that incorporate multiple counseling sessions, each lasting ≥10 minutes.18-20,22–24,29–31”
  • Findings confirm modest but significant impacts of brief physician advice or intervention on smoking cessation, improved dietary quality, and increased physical activity.

    “Findings confirm modest but significant impacts of brief physician advice or intervention on smoking cessation, improved dietary quality, and increased physical activity.14,15,19,22–27”

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Feedback conclusion conflicts with reported adherence comparison

    Major

    The conclusion says daily feedback enhanced adherence, but the reported comparison found no difference in adherence between the PDA group and the PDA+FB group.

  • Two different 24-month retention rates

    Minor

    The abstract reports 85.6% retention, while the Results section reports 85.7% retention at 24 months.

2 of 2

Cites

Flagged first, then by citations

2 of the 37 references couldn’t be matched to a known paper.

Research works printed but not linked: 2

  1. Burke, 2009, SMART trial: a randomized clinical trial of self-monitoring in behavioral weight management-design and baseline findings, Contemp Clin Trials, 30, 540, 10.1016/j.cct.2009.07.003 · DOI · Paper page
  2. Burke, 2011, The effect of electronic self-monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial, Obesity, 19, 338, 10.1038/oby.2010.208 · DOI · Paper page

Cited by

Sorted by citations

Authors
Burke, L. E., Styn, M. A., Sereika, S. M., Conroy, M. B., Ye, L., Glanz, K., Sevick, M. A., & Ewing, L. J.
Affiliations
  • University of Pittsburgh (US)
  • University of Pennsylvania (US)
Corresponding author
Burke, Lora E.
Venue
American Journal of Preventive Medicine
Publisher
Elsevier BV
Published
2012-07
Volume
43
Issue
1
Pages
20-26
ISSN
0749-3797 (ISSN-L)
OpenAlex
W1901026176
Cited by
295
References
37
Citations by year
2026: 4 · 2025: 7 · 2024: 11 · 2023: 18 · 2022: 20 · 2021: 19 · 2020: 20 · 2019: 22 · 2018: 28 · 2017: 32 · 2016: 33 · 2015: 27 · 2014: 33 · 2013: 16 · 2012: 5
FWCI
46.07
Type
journal article
Language
en
Open access
Locations
  • American Journal of Preventive Medicine (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • D-Scholarship@Pitt (University of Pittsburgh) (acceptedVersion)
Funders
  • National Institute of Nursing Research (P30NR003924, P30-NR-03924, K24NR010742)
  • National Institute of Diabetes and Digestive and Kidney Diseases (R01DK071817, R01-DK071817-05S1)
  • National Center for Research Resources (5M01-RR-000056, M01RR000056, UL1RR024153)
Topics
  • Health Sciences › Health Professions › General Health Professions › Mobile Health and mHealth Applications
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Keywords
mobile health, self-monitoring, weight loss, personal digital assistants, personalized feedback, paper diaries, adherence, weight maintenance, obesity, overweight adults, behavioral weight loss, SMART trial, remote feedback, physical activity goals, student retention, weight change over time
MeSH terms
Adult, Energy Intake, Diet, Female, Humans, Male, Middle Aged, Pennsylvania, Self Care, Weight Loss, Exercise, Feedback, Psychological, Computers, Handheld, Self Report

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