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.
AMS
Edmonton, Alberta
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
Thursday, January 27, 2011
Another white woman here. 🙂
I am currently over fifty pounds below my highest weight six years ago, and twenty-five pounds below the weight I was in late October. I have used various methods of weight loss over the years, including in recent years Overeaters Anonymous (with strict self-monitoring), an informal email accountability group of friends (with weekly weight/progress check-ins and mutual support), keeping food and weight logs on fitday.com (either strictly from day to day with particular nutrition goals, or now occasionally to check my habits/progress with nutrition since I’m eating mostly vegan), having strict accountability in a faith-based program with ongoing Bible study/prayer/one-on-one interaction via email, and now (and for a few months last year) having daily accountability for my food and sometimes exercise with an online message board (member center at drfuhrman.com ) AND with daily email accountability with a friend who knows my struggles.
In the last three months with the final methods of self-monitoring, I have done very well. I think just self-monitoring would not do it for me–it perpetuates my inward focus with my struggles. I have found a food plan that I can live with–in fact that I feel great pursuing–and my daily accountability to a dozen or so folks who are also giving daily accountability and commenting on one another’s food choices and struggles has been a real boost. My local friend gets the same accountability report from me, and she, too, has comments to help me along.
Last year I kept almost daily reports of my food at my blog, nutritarianrecipes.blogspot.com . This year I report my food only occasionally since I have the other outlets for that. I like using fitday.com from time to time to analyze the nutrients in what I’m actually eating to be sure I’m meeting goals with my more casual approach to calorie content in daily life.
You asked, so there’s my report! 🙂
Thursday, January 27, 2011
I’ve kept a food journal for nearly six months now and now associate it with eating, because I reach for it immediately. The biggest challenge is being honest. It’s very easy, psychologically, to want to underestimate the calorie content of foods and overestimate levels of exercise.
But now that I’ve pretty much got it right, it’s interesting to see that weight fluctuations are exactly what you could predict based on calories in/calories out. I’ve also become much more interested in the politics of food production, now that I check everything for calories. I get outraged now when I’m out (e.g. when I’m travelling and can’t cook) and need to buy something to eat and pick something up that looks healthy, but which has the calorie content equivalent to a full meal. I’m surprised that more of us aren’t morbidly obese, to be honest, when a pre-prepared ham sandwich turns out to be nearly 600 calories. Being a health conscious consumer means spending a huge amount of time dodging food traps.
Thursday, January 27, 2011
I combined a food/mood journal by creating a spreadsheet on Google Docs so that it would be accessible by any computer that I would come in contact with over the course of the day, and used it for four months as I ramped up psychological preparation for WLS (RNY in Dec). It helped to reveal a lot about my eating patterns – even at times, perhaps especially at times – where I fell out of practice with it.
Thursday, January 27, 2011
I started losing weight (portion control, moderate exercise) in January of 2009, and added an online food diary called “Fitday” a couple of months into it. I’ve never stopped, and today I weigh about 190 lbs less, and I’m still continuing the diary, continuing the exercise.
I’ve been thinking I’d do the journal for another 3 or 4 years at least, so as to raise my awareness to the point where estimating portion quantities and keeping a running daily calorie count was automatic and in my head. Your article seems to imply that if obesity is a chronic threat, keeping a strict account may be part of the chronic solution. Suits me!
Thursday, January 27, 2011
Hi Doc,
Love this blog, by the way. Just came across it recently and find it absolutely fantastic.
I’ve noticed that whenever I keep a food diary, it’s difficult for me to “cheat.” The mere thought of writing down “2 McDonalds cheeseburgers” is a sufficient disincentive for me to hit the drive-thru. Honesty, therefore, is key. Because if I really feel like having those cheeseburgers, then I’ll just leave my food diary on the counter and grab my car keys.
I’ve also been using FitDay recently in an attempt to get a better handle on what I’m eating, and I’ve noticed that whenever I take a break from keeping my food log up to date on there, I fall off the wagon, so to speak. What I find compelling and effective about tools like that (and LoseIt!, the iPhone app), is that it’s interactive and it provides instant feedback about your progress. The graphs and reporting are also super helpful, and I find it fascinating to compare my macronutrient breakdown for a given day with my moods and/or my perceived levels of hunger or satiety throughout that same day. In general terms, I can tell you that I’m the least hungry and grumpy when I eat the fewest carbs…
Thanks again for your excellent, top-notch work on here. I deeply appreciate what you’re doing here, I love and appreciate your approach, and I read every one of your postings every time.
With thanks,
Dustin (Halifax, NS)
Thursday, January 27, 2011
I used food diarying via Livestrong (after they bought The Daily Plate) and truly feel I could not have lost my 90 pounds without it. I tracked EVERYTHING down to the 3 calories in a stick of sugarless gum! (OK, so I probably overdid it…) It was key, as your post says, “the very act of self-monitoring is in itself an intervention that leads to behaviour change.” By seeing what I was eating and how many calories I was burning through exercise, I modified my behavior.
What I’m currently trying to avoid is this: “When patients stop keeping their food diaries, activity logs, or regularly weighing themselves, more often than not, the weight comes back.” I don’t feel like I can keep diarying everything forever, and haven’t done so for several months now. I’ve kept off almost all of the weight (what I have gained back might be due to muscle mass from exercise). However, even though I don’t keep a physical diary, I try to keep a mental one using my experience in estimating calories that I gained over the time I actually did keep a diary.
Thursday, January 27, 2011
I have kept food/exercise/weight journals off and on since the 1970s, and I am extremely ambivalent about them. I think that most people are surprised by what they find out — especially at first — about what they actually eat: portion sizes, nutrient content, etc. I still occasionally record everything for a month or two just to see whether or where any problems are happening.
I think also that being able to document any changes you make (and/or adherence to a plan) and compare them to measurable health outcomes is overall a good thing. I’m all about data collection!
On the other hand, if I use my recorded weight as the sole measure of “success” or “failure” I can see that the most successful strategy for me seems to have been a minimum of 4-6 hours of strenuous exercise a day (dance/aerobics classes, bicycle commuting, weight training, and/or running) and fewer than 800 calories a day, combined with frequent vomiting and meal skipping. The martini-and-snickers-bar diet seems to have been particularly effective, and the protein/fat/carb ratio does not seem to have mattered much.
Ah, youth 🙂
I feel better now.
Thursday, January 27, 2011
I’ve been keeping a journal for 16 mos and have lost 40 lbs. Not a lot by many standards, but it has been slow and steady with no regain. I find it soothes me to keep the journal, I feel much more in control and mindful. Couldn’t live without it now.
Saturday, January 29, 2011
Hi Dr. Sharma,
I have been on the Weight Watchers program and have been faithfully keeping a DAILY food log now for the past eight months. I have currently lost 110 lbs. In addition to the realization of what you’re putting in your mouth, I find that the food journal really helps me in planning. If I want to eat something, I eat it, but I also count it and write it down. Like I said, if I want to do something, I do it, but I plan for it and count it. A perfect example is this past Christmas Day. I sat down and decided what I wanted to do for Christmas dinner. I wrote it down and calculated how many points it was and then I worked backwards and figured out what I could do for the rest of the day i.e. Breakfast, lunch and snack, in order to be within my daily points range. I can’t stress enough the importance of keeping and maintaining a daily food journal as a planning tool.
Weight Watchers produces an excellent 3-month food journal, complete with eating and health tips and healthy recipes. If you are not a Weight Watchers member, but know someone who is, ask them to pick up a copy of the journal for you. I think it’s around $9.00.
Weight Watchers has a saying that is oh so true and it’s one that I now live by – “If you bite it, write it.”