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Self-monitoring (of weight, intake, and activity) is a core component in evidence-based lifestyle interventions for obesity. Research has shown that interventionist feedback increases adherence to self-monitoring and improves weight loss outcomes; however, little empirical evidence exists on how this feedback should be provided. This research study aims to optimize the provision of self-monitoring feedback.
Self-monitoring (e.g., of weight, dietary intake, and physical activity) is a core component in evidence-based comprehensive lifestyle interventions for obesity, and greater adherence to self-monitoring has been associated both with better short-term weight loss and long-term weight loss maintenance. Importantly, research has demonstrated that the provision of interventionist feedback on self-monitoring increases adherence to self-monitoring and improves weight loss outcomes. Little empirical evidence exists, however, to provide guidance on how this feedback should be provided. One study conducted in this area demonstrated that intentions to self-monitor differ by feedback complexity, such that too little (and, conversely, too much) feedback reduces future intentions to self-monitor and engage in related health behavior change; however, less is known regarding how the type and complexity of feedback messages affect actual self-monitoring behavior and subsequent weight loss outcomes. Importantly, provision of this feedback also represents a substantial investment of clinician time; research demonstrated that feedback messages incorporating self-monitoring data related to weight, dietary intake, and physical activity can take ~26 minutes per person to compose. Thus, the investigators propose a line of research that aims to optimize the provision of self-monitoring feedback (i.e., identifying the optimal number and type of feedback messages) for supporting adherence to weight-management behaviors. For the current study, the investigators propose to assess the feasibility and acceptability of a micro-randomized, factorial trial design that will ultimately be used (in a future, fully-powered trial) evaluate the proximal impact of different types and amount of feedback on change in weight and weight-related behaviors (e.g., adherence to self-monitoring, caloric goal attainment, physical activity goal attainment). Using a 2x2x2x2 factorial model, participants will be randomized each week for 16 weeks to one of 16 possible feedback conditions, allowing us to efficiently test four feedback components (i.e., feedback on calorie goal attainment, dietary quality, physical activity goal attainment, or on goal setting) in one study.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Component 1: Calorie Goal Attainment | Experimental | Participants will be randomized to either receive or not receive feedback based on calorie goal attainment. |
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| Component 2: Diet Quality | Experimental | Participants will be randomized to either receive or not receive feedback based on diet quality. |
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| Component 3: Physical Activity Goal Attainment | Experimental | Participants will be randomized to either receive or not receive feedback based on physical activity goal attainment. |
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| Component 4: Goal Setting | Experimental | Participants will be randomized to either receive or not receive feedback based on weekly goal setting. |
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| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Component 1: Calorie Goal Attainment | Behavioral | On weeks that participants are randomized to receive this component, they will be provided with feedback on the number of days that they met their calorie goal. |
| Measure | Description | Time Frame |
|---|---|---|
| Weight | Weight will be assessed using the study-provided e-scales | Daily throughout the study period (up to 17 weeks) |
| Measure | Description | Time Frame |
|---|---|---|
| Frequency of Self-Monitoring Weight | Frequency of self-monitoring of weight will be defined as the number of days (0-7) each study week that a participant had a valid (e.g., non-outlier) weight recorded via the study-provided e-scale. | Weekly throughout the study period (up to 17 weeks) |
| Frequency of Self-Monitoring Dietary Intake |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Kathryn M Ross, PhD, MPH | University of Florida | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| University of Florida | Gainesville | Florida | 32610 | United States |
De-identified data will be shared upon request following the establishment of an appropriate data use agreement.
The proposed study is a pilot for a larger trial; we will share data from the pilot within one year of completion of the larger trial.
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| ID | Term |
|---|---|
| D009765 | Obesity |
| D015431 | Weight Loss |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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Micro-randomized 2x2x2x2 factorial model; participants randomized to receive or not receive one of 4 feedback conditions each week for 16 weeks
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| Component 2: Diet Quality | Behavioral | On weeks that participants are randomized to receive this component, they will receive three comments regarding specific dietary choices that may impact weight loss success, including reinforcing comments for behaviors consistent with weight loss and potential areas for change. |
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| Component 3: Physical Activity Goal Attainment | Behavioral | On weeks that participants are randomized to receive this component, they will receive feedback related to attainment of that week's physical activity goal. |
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| Component 4: Goal Setting | Behavioral | On weeks that participants are randomized to receive the goal setting component, they will be asked to complete an open-text prompt encouraging them to set a specific weight-related behavior change goal for the next week. |
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A valid "day" of self-monitoring dietary intake will be defined as ≥ 800 kcal recorded via the Fitbit app or website, consistent with prior research. For each study week, frequency of self-monitoring dietary intake will be defined as the number of valid days (0-7) recorded. |
| Weekly throughout the study period (up to 17 weeks) |
| Total Caloric Intake | For each study week, total caloric intake will be calculated by summing calories recorded via the Fitbit app or website each day of that week between 12:00 AM and 11:59 PM local time. | Weekly throughout the study period (up to 17 weeks) |
| Calorie Goal Attainment | Calorie goal attainment each day of the week will be calculated as [TOTAL KCAL INTAKE FOR THE DAY] - [CALORIE GOAL], using calorie data recorded via the Fitbit app or website. Difference scores for the 7 days will be averaged over the week to assess overall adherence to the caloric intake goal during each study week. | Weekly throughout the study period (up to 17 weeks) |
| Frequency of Self-Monitoring Physical Activity | Consistent with the broader accelerometry literature, a "valid day" of self-monitoring physical activity will be defined as a day with ≥10 hours of Fitbit wear time, assessed as minutes of non-zero heart rate measurements captured by the Fitbit device. For each study week, frequency of self-monitoring physical activity will be defined as the number of "valid" days (0-7) of Fitbit use. | Weekly throughout the study period (up to 17 weeks) |
| Physical Activity Minutes | For each study week, total minutes of physical activity will be calculated by summing the total "active zone minutes" recorded via a Fitbit activity monitor for each day of the week. | Weekly throughout the study period (up to 17 weeks) |
| Physical Activity Goal Attainment | For each study week, physical activity goal attainment will be calculated as [TOTAL PHYSICAL ACTIVITY MINUTES] - [PHYSICAL ACTIVITY GOAL], with physical activity minutes recorded via a Fitbit activity monitor. | Weekly throughout the study period (up to 17 weeks) |
| Feedback Message Acceptability | Participants will be asked to rate the helpfulness of feedback messages received each week by selecting a "thumbs up" or "thumbs down" button displayed beneath the message. | Weekly throughout the study period (up to 17 weeks) |
| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D001836 | Body Weight Changes |