Defining Adherence to Mobile Dietary Self-Monitoring and Assessing Tracking Over Time: Tracking at Least Two Eating Occasions per Day Is Best Marker of Adherence within Two Different Mobile Health Randomized Weight Loss Interventions

Abstract

Background: Mobile dietary self-monitoring methods allow for objective assessment of adherence to self-monitoring; however, the best way to define self-monitoring adherence is not known.

Objective: The objective was to identify the best criteria for defining adherence to dietary self-monitoring with mobile devices when predicting weight loss.

Design: This was a secondary data analysis from two 6-month randomized trials: Dietary Intervention to Enhance Tracking with Mobile Devices (n=42 calorie tracking app or n=39 wearable Bite Counter device) and Self-Monitoring Assessment in Real Time (n=20 kcal tracking app or n=23 photo meal app).

Participants/setting: Adults (n=124; mean body mass index=34.7±5.6) participated in one of two remotely delivered weight-loss interventions at a southeastern university between 2015 and 2017.

Intervention: All participants received the same behavioral weight loss information via twice-weekly podcasts. Participants were randomly assigned to a specific diet tracking method.

Main outcome measures: Seven methods of tracking adherence to self-monitoring (eg, number of days tracked, and number of eating occasions tracked) were examined, as was weight loss at 6 months.

Statistical analyses performed: Linear regression models estimated the strength of association (R2) between each method of tracking adherence and weight loss, adjusting for age and sex.

Results: Among all study completers combined (N=91), adherence defined as the overall number of days participants tracked at least two eating occasions explained the most variance in weight loss at 6 months (R2=0.27; P<0.001). Self-monitoring declined over time; all examined adherence methods had fewer than half the sample still tracking after Week 10.

Conclusions: Using the total number of days at least two eating occasions are tracked using a mobile self-monitoring method may be the best way to assess self-monitoring adherence during weight loss interventions. This study shows that self-monitoring rates decline quickly and elucidates potential times for early interventions to stop the reductions in self-monitoring.

Trial registration: ClinicalTrials.gov NCT02632461 NCT02868853.

Keywords: Adherence; Diet; Self-monitoring; Weight loss; mHealth.

Conflict of interest statement

STATEMENT OF POTENTIAL CONFLICT OF INTEREST

A. Hoover and E. Muth have formed a company, Bite Technologies, to market and sell a bite counting device. Clemson University owns a US patent for intellectual property known as “The Weight Watch,” USA Patent No. 8310368, filed January 2009, granted November 13, 2012. Bite Technologies has licensed the method from Clemson University. A. Hoover and E. Muth receive royalty payments from bite counting device sales. All other authors report no potential conflict of interest.

Copyright © 2019 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.