How Effective is Self-Monitoring in Weight Management?Thursday, January 27, 2011
One of the key principles of behaviour modification in chronic disease management is self-monitoring. This is why we ask patients with pain to keep a pain diary, patients with diabetes to monitor their glucose levels, patients with hypertension to measure their blood pressure, and patients with asthma to monitor their peak flow.
In obesity management, the equivalent of this is keeping a food journal, an activity log, regular weighing, and in many cases, a mood journal.
The importance of self-monitoring is based on the self-regulation theory according to which, in order to change (and possibly maintain) behaviours, individuals need to pay adequate attention to their own actions and the conditions under which they occur, as well as their immediate and long-term effects.
But how effective is self-monitoring in weight management?
This question was now addressed in a systematic review of the literature by Lora Burke and colleagues from the University of Pittsburgh in a paper just published in the Journal of the American Dietetic Association.
The authors identified and examined 22 studies including, 15 on dietary self-monitoring, one on self-monitoring exercise, and six on self-weighing published between 1993 and 2009.
The studies included a wide array of methods, ranging from paper diary (most often) to the internet, personal digital assistants, and electronic digital scales.
Despite a consistent and significant association between self-monitoring and weight loss, the authors considered the level of evidence weak because of methodologic limitations.
The most significant limitations were the homogenous samples (most studies were in white women) and reliance on self-report.
The authors therefore conclude that there is a need for studies in more diverse populations, for including more objective measures of adherence to self-monitoring, and for studies that establish the required dose of self-monitoring for successful outcomes.
Thus, while more research may need to be done on the issue of self-monitoring, there is no doubt that it is effective and should probably be part of any weight management program.
Indeed, it is perhaps important for patients to realise that self-monitoring is not just to document the efficacy of the intervention. Rather, the very act of self-monitoring is in itself an intervention that leads to behaviour change.
As with any chronic disease, when intervention stops, the disease comes back. In my experience, the same applies to self-monitoring in weight management. When patients stop keeping their food diaries, activity logs, or regularly weighing themselves, more often than not, the weight comes back.
Remember, keeping a food journal or activity log and wearing a pedometer is not just to measure your progress – it is actually part of your treatment!
If you are keeping a food diary or have a hard time keeping one, I’d love to hear from you. If you have any tips or resources that can help keep track of food, activity, mood and/or weight, feel free to send me your comments.
Burke LE, Wang J, & Sevick MA (2011). Self-monitoring in weight loss: a systematic review of the literature. Journal of the American Dietetic Association, 111 (1), 92-102 PMID: 21185970