Adherence to self-monitoring and behavioral goals is associated with improved weight loss in an mHealth randomized-controlled trial.

Abstract

The SMARTER mobile health (mHealth) weight-loss trial compared adherence to self-monitoring (SM) of diet, physical activity (PA), and weight and adherence to study-prescribed diet and PA goals between SM + feedback (SM + FB) and SM-only arms over 12 months. Participants used digital tools to monitor their dietary intake, PA, and weight. We applied generalized linear mixed modeling to compare patterns of monthly adherence to SM and behavioral goals between groups over time and examine the association of adherence to SM and behavioral goals with ≥5% weight loss. The sample (N = 502) was 80% female and 82% White, with a mean (SD) BMI of 33.7 (4.0) kg/m². Adherence to SM and fat, calorie, and PA goals declined nonlinearly over time, with the SM + FB group displaying less of a decline compared with the SM-only group. Higher adherence to diet, PA, and weight SM and to calorie and PA goals was associated with greater odds of achieving ≥5% weight loss. A higher monthly probability of achieving ≥5% weight loss was associated with greater adherence to diet, PA, and weight SM and to calorie and PA goals. These results suggest that future research should examine the mechanisms underlying tailored FB to improve the effect of FB intervention strategies that can lead to improved weight loss.