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Self-Monitoring: Keyboard Beats Pencil



As blogged before – step one of weight management is self-monitoring.

As I explain to my patients, the very act of self-monitoring your intake, activity and perhaps even your mood, changes your behaviour. This is why virtually all credible weight management programs emphasize the importance of keeping a food diary – whether you are counting points, calories, or simply describing when and what you ate and how much you moved.

But for anyone, who has tried this, it can be tedious and most people abandon self-monitoring after a while – this is when I tell them that consistent self-monitoring is part of their treatment – when treatment stops – weight comes back!

So while self-monitoring is key to weight management does it matter if you use a pencil and notebook or one of the many electronic apps, devices, or online services?

This question was now addressed in a randomised controlled trial by Lora Burke and colleagues from the University of Pittsburgh, the results of which were just published OBESITY.

Two hundred adults with an average BMI of 34 were randomised to three different forms of self-monitoring: using a personal digital assistant (PDA) with dietary and exercise software, either with or without a feedback (FB) message vs. the traditional paper diary/record (PR).

All participants received standard behavioral treatment and adherence to self-monitoring and change in body weight was assessed at 6 months

Over 90% of participants completed the study and everyone lost weight with no differences in average weight loss between the groups.

However, a greater proportion of PDA+FB participants (63%) achieved ≥ 5% weight loss in comparison to the PDA group (49%) and the PR group (46%).

Self-monitoring adherence over the 6 months was higher in the PDA groups (PDA 80%; PDA+FB 90%) than in the PR group (55%).

This study clearly suggests that using an electronic journal, especially one that provides feedback , may not only help more people lose and sustain clinically relevant weight loss (probably for as long as they keep doing it) and that using an electronic monitoring app may be easier and therefore more sustainable in the long-term.

As there are now numerous such sites, programs, devices, and apps out there, I wonder if my readers have any favourite self-monitoring resources they would recommend.

Perhaps readers, who find self-monitoring helpful, may also want to share why this works for them (or does not?).

AMS
Heidelberg, Germany

Burke LE, Conroy MB, Sereika SM, Elci OU, Styn MA, Acharya SD, Sevick MA, Ewing LJ, & Glanz K (2011). The effect of electronic self-monitoring on weight loss and dietary intake: a randomized behavioral weight loss trial. Obesity (Silver Spring, Md.), 19 (2), 338-44 PMID: 20847736

24 Comments

  1. Hi Arya!
    Could you share some of the sites that are suggested? thanks
    LIsa

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  2. I really like the free tracking application CRON-O-Meter. It’s very easy to use but quite robust and customizable. Beyond tracking food intake, you can also record weight and other biomarkers, exercise, set target macronutrient intakes, and even run reports that summarize both macronutrient and micronutrient intake.

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  3. Dr. Sharma,

    I have lost 130 lbs. and kept it off for a year now. I RELIGIOUSLY keep a food journal every day. Sorry to disagree with you, but I keep my food journal the old fashioned way – by manually writing every single thing down that goes into my mouth. I could journal electronically, but I choose not to. Frankly, I choose not to spend the money. An electronic journal comes as part of my commercial “weight loss” program, if I so desire, but I choose not to spend the $27.00 per month to take advantage of this “scheme.”

    While journaling electronically is viewed by many in our society today as “sexy,” slick, vogue and many other things, it is, in fact, just that – “sexy,” slick, vogue, hip and whatever other adjectives you want to use to describe it. Whether it is any more effective than somebody keeping a very detailed manual journal is very questionable, to say the least.

    Have you ever considered, or done a study, that might examine the hypothesis that at least part of the reason we are facing such an obesity epidemic today is because of the exact technological advances of which you speak?

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  4. I like Dailyburn, it was great for tracking all my foods and portions and even gave graphs of my nutrient intake (fats,carbs, protein). They also track physical activity.
    there are challenges you can join to increase motivation, and they set nutritional goals based on your weight loss goals, it was a really good website (used to be free, now it is not)

    The other one I use now is MyNetDiary they way it tracks food is great, the feedback is awesome, the exercise tracking is also good. i think it is fairly accurate. they also help you set nutritional goals based on how much you wish too lose and in what timeframe. both very good websites that have decent motivational boosts and great feedback.

    The one thing i miss about daily burn is the challenges, I always found them so motivating, and there was challenges for everything from weightloss (5, 10, 15, 20….100lbs) to exercise (a certain distance running, 10 000 pushups, km;s on a bike) and everything between. There are challenges for the short term, intermediate and long term to keep you motivated and hundreds of people participating to encourage you on.

    let me know if there are any others.

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  5. I have been computing calories by hand for about 3 years now, and that forms my record. First, I need somewhere to compute calories any way. I use weight and caloric density for higher caloric density foods and garnishes when at home. I also compute the hungering rate for various meals, that is the calories per hour until I get hunger, which is more useful than glycemic load for evaluating the weight loss potential of a meal.

    What have I learned from my records?

    Much of the information on calories questionable, if not wrong. My weight was stable at 1500 calories on 50% starch and I was loosing on 1800 calories and 20% starch.

    Sugar, grains, oils, and manufactured eatable products are too calorie dense, are not essential foods and do not stave off hunger long enough to be part of a weight loss program.

    Grains make me hungry. They a detrimental to weight loss. The line should be “eat less carbohydrate (no dense), move more.” … (Eat vegetables for carbohydrate only)

    We need to consider bio-available energy only, which varies between people. I needed to determine my own caloric densities for carbs, protein and fats. My personal values are about closer to 5, 4, 7. I am assuming gut fauna is causing the increase in carbohydrate value; however, it may be a total offset and a efficiency of digestion issue.

    Calorie is a heat measurement, and the chemical bio-available energy for carbohydrates and fats are off. Carbohydrates are underrated and fats are overrated. Atwater threw out 1/2 of is data, those of people who’s data did not match his average value closely. In addition, fats produce considerable more water, which is a highly thermogeneic reaction, skewing the heat to bio-available energy ratio.

    Hall & Chow have tried to create a mathematical model, and had to simplify the model to resolve it. The nutrition community does not have the mathematical ability to deal with their model, and what the nutrition community and medical community currently uses a model that is so dummied down, that it provides direction only.

    My key problem is a “perverted hunger issue”, possible hyperinsulinemia with insulin resistance and leptin resistance, or some mild form of Prander-Willy. The medical community have been useless in resolving this. They want me to live hungry, which has little chance of success.

    The best relief I have found is with the Tim Irving’s Leptin Resistance approach, and that is similar to Paleo, Panu, Primal, and LoBAG. I am still weighing food and am down in excess of 55 kgs.

    I have learned a lot about food, diet, physiology, bio-chemistry, and sorting valid information from ca-ca-el-toro, of which there is a lot.

    but what do I know

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  6. While I am not questioning the results of the study, nor any anecdotal evidence, such as that provided by Jim above, I do feel uncomfortable with the whole idea of tracking every single morsel of food that enters our mouths. For me, this smacks of disordered eating. Certainly, I can easily imagine food journalling leading to obsessive, destructive behaviours (like anoriexia or bulimia), especially among psychologically vulnerable groups like adolescent females.

    Yet again, this underscores the complexity of the weight management conundrum.

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  7. I failed to answer the question:

    Ultimately why tracking the food has worked is obsession with diet and weight loss, and figuring out the true facts of the matter.

    But what do I know. This is just a retirement project anyway.

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  8. The ‘Lose It!’ app on IPhone is a one time cost of $4.99 and I find it to be quite good. You can enter your dietary and fitness goals, including planned daily caloric, fat & protein intake. The app calculates nutrient values based on the foods and portions inputted and calories burned based on BMI, duration of workout and perceived level of exertion. Obviously the numbers aren’t perfectly accurate, but if you read food labels, you can get it to be sufficiently correct. The only problem with this app is that there’s no place to enter the time each food item was consumed, you can only categorize by breakfast, lunch, dinner and snack. If you are within an arms reach of your IPhone all day, it’s the way to go.

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  9. I’ve tracked food intake plenty of times in my life, and it has helped with dieting. But the idea of tracking food obsessively for the rest of my life seems worse than actually being fat. I don’t want to live my life obsessed with food; it just doesn’t seem healthy. Right now I sort of follow a standard structure for my meals and what food groups to include, although I don’t always stick to it, and I keep mental track of how many servings of fruits and vegetables I’ve had each day. It’s easy to keep track of mentally because it’s essentially the same every day.

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  10. I use My Fitness Pal to track my food intake. It is free and can be accessed by my home computer as well as my ipod. It has a huge database with a lot of Canadian food values in it. It can print out records of your eating and exercise for whatever period you wish. Also, very importantly, you can, at your discretion, let your friends see what you are eating from day to day. Friends who are also on My Fitness Pal, that is. This is a huge motivator I found. It has stopped me from eating junk most of the time. Maybe as a doctor, you should monitor your patients this way. If my doctor could see what I was eating from day to day, it would make me very compliant.

    For a free program it is terrific. I’d be willing to pay monthly because it is so useful. I’ve also heard good things about Sparkpeople, Daily Plate, Livestrong etc.

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  11. Tracking by computer programs works well for people who eat a lot of packaged food, and for those who like eating the same thing all the time. It quickly gets pretty tedious if you are a creative cook who is not relying on ‘ready made’ food. I use paper and pen. I do not consider it ‘disordered’ or ‘obsessive’. I had to face the fact that unlike many people, I am unable to just eat what I like. I have to pay attention. I make a daily plan, then check off items as they are consumed and note variances. I will usually plan on Sunday for the week ahead. It then becomes a shopping list sometimes, and if I go off track I try to record why (extreme stress, failure to eat breakfast etc) so then it becomes a bit of a journal. It has never occured to me to share it with friends, however it does provide me with the data to discuss how things have been going with my doctor.

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  12. I use http://www.myhealtheme.com to track my food, exercise, water intake, mood, and other things. The program tailors messages so I receive support in the way I want it! For example, I love texting and I receive supportive, informative messages via my cell phone. Plus, I can text in my weight and water intake and it will upload the information to my personal website. I can use this site on my computer or my cell phone. The best part is that the program a physician-directed program so they can send reports directly to my health care provider! Love it!!

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  13. I just use excel … have created a spreadsheet and enter my intake, physical activity, moods and when/where/with whom I eat … since breakfast is the same I just use copy/paste and done. I set up the colums to add my protein & fluid intake, can create graphs to see monthly weight changes (or whatever frequency I like to see) or use graphs for food categories.
    Although I hate doing it by now (after 3 years) I try to do it most days.

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  14. I try not to journal online – mainly because I find it takes me longer than on paper and I find that I spend enough time already behind the computer. However, I have put my food journal onto an Excel spreadsheet and included the info for the foods that I regularly eat – and then I print out those sheets, so part of the “figuring out” is done already for me. I wear an Omron pedometer, and I aim for a minimum of 10,000 steps – and my pedometer attaches to my computer to graph how I’m doing at my goals. I have looked into adding an app on my Blackberry for tracking when I’m away from home – but so far, I haven’t found one that seemed like it would work for my situation.

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  15. I use an android app called Cardiotrainer for tracking activity. A plugin is available called Calorific for tracking calories. The calorie tracking is done by estimating amounts from three food categories green, yellow and red. Green are good foods (fruits, vegetables etc), yellow are okay foods (breads, pasta) and red are “bad” foods (red meats, sugary foods). You enter rough amounts of the types of foods for your daily meals & snacks using a simple interface.

    I also use a simple spreadsheet for food journalling.

    I have been using these programs since early Jan and have lost about 16 kilos so far. I doubt I would have stuck with it using a manual method.

    Cardiotrainer and Calorific have a lot of great features. Info here: http://www.worksmartlabs.com/

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  16. I use myfitnesspal on the iPad (http://www.myfitnesspal.com/) it’s free, and I’ve only twice come across a food that I couldn’t find in their database. It’s easy, and I can input my own recipes so it can determine calories/nutrient value for me, and it can store custom meals too, so I don’t have to enter each ingredient every time. It also allows exercise input for cardio & strength, tracks progress and has social media features that I don’t use.

    The only thing I don’t like is that it subtracts 1:1 the calories burned from the goal calories I set for the day. Even if it subtracted them – the RMR, I would be happier or if I could not to have it deduct at all.

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  17. I use pen and paper and have an aesthetically pleasing journal that I write in. It’s brilliant, because I can make notes about mood or if something has changed in my life, and that has shown where I have problems with food e.g. when my partner goes away, my food routines go to hell in a hand basket. Now that I’ve learned to calculate calories pretty accurately (I round it up quite a bit because I know people underestimate what they eat), it’s very obvious that for me, anyway, the calories in/calories out relationship works like a charm. I can also see that some types of foods make me hungry quickly.

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  18. I discovered Sparkpeople.com and used it while I was losing weight. A community site with – I think – an excellent tracking system. In fact I discovered it while looking for a place to track food. I haven’t been tracking for quite a while with no weight gain (yet). However the option to track is always there.

    I’m from the US and really like your site. I like the fact that you post every day. I also think that reading about weight every day helps me maintain.

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  19. I didn’t mention but Sparkpeople.com is free.

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  20. I use google docs to track my food intake, and feelings. The beauty of google docs is you can access it from any computer. I use a spreadsheet there. Google docs is free and all you need to access it is a gmail account. I also use it to create my menu planner in a google word doc, which my husband and I can both access at the same time! On my menu planner I create my grocery list as well. I also add non food items to that doc so that I have one place to go print my list before I do any shopping. Its very handy.

    In the past, I could never find a good way to document with pen and paper. It was not very practical to carry a journal with me in the type of work I do. And, I could never find the “right” book to do it in (excuses – excuses!) Funnily enough, I always have a computer or smart phone at my beck and call. However, if you don’t have these available, then pen and paper can be just as good. I don’t think its so much how you do it, but, that you do it. The stats speak for themselves of course that technology helps people to document but there are always those that don’t fit the statistics and you just might be one of those people that can do it better with pen and paper.

    Techno gadgetry is my thing and I have now lost nearly 20 pounds in 20 weeks. I know I could not have done this without documenting be it by keyboard or pencil. I was in denial of how much I was eating for one thing. And going to the Weight Wise modules fine tuned my knowledge of what I was eating. Weight wise showed me how to eliminate a lot of those sneaky calories that you don’t even realize you are eating. Most importantly, in documenting I can see patterns that were sabotaging my best intentions and can change my lifestyle accordingly.

    Rosemary Dinsdale, Geekette in Edmonton Alberta

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  21. I forgot to mention tracking of my daily steps.

    I use the electronic Omron pedometer with software to track my steps every day. (The software works with an Omron blood pressure tester, so I purchased that as well. )

    With this gadget, I can make sure I get my goal number of steps each day and it is encouraging me to exercise more. I can print out the steps in graphs and there is nothing like a visual measure of how you are doing to get to your goals.

    Thanks again,
    Rosemary Dinsdale in Edmonton

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  22. I also use LoseIt. I lost 50lb using it and 1 year into maintenance now I still use it to track every day. I have it on my iPhone so it’s very handy, and in addition to the foods database I have a lot of my regularly repeating meals and recipes in it (home-made burrito, entire usual breakfast, etc.). I like that I can also track my saturated fats, fiber, protein. I know that some people consider calorie counting obsessive, but I gained weight originally not because I was eating especially high-calorie or unhealthy foods, but because I was eating too much food without realizing it. Tracking helps me with portion control, which my natural intuition never did. Over time, the tracking has also helped make me aware of when I’m really hungry and when I just stupidly want to put something in my mouth without thinking about it — having to enter it makes me actually think, and often stop. But it doesn’t prevent me when I can say, “Yes, I really am hungry right now.” That’s why I don’t consider it obsessive, I think. It’s just compensating for my lack of an internal tracker.

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  23. Also, regarding Motera’s comment: I eat very little packaged food, mostly vegetables, fruit, lean meats. Since maintenance I have also baked most of the bread I eat; It’s no harder to track these on LoseIt than packaged foods — it has “_____ oz salmon, baked/broiled” and “grapes, ______ cup”, “______ cup whole wheat flour” Just as well as Oreos or Lean Cuisine or whatever. I do wish the database listed more things by weight though, because I never know what they mean by entries like “medium size potato” and end up having to double check on sites that give calories by weight. You can program that in after the first time, though, and then it’s in there.

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  24. I agree with Sugarpuss that My Fitness Pal is a fantastic tool! Just wanted to add that you can choose nutrient categories to track beyond calories too. I track calories, fat, carbs (the standards) and added iron, protien (I’m vegetarian) and sodium. I feel that it lets me track my intake for nutrition not just weight loss. I have about 20 lbs to lose but find this system is a great tool. Thanks for reminding me Dr. Sharma that tracking is essential. I had a little fall off the tracking wagon last week which probably contributed to a couple of bad choices!

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