The Effect of Electronic Self‐Monitoring on Weight Loss and Dietary Intake: A Randomized Behavioral Weight Loss Trial

May combine two claims.

The decline observed in this study is slightly less than in a previous trial, and the decline in PDA groups was significantly less than in the PR group.

“The decline that we observed in this study is slightly less than what we observed in a previous trial (23) and most important, the decline in the PDA groups was significantly less than what was observed in the PR group.”

• cites [23]Not checked yet

  Not checked in the free run.

May combine two claims.

Adherence to self-monitoring physical activity was higher in PDA groups than PR: PR recorded 2.2 entries/week, PDA 2.7, PDA+FB 3.2 (P=0.006); post hoc PR was less adherent than combined PDA groups (P=0.007).

“On average, the PR group recorded 2.2 (1.8) entries per week over the 6-month period compared to the PDA group recording 2.7 (1.8) and the PDA+FB group recording 3.2 (1.8) entries per week (P = 0.006). Post hoc analyses revealed that the PR group was significantly less adherent than the combined PDA and PDA+FB groups (P = 0.007).”

May combine two claims. The quote only partly states this claim.

Waist circumference decreased significantly within each group (P<0.01) and differed significantly among groups (P=0.03); post hoc combined PDA groups had greater percent decrease than PR (P=0.02).

“Percent median [IQR] waist circumference also decreased significantly (P < 0.01) within each group (PR −4.0% [−8.4, 0.0]%; PDA −5.0% [−8.5, −1.7]% and PDA+FB −6.4% [−11.5, −1.8]%) and was significantly different among groups (P = 0.03).”

• Also stated in: § RESULTS · plain

  “Post hoc analyses revealed a significant difference in percent waist circumference change between the PDA groups and the PR group (P = 0.02).”

May combine two claims.

At 6 months, all three self-monitoring groups achieved statistically significant mean weight loss, and mean weight loss did not differ significantly among the groups.

“All participants had a significant weight loss (P < 0.01) but weight loss did not differ among groups.”

• Also stated in: § RESULTS · plain

  “At 6 months, the percent mean [SD] weight loss was statistically significant (P< 0.01) for all treatment groups (PR 5.3% [5.9]%; PDA 5.5% [7.0]%; and PDA+FB 7.3% [6.6]%), with no significant differences among the groups.”

• Also stated in: § DISCUSSION · boosted

  “This study demonstrated that participants who used a PR, a PDA with dietary and exercise software or a PDA with the same software and a daily, tailored feedback message achieved significant weight loss at 6 months.”

May combine two claims.

Total energy intake decreased significantly in all three groups (P=0.05); combined PDA groups reduced total energy (P=0.03) and saturated fat (P=0.03) intake more than PR.

“Total energy intake (median [IQR]) decreased significantly among the three groups (PR −12.5 [−34.7, 0.0]%; PDA −19.9 [−39.2, −1.6]%; and PDA+FB −23.3 [−40.6, −8.3]% (P = 0.05). The combined PDA group reduced total energy (P = 0.03) and saturated fat (P = 0.03) intake more than the PR group.”

May combine two claims.

The proportion achieving at least 5% weight loss was higher in PDA+FB (63%) than PDA (49%), but the difference was not statistically significant (P=0.09).

“and PDA group (49%) (P = 0.09)”

• Also stated in: § RESULTS · plain

  “and PDA (49%) (P=0.09) groups”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Use of technological devices might have been a barrier for some individuals; however, participants who were technologically naive were able to learn how to use the device.

“Use of technological devices might have been a barrier for some individuals; however, participants who were technologically naive were able to learn how to use the device.”

May combine two claims.

All three treatment groups received the same standard behavioral intervention, differing only in self-monitoring tool.

“All 3 treatment groups received the same standard behavioral intervention”

• Also stated in: § Study design · plain

  “All participants received a 24-month standard behavioral weight loss treatment and were randomly assigned to use 1 of 3 self-monitoring tools”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

The feedback message functioned as a compass and as a source of more frequent attention, which was a powerful reinforcer.

“The feedback message functioned as a compass that enabled the individual to stay on course toward the goal; it also functioned as a source of more frequent attention that `someone' was noticing what the participant was doing, which was another powerful reinforcer”

Classified as probably not a substantial claim.

Participants were randomly assigned, stratified by gender and ethnicity, to one of three self-monitoring modes.

“The participants were randomly assigned, stratified by gender and ethnicity, to 1 of the 3 different modes of self-monitoring.”

Probably not a substantial claim: may not pass S4 (based).

No one has examined the use of PDAs with dietary and exercise software for self-monitoring in behavioral weight loss treatment.

“Despite the proliferation of hand-held devices, no one has examined the use of PDAs with dietary and exercise software for self-monitoring in behavioral weight loss treatment.”

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

It was unclear why improved adherence in PDA without feedback did not lead to greater weight loss than observed; this may suggest a more central role for individualized feedback to goal attainment.

“it was unclear why the improved adherence in the PDA without feedback group did not lead to a greater weight loss than what we observed. This may suggest a more central role for individualized feedback to goal attainment.”

May combine two claims.

In Tate's study, the automatic computer feedback group was comparable in weight loss to human e-mail counseling at 3 months; at 6 months, e-mail counseling had significantly greater weight loss than computer-automated feedback or no counseling.

“While the group receiving the automatic computer feedback messages was comparable in weight loss to the human e-mail counseling group at 3 months; at 6 months, the e-mail counseling group had significantly greater weight loss than the computer-automated feedback group or no counseling group.”

• cites [12] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Two previous studies reported a significant association between number of diaries completed and weight loss, but neither reported a group difference in weight loss.

“Two previous studies addressed self-monitoring methods and reported a significant association between the number of diaries completed and weight loss; however, neither of them reported a group difference in weight loss (20, 21).”

• cites [20] sourceNot checked yet

  Not checked in the free run.

• cites [21] sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study design was for 24-month final testing; results presented were for 6 months and only revealed short-term outcomes.

“the study design was for a 24-month final testing of the hypothesis; the results presented here were for 6 months and thus only revealed the short-term outcomes.”

May combine two claims.

In that later study, weight loss between groups was comparable at 3 months, but the e-mail message group lost significantly more weight at 6 months.

“Weight loss between the groups was comparable at 3 months; however, the group that received the e-mail message lost significantly more weight at 6 months.”

• cites [12] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

This was the first large randomized clinical trial to compare different self-monitoring methods in behavioral weight loss and to compare PDAs with paper diaries.

“This was the first large randomized clinical trial to compare different methods of self-monitoring in a behavioral weight loss intervention and to compare the use of PDAs to conventional paper diaries.”

May combine two claims.

In a pilot study, women in a diet modification trial given PDAs for self-monitoring with feedback significantly increased self-monitoring and more often achieved dietary goals.

“In a pilot study where women in a diet modification trial were given personal digital assistants (PDAs) for self-monitoring with feedback, participants significantly increased their self-monitoring and more often achieved dietary goals (14).”

• cites [14] sourceNot checked yet

  Not checked in the free run.

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

The standard behavioral intervention has been successfully used in multiple studies.

“All 3 treatment groups received the same standard behavioral intervention, which has been successfully used in multiple studies (8, 17, 18).”

• cites [8] sourceNot checked yet

  Not checked in the free run.

• cites [17] sourceNot checked yet

  Not checked in the free run.

• cites [18]Not checked yet

  Not checked in the free run.

May combine two claims.

Attention and guidance from the standard behavioral intervention facilitated weight loss across all groups, making the difference by self-monitoring method less pronounced than expected.

“The attention and guidance received through the standard behavioral intervention facilitated weight loss across all groups and thus the difference by method of self-monitoring was less pronounced than what was expected.”

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

The decline in self-monitoring over time has been a consistent finding in several studies.

“This decline in self-monitoring over time has been a consistent finding in several studies (12, 22).”

• cites [12] sourceNot checked yet

  Not checked in the free run.

• cites [22] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The study had 91% retention at 6 months and 21.4% minority representation.

“An additional strength was our 91% retention rate at 6 months and the 21.4% minority representation.”

May combine two claims.

91% (n=192) completed the 6-month assessment, with no differences in race, gender, age, weight or BMI between completers and non-completers.

“Ninety-one percent (n = 192) completed the 6-month assessment with no differences in race, gender, age, weight or BMI between completers and non-completers.”

May combine two claims.

In a 4-week diet-focused weight loss trial comparing PDA to PR, dietary adherence was significantly higher in PDA (43%) than PR (28%); adherence to the self-monitoring method was not reported.

“In a 4-week, diet-focused weight loss trial that compared PDA for self-monitoring to PR, dietary adherence was significantly higher in the PDA group (43%) compared to the PR group (28%) (15); adherence to the self-monitoring method was not reported.”

• cites [15] sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Analyses were performed using the intention-to-treat principle regardless of adherence and retention.

“Analyses were performed using the intention-to-treat principle regardless of the participant's adherence and retention.”

May combine two claims.

Sensitivity analyses omitting outliers did not change the results, supporting robustness.

“When outliers were omitted via sensitivity analysis, the results did not change, supporting the robustness of our findings.”

Probably not a substantial claim: may not pass S4 (based).

No clinical trials have examined the use of a PDA to deliver a tailored feedback message in response to recorded behavior.

“Moreover, no clinical trials have examined the use of a PDA to deliver a tailored feedback message in response to the recorded behavior.”

Classified as probably not a substantial claim.

Tate and colleagues showed that the number of weekly diaries submitted online was significantly related to weight loss.

“Tate and colleagues showed that the number of weekly diaries submitted online was significantly related to weight loss (4).”

• cites [4] sourceNot checked yet

  Not checked in the free run.

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

Missing data were handled by baseline value carried forward imputation.

“Missing data were handled by a baseline value carried forward imputation approach.”

May combine two claims.

Many individuals do not make the connection between self-monitoring and behavior change easily, which probably contributes to stopping self-monitoring.

“However, many individuals do not make that connection easily, which probably contributes to their stopping self-monitoring”

May combine two claims.

Benefits of using the PDA included portability, immediate access to a USDA database, real-time calculation and display of dietary subtotals, and saving commonly eaten meals.

“benefits of using the PDA included its portability and immediate access to a U.S. Dept. of Agriculture database containing 5000 to 6000 food items including brand and restaurant foods, real-time calculation and display of dietary subtotals in relation to daily goals, and saving commonly eaten meals.”

May combine two claims.

In a previous study, participants reported self-monitoring was often time-consuming and burdensome, which often led them to record at the end of the day or days later.

“In a previous study of participants who used PR, participants reported that self-monitoring was often time-consuming and burdensome (26), which often led them to record at the end of the day or days later (27).”

• cites [26] sourceNot checked yet

  Not checked in the free run.

• cites [27] sourceNot checked yet

  Not checked in the free run.

May combine two claims.

These findings suggest that use of an electronic diary facilitates improved self-monitoring; however, use of an electronic diary plus daily tailored feedback was related to the best weight loss.

“These findings suggest that use of an electronic diary facilitates improved self-monitoring; however, the use of an electronic diary plus a daily feedback message that was tailored to what had been entered in the diary was related to the best weight loss.”