AbstractObjectivesGreater dietary self‐monitoring adherence is associated with weight loss, however, the dietary self‐monitoring adherence criteria that predict weight loss are unknown. The criteria used to define adherence to dietary self‐monitoring in obesity treatment tend to vary, particularly in studies that include dietary self‐monitoring via mobile applications (apps). The objectives of this study were to (a) determine weight change outcomes related to app‐based dietary self‐monitoring and (b) determine the associations between the frequency, consistency, and completeness of dietary self‐monitoring and weight change.MethodsIn this single‐arm uncontrolled prospective study, employees at a large, urban health system who had overweight or obesity self‐monitored dietary intake for 8 weeks using the Calorie Counter by FatSecret app. A paired sample t‐test examined the association of app‐based dietary self‐monitoring and weight change; linear regression examined the associations of frequent, consistent, and complete dietary self‐monitoring and weight change.ResultsA significant mean difference [t (89) = 6.59, p < 0.001] was found between baseline and 8‐week weight (M = −1.5 ± 2.1 kg) in the sample (N = 90). Linear regression revealed a significant association [F (1, 88) = 7.18, p = 0.009] between total weeks of consistent dietary self‐monitoring (M = 4.4 ± 2.8) and percent weight loss (M = −1.54% ± 2.26%), and a significant association [F (1, 88) = 6.42, p = 0.013] between dietary self‐monitoring frequency (M = 50.1% ± 33.3%) and percent weight loss. The total weeks of complete dietary self‐monitoring (M = 3.42 ± 2.87) was not associated [F (1, 88) = 3.57, p = 0.062] with percent weight loss.ConclusionsConsistent and frequent app‐based dietary self‐monitoring were associated with short‐term weight loss. Emphasizing these aspects of self‐monitoring may be an avenue for decreasing the burden of self‐monitoring.

Background: Approximately 70% of the U.S. adult population has obesity and/or overweight and thus increased risk for heart disease, stroke, and type II diabetes mellitus. Standard obesity treatment includes a behavior modification technique, dietary self-monitoring, which entails recording all foods and beverages consumed with calorie amounts and time of consumption. Greater adherence to dietary self-monitoring using a paper diary is associated with weight loss. Self-monitoring via a mobile phone application (app) is an appealing, convenient alternative to paper-based techniques; however, few studies have examined the relationship between adherence to a dietary self-monitoring app and weight loss. Objectives: The objectives of the study were to 1) examine if there is an association between app-based dietary self-monitoring and weight change and 2) explore the relationships between the frequency, consistency, and completeness of app-based dietary self-monitoring and weight change at 8 weeks among adults with overweight or obesity. Frequency was the percentage of days that any self-monitoring occurred during the study; consistency was the recording of any dietary intake on > 3 days each week; completeness was the recording of 50% or more of the weekly individual calorie goal. Methods: Ninety participants interested in weight loss were recruited to self-monitor dietary intake for 8 weeks using the app Calorie Counter by FatSecret. Participants were assigned a daily calorie goal to achieve a one-pound weight loss per week. Paired sample t-test and linear regression were used to examine the relationships between app-based self-monitoring and weight change as well as the frequency, consistency and completeness of self-monitoring and weight change at 8 weeks. Results: The sample [N = 90, mean ( M ) age = 42 ± 10 years (SD)] was employed (100%), primarily female (96.7%), White (90%), and married (63.3%) with a Bachelor’s or Associate’s degree (60%). Paired-sample t test revealed a significant mean difference [ t (89) = 6.59, p < .001] between baseline and 8-week weight in pounds ( M = -3.26 ± 4.70). Linear regression analysis revealed an association [ F (1, 88) = 7.18, p = .009] between total weeks of consistently self-monitoring ( M = 4.44 ± 2.77) and percent weight loss ( M = -1.54 ± 2.26) as well as an association ( F (1, 88) = 6.42, p = .013] between the frequency of self-monitoring ( M = 50.14 ± 33.0) and percent weight loss. Completeness of self-monitoring was not associated with percent weight loss. Conclusion: Results suggest that consistent ( > 3 days/week) and frequent ( > 50% of days) app-based self-monitoring aids weight loss. Clinicians may wish to emphasize frequent and consistent self-monitoring, rather than complete self-monitoring, when providing weight loss counseling. Future research should examine app-based self-monitoring in men as well as ethnically and racially diverse populations. .

Understanding how adherence to dietary self-monitoring with apps has been defined is a first step toward examining the relationship between adherence and weight loss. The purpose of this review was to explore how adherence to dietary self-monitoring has been defined in the empirical literature that addresses weight loss app use by overweight and obese adults. The integrative review method and the preferred reporting items for systematic reviews and meta-analyses guided this review. Scientific databases (n=5) were searched, which yielded 29 studies. Studies were screened, evaluated for data quality, and then analyzed according to the constant comparison method. Most studies were weak to moderate quality. Results indicated that adherence was operationally defined in two ways. Adherence was defined as either adherent or nonadherent based on the completion of recording a minimum amount of calorie intake or a calorie amount within a specific range of calories. Another way that adherence was defined was the frequency of dietary self-monitoring, which included the frequency of dietary intake recording, interaction with apps, and the timing of recording. Some studies defined adherence in both ways. Most included studies lacked diversity in study samples. Until a consensus is reached, it may be prudent to study multiple indicators of adherence to dietary self-monitoring using apps, and their respective relationships with weight loss. Studies are needed that address the type and degree of adherence to dietary self-monitoring with an app that is associated with weight loss in diverse populations.