JMIR Publications

ABSTRACT

Background:

Long-term self-monitoring (SM) of weight, diet, and exercise is commonly recommended by behavioral weight loss (BWL) treatments. However, sustained SM engagement is notoriously challenging, so more must be learned about patterns of engagement with digital SM tools during weight loss maintenance (WLM). Additionally, insight into characteristics that may influence SM engagement could inform tailored approaches for participants at risk for poor adherence.

Objective:

This study explored patterns of digital SM of weight, diet, and exercise during WLM (Aim 1) and examined timing, patterns, and rates of disengagement/re-engagement (Aim 2). This study also assessed relationships between individual-level factors (previous weight loss, information avoidance, and weight bias internalization) and SM engagement (Aim 3).

Methods:

Participants (N = 72) were adults enrolled in a BWL program, consisting of a 3-month period of weekly treatment designed to induce weight loss (Phase I) following by a 9-month period of less frequent contact to promote WLM (Phase II). Participants were prescribed daily digital SM of weight, diet, and exercise. At baseline, self-report measures assessed weight-related information avoidance and weight bias internalization. SM adherence was objectively measured with days per month participants tracked weight, diet, and exercise. Repeated-measures ANOVA examined differences in adherence across SM targets. Multi-level modeling examined change in adherence across Phase II. Relationships between individual-level variables and SM adherence were assessed with Pearson correlations, independent samples t-test, and multi-level modeling.

Results:

During WLM, consistently high rates of SM (≥ 50% of days in each month) were observed for 61.1% of participants for exercise, 29.2% of participants for weight, and 20.8% of participants for diet. Adherence for SM exercise was higher than weight or diet (P < .001). Adherence decreased over time for all SM targets throughout Phase II (P < .001), but SM of exercise dropped off later in WLM (month = 10.07) than SM of weight (month = 7.92) or diet (month = 7.58; P < .001). Among participants with a period of low SM adherence (i.e., <50% of days in a month), only 33.3%-46.4% subsequently had one or more months with high adherence. Individuals with higher Phase I weight loss had higher diet and exercise SM during WLM (P’s > .05). High weight-related information avoidance predicted a faster rate of decrease in dietary SM (P’s <.001). Participants with high weight bias internalization had the highest rates of weight SM (P = .027).

Conclusions:

Participants in BWL programs have low adherence to the recommendation to sustain daily SM during WLM, particularly for SM of diet and weight. Initial weight loss, weight-related information avoidance, and weight bias internalization may be relevant indicators for SM engagement. Interventions may benefit from innovative strategies that target participants at key moments of risk for disengagement. Clinical Trial: ClinicalTrials.gov NCT03337139