Effect of Daily Self-weighing on Weight Loss in Adults

Limited experimental evidence has examined the impact of daily self-weighing on weight loss and psychological outcomes. The purpose of this dissertation was to assess the effect of daily self-weighing on weight loss, behavioral, and psychological outcomes among overweight and obese adults using an experimental design and robust analytic methods. This dissertation followed three aims. Aim 1 consisted of a secondary data analysis among participants enrolled in a 12-month Internet-based weight loss intervention to examine the association between daily weighing and weight loss and explore whether diet and physical activity behaviors explain that relationship. Those who reported daily weighing had greater percent weight loss compared to those who reported less frequent weighing at 6 months [(8.27% (5.40) vs. 5.51% (5.41); p=.003] and 12 months [8.09% (7.81) vs. 4.60% (6.35); p=.004]. At 6 months, multiple mediation analysis showed that eating and exercise behaviors acted as mediators between daily self-weighing and weight loss. At 12 months, only eating behaviors explained the relationship. Aim 2 included a randomized controlled trial (n=91) comparing a 6-month low-intensity, daily self-weighing intervention to a delayed intervention control group that included an objective measure of self-weighing. On average, the intervention group self-weighed more days per week (6.1±1.1 vs. 1.1±1.5; p<.0001) and lost significantly more weight compared to the control group [Mean (95%CI); 3 months: -4.41%(-5.5, -3.3) iv vs. -0.37%(-1.5, .76); 6 months: -6.55%(-7.7, -5.4) vs. -0.35%(-1.5, .79); group x time interaction: p<.001]. At 6 months, a greater percentage of the intervention group achieved 5% (42.6% vs. 6.8%; p<.0001) and 10% weight loss (27.7% vs. 0%; p<.0001). Aim 3 examined the psychological effects of the daily self-weighing intervention compared to controls. There were no significant differences between groups in depressive symptoms, anorectic cognitions, disinhibition, susceptibility to hunger, and binge eating. At 6 months, there was a significant group by time interaction for both body dissatisfaction (p=.007) and dietary restraint (p<.001) with the intervention group reporting improved outcomes on these constructs. The results of this dissertation indicate that daily self-weighing is a feasible and effective behavior for weight loss among overweight and obese adults that does not lead to adverse psychological outcomes.Doctor of Philosoph

Weighing Every Day Matters: Daily Weighing Improves Weight Loss and Adoption of Weight Control Behaviors

Daily weighing is emerging as the recommended self-weighing frequency for weight loss. This is likely because it improves adoption of weight control behaviors

The efficacy of a daily self-weighing weight loss intervention using smart scales and email

ObjectiveTo examine the impact of a weight loss intervention that focused on daily self-weighing for self-monitoring as compared to a delayed control group among 91 overweight adults.Design and MethodsThe 6-month intervention included a cellular-connected “smart” scale for daily weighing, web-based weight loss graph, and weekly emails with tailored feedback and lessons. An objective measure of self-weighing frequency was obtained. Weight was measured in clinic at 3 and 6 months. Caloric intake and expenditure, and perceptions of daily self-weighing were also measured.ResultsUsing intent-to-treat analyses, the intervention group lost significantly more weight compared to the control group [Mean (95%CI); 3 months: −4.41%(−5.5, −3.3) vs. −0.37%(−1.5, .76); 6 months: −6.55%(−7.7, −5.4) vs. −0.35%(−1.5, .79); group×time interaction: p<.001] and a greater percentage achieved 5% (42.6% vs. 6.8%; p<.0001) and 10% (27.7% vs. 0%; p<.0001) weight loss. On average, the intervention group self-weighed more days/week (6.1±1.1 vs. 1.1±1.5; p<.0001) and consumed fewer calories/day compared to the control group [Mean (95% CI); 6 months: 1509 (1291,1728) vs. 1856 (1637,2074); group×time interaction: p=.006]. Among intervention participants, daily self-weighing was perceived positively.ConclusionsThese results indicate that an intervention focusing on daily self-weighing can produce clinically significant weight loss

Daily Self-Weighing and Adverse Psychological Outcomes: A Randomized Controlled Trial

Despite evidence that daily weighing is an effective strategy for weight control, concerns remain regarding the potential for negative psychological consequences

Will Obesity Treatment Reimbursement Benefit Those at Highest Risk

Historically, providers have lacked reimbursement for obesity management in the primary care setting. In 2011, the Centers for Medicare and Medicaid Services released the decision to reimburse qualified primary care providers for obesity counseling. We are concerned particularly about how the policy might adversely impact high-risk groups, namely racial/ethnic minority and socioeconomically disadvantaged population

Engagement with eHealth Self-Monitoring in a Primary Care-Based Weight Management Intervention

Background: While eHealth approaches hold promise for improving the reach and cost-effectiveness of behavior change interventions, they have been challenged by declining participant engagement over time, particularly for self-monitoring behaviors. These are significant concerns in the context of chronic disease prevention and management where durable effects are important for driving meaningful changes. Purpose: “Be Fit, Be Well” was an eHealth weight loss intervention that allowed participants to self-select a self-monitoring modality (web or interactive voice response (IVR)). Participants could change their modality. As such, this study provides a unique opportunity to examine the effects of intervention modality choice and changing modalities on intervention engagement and outcomes. Methods: Intervention participants, who were recruited from community health centers, (n = 180) were expected to self-monitor health behaviors weekly over the course of the 24-month intervention. We examined trends in intervention engagement by modality (web, IVR, or changed modality) among participants in the intervention arm. Results: The majority (61%) of participants chose IVR self-monitoring, while 39% chose web. 56% of those who selected web monitoring changed to IVR during the study versus no change in those who initially selected IVR. Self-monitoring declined in both modalities, but completion rates were higher in those who selected IVR. There were no associations between self-monitoring modality and weight or blood pressure outcomes. Conclusions: This is the first study to compare web and IVR self-monitoring in an eHealth intervention where participants could select and change their self-monitoring modality. IVR shows promise for achieving consistent engagement

The assessment of caregiver self-efficacy in a virtual eating disorder setting

Abstract Background Caregiver self-efficacy is thought to be a key component for successful family-based treatment (FBT) for individuals with eating disorders. As such, interventions aimed at enhancing caregiver self-efficacy, often measured via the Parents Versus Anorexia scale, have been a focal point of FBT literature. However, studies looking at the relationship between caregiver self-efficacy and treatment outcomes have been mixed. We aimed to better understand the influence of caregiver self-efficacy on eating disorder treatment outcomes during FBT. Methods Caregiver self-efficacy was measured using the Parents Versus Eating Disorders (PVED) scale, an adapted version of the Parents Versus Anorexia scale, in a sample of 1051 patients with an eating disorder and 1528 caregivers (patients can have more than one caregiver) receiving virtual FBT. Across two multilevel models, we tested how caregiver self-efficacy changed over time and its association with changes in eating disorder symptoms and weight over the first 16 weeks of treatment. Results Over treatment, PVED scores increased (b = 0.79, SE = 0.04, CI [0.72, 0.86]) and starting PVED scores were predictive of improved eating disorder symptoms (b = − 0.73, SE = 0.22, CI [− 1.15, − 0.30]), but not weight (b = − 0.96, SE = 0.59, CI [− 2.10, 0.19]). We also found that PVED change-from-baseline scores were predictive of weight (b = − 0.48, SE = 0.03, CI [− 0.53, − 0.43]) such that patient weight was lower when caregiver reports of PVED were higher. Likewise, the association between caregiver change in PVED scores and weight varied as a function of treatment time (b = 0.27, SE = 0.01, CI [0.24, 0.29]). Results were consistent when isolating patients with anorexia nervosa. Conclusions Caregiver self-efficacy during FBT improved over time but was not robustly associated with treatment outcomes. This may, in part, be due to psychometric properties of the PVED scale. We describe these issues and illustrate the need for development of a new measure of self-efficacy for caregivers supporting their loved ones through eating disorder treatment

Designing Ruby: Protocol for a 2-Arm, Brief, Digital Randomized Controlled Trial for Internalized Weight Bias

BackgroundWeight bias internalization, also known as weight self-stigma, is a serious health concern for individuals with higher body weight. Weight bias internalization is associated with the greater avoidance of health care and health-promoting activities, disordered eating, social isolation, and weight gain. Elevated weight bias internalization has been associated with low self-compassion, yet few investigations have explored self-compassion as a potential mechanism for reducing internalized weight bias. ObjectiveRuby is a 2-arm randomized controlled trial that was designed to test the efficacy of a 4-week digital self-compassion intervention to reduce internalized weight bias compared with a wait-list control. MethodsAdults with elevated internalized weight bias and a BMI of >30 kg/m2 (N=80) were recruited. Ruby is a standalone digital trial that will be delivered entirely via a smartphone and will involve web-based data collection and text messages. The intervention content will include psychoeducation and daily mindfulness practices with a focus on self-compassion and body concerns. We will use intent-to-treat analyses to examine changes in weight bias internalization throughout time by treatment arm. The analyses will be conducted by using one-way analysis of covariance models and linear mixed models. ResultsThe protocol was designed in May 2020 and approved in December 2020. Data collection is currently underway. ConclusionsRuby will be the first digital standalone, self-compassion–based intervention designed to reduce internalized weight bias. Owing to its standalone digital delivery, Ruby may be a highly scalable treatment for internalized weight bias that can be delivered on its own or combined with other treatments. We expect Ruby to be accessible to many, as participants can access the digital intervention at times of the day that are the most convenient in their schedule and are not burdened by in-person time commitments, which can be a barrier for participants with competing demands on their time and resources. If efficacious, Ruby will be poised to expand a burgeoning body of literature related to psychological intervention in this area. Trial RegistrationClinicalTrials.gov NCT04678973; https://clinicaltrials.gov/ct2/show/NCT04678973 International Registered Report Identifier (IRRID)DERR1-10.2196/3130