Main content area

Dietary self-monitoring through calorie tracking but not digital photography app is associated with significant weight loss: The 2SMART pilot study, a six-month randomized trial

Dunn, Caroline Glagola, Turner-McGrievy, Gabrielle M., Wilcox, Sara, Hutto, Brent
Journal of the Academy of Nutrition and Dietetics 2019
adults, beverages, body mass index, diet, digital images, models, overweight, weight loss
Dietary self-monitoring (DSM) of foods and beverages is associated with weight loss in behavioral interventions; however, DSM may be burdensome, and adherence may decrease over time. Novel methods of DSM, including apps that track food using photos, may decrease burden, increase DSM adherence, and improve weight loss.The objective was to test a mobile photo DSM app compared to a calorie-tracking DSM app on tracking frequency and weight loss in a remotely delivered behavioral weight loss intervention.This was a six-month (October 2016-April 2017) randomized trial.Participants were adults (n=41) classified as overweight or obese (BMI 25-49.9 kg/m2) from South Carolina.Participants received remotely delivered twice-weekly behavioral weight loss podcasts and tracked diet using a calorie-tracking DSM app (Calorie) or a photo DSM app (Photo).Main outcomes were the number of days diet was tracked, podcasts downloaded, and weight change at six weeks and six months.Researchers used non-parametric Wilcoxon Rank Sum tests and χ2 analysis to test for differences between groups at baseline; repeated-measures models to estimate weight change and Spearman’s correlations to determine relationships between DSM frequency, podcasts downloaded, and weight change at six months.There were no differences between groups for the number of days that diet was recorded (P=0.18), which was low overall (<30% of days) but was statistically significantly and strongly correlated with weight change for all participants pooled (r= 0.63, P<0.001) and for the calorie tracking group (r=0.70, P=0.004), but not the photo tracking group (r=0.51, P=0.06). Participants in both groups had significant weight loss at six months (Photo, -2.5±0.9kg, P=0.008; Calorie -2.4±0.9kg, P=0.007), with no differences between groups at either six weeks (P=0.66) or at six months (P=0.74).As part of a remotely delivered weight loss intervention, frequency of DSM was significantly associated with overall weight loss for participants using a calorie DSM app but not a photo DSM app. DSM was low regardless of group and weight loss was significant though minimal. Increasing user engagement with any DSM may be important to increase self-monitoring and improve weight loss.