Daily self-weighing compared with an active control causes greater negative affective lability in emerging adult women: A randomized trial

Age-related weight gain prevention may reduce population overweight/obesity. Emerging adulthood is a crucial time to act, as rate of gain accelerates and health habits develop. Evidence supports self-weighing (SW) for preventing weight gain; however, how SW impacts psychological states and behaviors in vulnerable groups is unclear. This study assessed daily SW effects on affective lability, stress, weight-related stress, body satisfaction, and weight-control behaviors. Sixty-nine university females (aged 18-22) were randomized to daily SW or temperature-taking (TT) control. Over 2 weeks, participants completed five daily ecological momentary assessments with their intervention behavior. A graph of their data with a trendline was emailed daily, with no other intervention components. Multilevel mixed models with random effect for day assessed variability in positive/negative affect. Generalized linear mixed models assessed outcomes pre- and post-SW or TT and generalized estimating equations assessed weight-control behaviors. Negative affective lability was significantly greater for SW versus TT. While general stress did not differ between groups, weight-related stress was significantly higher and body satisfaction was significantly lower post-behavior for SW but not TT. Groups did not significantly differ in the number or probability of weight-control behaviors. Caution is advised when recommending self-weighing to prevent weight gain for emerging adults.

Self-Weighing Behaviors of Diverse Community-Dwelling Adults Motivated for a Lifestyle Change

We aimed to understand adults’ self-weighing behaviors and explore significant predictors of body mass index (BMI) accuracy based on self-reported height and weight in a diverse sample of community-dwelling adults. Methods: In this cross-sectional study, 531 adults participating in a physical activity program or a weight loss program were analyzed. Participants’ self-reported and objectively measured weight, height, weight scale ownership, self-weighing behaviors, and medical history were collected. Results: The mean age (standard deviation) was 50.0 (12.0) years with a range of 24 to 78 years. Out of 531 participants, 455 (85.7%) were women. The study population was diverse (58.9% non-White). In total, 409 (77.0%) participants had a weight scale at home, but only 222 (41.8%) weighed themselves at least once a week. The weight and BMI underestimation became much more significant as the participant’s weight increased (p ≤ 0.001). Employment status, high cholesterol, and low objectively measured weight were significant predictors of self-reported BMI accuracy after controlling for potential confounding factors (p < 0.05). Interestingly, ownership of a home weight scale and the frequency of self-weighing behavior were not significantly associated with the accuracy of self-reported BMI (p > 0.05). Conclusion: The accuracy of the participants’ BMI, based on self-reported height and weight, was significantly associated with employment status, high cholesterol, and low objectively measured weight, suggesting that BMI accuracy depends on multi factors.

A Pragmatic Intervention Using Financial Incentives for Pregnancy Weight Management: Feasibility Randomized Controlled Trial

BACKGROUND

Excessive gestational weight gain (GWG) is common and can result in maternal and child health complications. Pragmatic behavioral interventions that can be incorporated into standard obstetric care are needed, and financial incentives are a promising approach.

OBJECTIVE

The aim of this study is to evaluate the feasibility of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, in a behavioral program. The program provided small incentives for meeting behavioral goals of self-weighing and physical activity as well as larger outcome incentives for meeting GWG goals.

METHODS

We recruited 40 adult women in their first trimester of pregnancy from February 2019 to September 2019 at an obstetric clinic. Participants were randomized to 3 intervention components using a 2×2×2 factorial design: daily incentives for self-weighing (lottery vs certain loss), incentives for adhering to the Institute of Medicine's GWG guidelines based on BMI category (monthly vs overall), and incentives for reaching physical activity goals (yes vs no). Participants were asked to complete daily weigh-ins using the Withings Body wireless scale provided by the study, as well as wear a physical activity tracker (Fitbit Flex 2). Feasibility outcomes of recruitment, randomization, and retention, as well as treatment engagement and intervention satisfaction, were assessed. Weight assessments were conducted at baseline, 32-week gestation, and 36-week gestation.

RESULTS

Participants were enrolled at, on average, 9.6 (SD 1.8) weeks' gestation. Of the 39 participants who were oriented to their condition and received the intervention, 24 (62%) were Black or African American, 30 (77%) were not married, and 29 (74%) had an annual household income of less than US $50,000. Of the 39 participants, 35 (90%) completed the follow-up data collection visit. Participants were generally quite positive about the intervention components, with a particular emphasis on the helpfulness of, and the enjoyment of using, the e-scale in both the quantitative and qualitative feedback. Participants who received the loss incentive, on average, had 2.86 times as many days of self-weighing as those who received the lottery incentive. Participants had a relatively low level of activity, with no difference between those who received a physical activity incentive and those who did not.

CONCLUSIONS

A financial incentive-based pragmatic intervention was feasible and acceptable for pregnant women for promoting self-weighing, physical activity, and healthy GWG. Participants were successfully recruited early in their first trimester of pregnancy and retained for follow-up data collection in the third trimester. Participants demonstrated promising engagement in self-weighing, particularly with loss-based incentives, and reported finding the self-weighing especially helpful. This study supports further investigation of pragmatic, clinic-based financial incentive-based interventions for healthy GWG behaviors.

TRIAL REGISTRATION

ClinicalTrials.gov NCT03834194; https://clinicaltrials.gov/ct2/show/NCT03834194.

Affordability and features of home scales for self-weighing

Self-weighing is an evidence-based weight management strategy, which requires patients to have a home scale. For clinicians to effectively counsel patients on self-weighing, they should be aware of the costs and features available in typical home scales. Our objective was to describe the cost and features of the top bathroom scales available online. We performed content analysis of top 100 scales listed on a popular online retailer. Two coders independently extracted price and scale features (i.e., digital connectivity, body mass index [BMI] calculation, maximum weight accommodated). We used t-tests and ANOVA, as appropriate, to examine the relationships between price and features. Among the 97 scales included, mean scale price was $28.99 (SD $21.06; range $7.20-$139.95). Of the advanced features, 20.6% of scales had digital connectivity and 28.9% calculated BMI. Scales with advanced features cost significantly more than scales without (digital connectivity: $49.18 vs. $23.74, P < 0.001; BMI calculation: $42.92 vs. $23.33, P < 0.001). Most scales (76.2%) had a maximum weight of 351-400 lbs, and only 17.5% could accommodate >400 lbs. Price was higher for scales with a higher maximum weight (P = 0.002). No scale with maximum weight > 500 lbs had advanced features. Scales that have digital connectivity for telemedicine or can accommodate higher weights are less commonly available online and their costs may be prohibitive for some patients who need these features. Future research might consider testing whether insurance coverage for scales improves scale access and patient weight management outcomes.

Self-weighing behavior in individuals with binge-eating disorder

This study examined self-weighing behaviors and correlates in patients with BED. Hypotheses: (1) women would weigh more frequently than men, (2) > weekly weighers would have higher restraint scores than < weekly weighers, (3) the self-weighing-restraint relationship would be stronger in women, (4) self-weighing frequency would be inversely related to BMI, and (5) self-weighing frequency and depression would be independently but not interactively related to BMI. The EDE, administered by trained doctoral-level interviewers, assessed self-weighing and eating-disorder psychopathology in 423 treatment-seeking individuals meeting DSM-5 BED criteria. Self-weighing frequency (1) did not differ by gender (Wald = 1.3; p = .3). (2) > weekly weighers reported significantly higher restraint (2.0±1.2 versus 1.6±1.3; t(421) = 3.1, p = .02). (3) No significant gender*self-weighing interaction on restraint (p = .99). (4) Self-weighing is inversely correlated with BMI (rho = -0.20; p < .001). 5) Self-weighing nor depression, nor self-weighing*depression interaction predicted BMI (p = .51). These analyses lay the groundwork for further investigation of the role of self-weighing in BED treatment.

Frequency of Self-Weighing and Weight Change: Cohort Study With 10,000 Smart Scale Users

Background

Frequent self-weighing is associated with successful weight loss and weight maintenance during and after weight loss interventions. Less is known about self-weighing behaviors and associated weight change in free-living settings.

Objective

This study aimed to investigate the association between the frequency of self-weighing and changes in body weight in a large international cohort of smart scale users.

Methods

This was an observational cohort study with 10,000 randomly selected smart scale users who had used the scale for at least 1 year. Longitudinal weight measurement data were analyzed. The association between the frequency of self-weighing and weight change over the follow-up was investigated among normal weight, overweight, and obese users using Pearson’s correlation coefficient and linear models. The association between the frequency of self-weighing and temporal weight change was analyzed using linear mixed effects models.

Results

The eligible sample consisted of 9768 participants (6515/9768, 66.7% men; mean age 41.5 years; mean BMI 26.8 kg/m2). Of the participants, 4003 (4003/9768, 41.0%), 3748 (3748/9768, 38.4%), and 2017 (2017/9768, 20.6%) were normal weight, overweight, and obese, respectively. During the mean follow-up time of 1085 days, the mean weight change was –0.59 kg, and the mean percentage of days with a self-weigh was 39.98%, which equals 2.8 self-weighs per week. The percentage of self-weighing days correlated inversely with weight change, r=–0.111 (P<.001). Among normal weight, overweight, and obese individuals, the correlations were r=–0.100 (P<.001), r=–0.125 (P<.001), and r=–0.148 (P<.001), respectively. Of all participants, 72.5% (7085/9768) had at least one period of ≥30 days without weight measurements. During the break, weight increased, and weight gains were more pronounced among overweight and obese individuals: 0.58 kg in the normal weight group, 0.93 kg in the overweight group, and 1.37 kg in the obese group (P<.001).

Conclusions

Frequent self-weighing was associated with favorable weight loss outcomes also in an uncontrolled, free-living setting, regardless of specific weight loss interventions. The beneficial associations of regular self-weighing were more pronounced for overweight or obese individuals.

Relationships between patterns of weight-related self-monitoring and eating disorder symptomology among undergraduate and graduate students

OBJECTIVE

To characterize patterns of weight-related self-monitoring (WRSM) among US undergraduate and graduate students and examine associations between identified patterns of WRSM and eating disorder symptomology.

METHOD

Undergraduate and graduate students from 12 US colleges and universities (N = 10,010) reported the frequency with which they use WRSM, including self-weighing and dietary self-monitoring. Eating disorder symptomology was assessed using the Eating Disorder Examination Questionnaire. Gender-specific patterns of WRSM were identified using latent class analysis, and logistic regressions were used to identify differences in the odds of eating disorder symptomology across patterns of WRSM.

RESULTS

Among this sample, 32.7% weighed themselves regularly; 44.1% reported knowing the nutrition facts of the foods they ate; 33.6% reported knowing the caloric content of the foods they ate; and 12.8% counted the calories they ate. Among women, four patterns of WRSM were identified: "no WRSM," "all forms of WRSM," "knowing nutrition/calorie facts," and "self-weigh only." Compared with the "no WRSM" pattern, women in all other patterns experienced increased eating disorder symptomology. Among men, three patterns were identified: "no WRSM," "all forms of WRSM," and "knowing nutrition/calorie facts." Only men in the "all forms WRSM" pattern had increased eating disorder symptomatology compared with those in the "no WRSM" pattern.

DISCUSSION

In a large sample of undergraduate and graduate students, engaging in any WRSM was associated with increased eating disorder symptomology among women, particularly for those who engaged in all forms. Among men, engaging in all forms of WRSM was the only pattern associated with higher eating disorder symptomology.

Minority and low-income patients are less likely to have a scale for self-weighing in their home: A survey in primary care

Daily self-weighing is a weight management behaviour that requires a scale; however, scale ownership may be cost-prohibitive for some patients. Our objective was to understand the proportion of primary care patients with a scale at home, and factors associated with home scale access, to potentially inform future interventions that facilitate scale access. Cross sectional survey of 216 adult patients from three primary care clinics: mixed-income urban/suburban (n = 68); mixed-income urban (n = 70); low-income urban (n = 74). The dependent variable was presence of a home scale; bivariate associations were conducted with variables including demographics, insurance type, clinic setting and self-reported height/weight. Mean age was 53 years; 71% women; 71% racial minority; mean body mass index 32 kg/m2 . Overall, 56% had a home scale. Most (79%) white patients owned a scale, compared to 46% of racial minority patients (P < .01); 33% of low-income patients owned scale, compared to over 66% of patients at the clinics serving mixed-income populations (P < .01). Most low-income urban clinic patients do not own a home scale. Because self-weighing is an effective weight-management behaviour, clinicians could consider assessing scale access, and future research should assess the health impact of providing scales to patients with overweight/obesity who desire weight loss or maintenance.

Weighing on us all? Quantification and cultural responses to obesity in NHS Britain

How do cultures of self-quantification intersect with the modern state, particularly in relation to medical provision and health promotion? Here I explore the ways in which British practices and representations of body weight and weight management ignored or interacted with the National Health Service between 1948 and 2004. Through the lens of overweight, I examine health citizenship in the context of universal health provision funded from general taxation, and track attitudes toward "overweight" once its health implications and medical costs affected a public service as well as individual bodies and households. Looking at professional and popular discourses of overweight and obesity, I map the persistence of a highly individual culture of dietary and weight self-management in postwar Britain, and assess the degree to which it was challenged by a new measure of "obesity" - the body mass index - and by visions of an NHS burdened and even threatened by the increasing overweight of the citizens it was created to serve.

Frequency and Consistency of Self-Weighing to Promote Weight-Loss Maintenance

OBJECTIVE

This study aimed to investigate the roles of frequency and consistency of self-weighing in promoting weight-loss maintenance.

METHODS

Participants were 74 adults who completed a 3-month internet-based weight-loss program followed by a 9-month no-intervention maintenance period. Frequency of self-weighing was defined as the number of days that participants self-weighed during the maintenance period via a study-provided smart scale. Consistency was defined as the number of weeks that participants self-weighed at a certain frequency, with multiple minimum thresholds examined. Hierarchical regression analyses were used to assess associations among frequency, consistency, and weight change during the maintenance period.

RESULTS

Greater consistency was significantly associated with less weight regain when defined as the number of weeks that participants self-weighed on ≥6 d/wk or 7 d/wk (P values < 0.05). Contrary to hypotheses, frequency was not associated with weight change (P = 0.141), and there was not a significant interaction between frequency and consistency.

CONCLUSIONS

Results demonstrate that consistency of self-weighing may be more important than total frequency for preventing weight regain after the end of a weight-loss program. Further, results suggest that a high level of consistency (self-weighing for ≥6 d/wk or 7 d/wk) may be necessary to promote successful weight-loss maintenance.

Self-Weighing and Visual Feedback Facilitates Self-Directed Learning in Adults Who Are Overweight and Obese

OBJECTIVE

Understanding how and why self-weighing works for some individuals but not others in weight management is vital. This study investigated how self-weighing and tracking of weight using a Web site facilitated a self-directed learning process in overweight or obese adults interested in losing weight.

DESIGN

Semistructured interviews with study completers (n = 47) and voluntary withdrawals (n = 10) about their experience after 6 and 12 months of using the program or when they withdrew.

ANALYSIS

Qualitative, guided by self-directed learning theory.

RESULTS

Although both completers and those who withdrew engaged in self-directed learning, often exemplifying the same concepts (eg, instrumental learning), experiences described a positive sense of control over weight in completers and a lack of sense of control in those who withdrew.

CONCLUSIONS AND IMPLICATIONS

Overall, it seemed that frequent self-weighing and visual feedback of body weight over time facilitated a self-directed learning process in both completers and those who withdrew. This research provides a rich understanding of how adults use self-weighing to facilitate self-directed learning for weight loss. Future studies assessing how self-weighing and visual displays of weight facilitate a self-directed learning process in diverse populations and age groups are necessary to better understand how self-weighing works and for whom self-weighing is beneficial.

Effects of Self-Weighing During Weight Loss Treatment: A 6-Month Randomized Controlled Trial

Objective

To examine the effectiveness of self-weighing for weight loss in men for 6 months.

Methods

In the present study, 54 men, mean age of 40.1 ± 11.1 years, with overweight or obesity, were recruited and randomly assigned into two groups: control group (CG), without weight self-monitoring and intervention group (IG), with weight self-monitoring. Both groups received the same nutritional and educational advice and the establishment of a weight target to reach in the weight loss program. Subjects of IG also had individualized motivating content to improve self-management for 24 weeks. Anthropometric indices were measured at baseline and weekly for 24 weeks.

Results

When the group assigned after randomization was introduced in the analysis, its influence was significant in weight loss (F1.52 = 19.465, ± 2 = 0.272, p < 0.001) and in the decrease in body fat percentage (F1.52 = 8,306, ± 2 = 0.132, p < 0.01).

Conclusion

Study results indicate that self-weighing can help patients to lose additional weight. Our findings have implications in the emerging area of the behavioral approach of patients undergoing weight-loss treatment, as well as clinical care processes.

Clinical Trial Registration

www.ClinicalTrials.gov, identifier NCT04032249.

Effects of Intervention Characteristics on Willingness to Initiate a Weight Gain Prevention Program

PURPOSE

To determine characteristics of weight gain prevention programs that facilitate engagement.

DESIGN

Randomized factorial experiment (5 × 2).

SETTING

Recruited nationally online.

PARTICIPANTS

Adults aged 18 to 75 with body mass index ≥25 who decline a behavioral weight loss intervention (n = 498).

MEASURES

Participants were randomly presented with one of 10 possible descriptions of hypothetical, free weight gain prevention programs that were all low dose and technology-based but differed in regard to 5 behavior change targets (self-weighing only; diet only; physical activity only; combined diet, physical activity, and self-weighing; or choice between diet, physical activity, and self-weighing targets) crossed with 2 financial incentive conditions (presence or absence of incentives for self-monitoring). Participants reported willingness to join the programs, perceived program effectiveness, and reasons for declining enrollment.

ANALYSIS

Logistic regression and linear regression to test effects of program characteristics offered on willingness to initiate programs and programs' perceived effectiveness, respectively. Content analyses for open-ended text responses.

RESULTS

Participants offered the self-weighing-only programs were more willing to initiate than those offered the programs targeting all 3 behaviors combined (50% vs 36%; odds ratio [OR] = 1.79; 95% confidence interval [CI], 1.01-3.13). Participants offered the programs with financial incentives were more willing to initiate (50% vs 33%; OR = 2.08; 95% CI, 1.44-2.99) and anticipated greater intervention effectiveness (β = .34, P = .02) than those offered no financial incentives. Reasons for declining to initiate included specific program features, behavior targets, social aspects, and benefits.

CONCLUSION

Targeting self-weighing and providing financial incentives for self-monitoring may result in greater uptake of weight gain prevention programs.

STUDY PREREGISTRATION

https://osf.io/b9zfh, June 19, 2018.

Understanding Primary Care Patients' Self-weighing Habits: Cohort Analysis from the PaTH Clinical Data Research Network

BACKGROUND

Greater than 60% of adults have overweight or obesity. Self-weighing is an effective weight loss and weight maintenance tool. However, little is known about self-weighing habits among the primary care patient population. Our objective was to examine the frequency of patient-reported self-weighing, and to evaluate the associations of self-weighing with demographic characteristics and self-monitoring behaviors.

METHODS

We conducted an analysis of survey data collected as part of the PaTH Clinical Data Research Network, which recruited a cohort of 1,021 primary care patients at 4 academic medical centers. Patients of all body mass index (BMI) categories were included.

RESULTS

Response rate of 6-month survey was 727 (71%). The mean age was 56 years, and most were female (68%), White (78%), college graduates (66%), and employed/retired (85%). The mean BMI was 30.2 kg/m², 80% of participants had a BMI ≧ 25 kg/m². Of patients with BMI ≧ 25 kg/m², 35% of participants self-weighed weekly and 23% daily. Participants who reported self-weighing at least weekly were more likely to be older (59 vs 54 years, p < 0.01), married (p = 0.01), college graduates (p = 0.03), White (p < 0.01), and employed vs disabled/unemployed (p < 0.01). Patients who self-weighed daily had a lower BMI (29 kg/m² vs 31 kg/m², p = 0.04). Patients who tracked exercise or food intake were more likely to self-weigh daily (p < 0.01), as were patients wanting to lose or maintain weight (p < 0.01).

CONCLUSIONS

Despite its potential for primary and secondary obesity prevention, only 35% of primary care patients with overweight or obesity engage in self-weighing weekly and less than a quarter (23%) self-weigh daily. Socioeconomic status appears to be a factor influencing regular self-weighing in this population, potentially contributing to greater health disparities in obesity rates. Patients who self-weighed daily had a lower BMI, suggesting that it may play a role in primary prevention of obesity. More work is needed to explore self-weighing among patients.

Changes in the Perceptions of Self-weighing Across Time in a Behavioral Weight Loss Intervention

OBJECTIVE

Changes in beliefs about self-weighing were examined across time in a behavioral weight loss intervention.

METHODS

Active duty military personnel (n = 248) enrolled in a 12-month counselor-initiated or self-paced intervention based on the Look AHEAD (Action for Health in Diabetes) Intensive Lifestyle Intervention. Using an electronic scale, participants were asked to self-weigh daily. Self-weighing perceptions were compared from baseline to 4 months (weight loss phase), from 4 months to 12 months (weight maintenance phase), and from baseline to 12 months (full intervention), as well as across time by behavioral and demographic characteristics.

RESULTS

Overall, participants perceived self-weighing as more helpful and positive, less frustrating, and making them less self-conscious after the weight loss phase. After weight maintenance, individuals believed self-weighing was less helpful and positive, more frustrating and anxiety provoking, and making them more self-conscious. However, after the intervention, participants still viewed self-weighing as more helpful and positive and less frustrating than at baseline. Weight change, self-weighing behavior prior to the intervention, and intervention condition were associated with perception change. Controlling for these influencing factors, differences in gender, BMI, age, ethnicity, and race were observed in how beliefs changed across time.

CONCLUSIONS

Results suggest engaging in a weight loss intervention promoting daily self-weighing increases positive and decreases negative beliefs about self-weighing.

Access to a scale and self-weighing habits among public housing residents

Having access to a scale is essential for individuals to engage in self-weighing; however, few studies examine scale access, particularly among low-income individuals. Our objectives were to (i) determine how many public housing residents have access to a scale and (ii) describe their self-weighing habits. We conducted a cross-sectional survey of public housing residents in Baltimore, MD, from August 2014 to August 2015. Participants answered questions about their access to a scale ('yes'/'no') and daily self-weighing habits ('no scale/never or hardly ever' vs. 'some/about half/much of the time/always'). We used t-tests or chi-square tests to examine the association of scale access with respondent characteristics. Overall, 266 adults participated (48% response rate). Mean age was 45 years with 86% women, 95% black and 54% with obesity. Only 32% had access to a scale; however, 78% of those with this access reported engaging in some self-weighing. Residents who lacked access to a scale were younger (P = 0.03), and more likely to be unemployed/disabled (P = 0.01) or food insecure (P < 0.01). While few public housing residents have access to a scale, those who do report daily self-weighing with some regularity. Financial hardship may influence scale access in this population, as potential proxies of this status were associated with no scale access.

How Accurate are Recalls of Self-Weighing Frequency? Data from a 24-Month Randomized Trial

INTRODUCTION

Self-weighing is an important component of self-monitoring during weight loss. However, methods of measuring self-weighing frequency need to be validated. This analysis compared self-reported and objective weighing frequency.

METHODS

Data came from a 24-month randomized controlled trial. Participants received 12 months of a behavioral weight-loss program and were randomly assigned to (1) daily self-weighing, (2) weekly weighing, or (3) no weighing (excluded from analysis). Objective weighing frequency was measured by Wi-Fi enabled scales, and self-reported weighing frequency was assessed every 6 months by questionnaire. Objective weights were categorized to match the scale of the self-report measure.

RESULTS

At 12 months, there was 80.8% agreement between self-reported and objective weighing frequency (weighted kappa = 0.67; P < 0.001). At 24 months, agreement decreased to 48.5% (kappa = 0.27; P < 0.001). At both time points in which disagreements occurred, self-reported frequencies were generally greater than objectively assessed weighing. Both self-reported and objectively assessed weighing frequency was associated with weight loss at 12 and 24 months (P < 0.001).

CONCLUSIONS

Self-reported weighing frequency is modestly correlated with objective weighing frequency; however, both are associated with weight change over time. Objective assessment of weighing frequency should be used to avoid overestimating actual frequency.

Why Do People Act Like the Proverbial Ostrich? Investigating the Reasons That People Provide for Not Monitoring Their Goal Progress

Two studies examined peoples' reasons for not monitoring their progress toward their personal goals—a phenomenon that has been termed “the ostrich problem” (Webb et al., 2013). Study 1 used factor analysis to organize the reasons that people gave for not monitoring their goal progress, resulting in 10 factors. The most strongly endorsed reasons were: (a) that information on goal progress would demand a change in beliefs, or (b) undesired action; (c) that progress was poor, and (d) that thinking about and/or working on the goal was associated with negative emotions. Study 2 adopted a prospective design and investigated whether the reasons identified in Study 1 predicted: (a) the likelihood that participants would decline an opportunity to monitor their goal progress, and (b) the frequency with which participants monitored their goal progress. We found evidence that some of the most strongly endorsed reasons from Study 1 also predicted the avoidance of monitoring in Study 2; however, the belief that information about goal progress was likely to be inaccurate and not useful, and perceived control over goal attainment also reliably predicted the avoidance of monitoring in Study 2. Taken together, the findings explain why people do not monitor their goal progress and point to potential avenues for intervention.

Feasibility and Potential Benefits of a Self-Monitoring Enhanced Lifestyle Intervention to Prevent Excessive Gestational Weight Gain in Women Who Are Overweight or Obese

OBJECTIVE

To evaluate the feasibility and potential benefits of a self-monitoring enhanced lifestyle intervention to prevent excessive gestational weight gain in women who are overweight and obese.

DESIGN

A one-group, prospective design involving 8 weeks of healthy eating and physical activity and self-monitoring of weight, nutrition, and walking.

SETTING

Recruitment and enrollment in prenatal clinics and self-monitoring at home.

PARTICIPANTS

Women (N = 22) at 14 to 24 gestational weeks, with body mass indexes of 25 to 40 kg/m², without medical and psychiatric diseases that affected cognition or walking.

METHODS

Participants self-monitored weight and nutrition intake for the first 4 weeks and weight, nutrition intake, and walking in the second 4 weeks. Feasibility data were collected weekly (attrition, self-monitoring adherence, program safety, participant feedback) or at the end of Week 8 (satisfaction ratings). Potential benefits included weight, nutrition, and physical activity, measured at baseline (T1), the end of Week 4 (T2), or the end of Week 8 (T3).

RESULTS

Attrition rates were 27.3% by T2 and 40.9% by T3. Adherence to log return was 100%. No adverse effects were noted, but food craving was persistent, and stress levels were high. Program satisfaction was high. Trends for improved activity and reduced trans fat consumption were seen.

CONCLUSION

Our findings indicate that the intervention is worthy of further development and testing with a randomized controlled trial.

Overeat today, skip the scale tomorrow: An examination of caloric intake predicting nonadherence to daily self-weighing

OBJECTIVE

Daily self-weighing is an effective weight loss strategy. Little is known about "micro" factors influencing nonadherence to self-weighing (e.g., daily overeating). It was hypothesized that increased caloric intake on a given day would increase odds of not self-weighing the following day.

METHODS

Daily self-reports of weight and caloric intake were collected from 74 adults with overweight and obesity (mean BMI = 31.2 ± 4.5 kg/m² , age = 50.6 ± 10 years, 69% female, 87% Caucasian) throughout a 12-week Internet-based weight management intervention. Multilevel logistic regression investigated odds of nonadherence to self-weighing on a given day based on the previous day's caloric intake.

RESULTS

Self-monitoring adherence was high (weights: 87%; calories: 85%); adherence was associated with greater 12-week weight loss (weighing: r = -0.24, P = 0.04; calories: r = -0.26, P = 0.04). Increased caloric intake on a given day, relative to the individual's average intake, was associated with increased odds of nonadherence to self-weighing the next day (F_(1,5106)  = 12.66, P = 0.0004, β = 0.001). For example, following a day of eating 300 calories more than usual, odds of not self-weighing increased by 1.33.

CONCLUSIONS

Odds of nonadherence to self-weighing increased following a day with higher-than-usual caloric intake. Weight management interventions collecting daily self-monitoring data could provide support to participants who report increased caloric intake to prevent self-weighing nonadherence.

Self-weighing behavior in individuals with eating disorders

OBJECTIVE

To describe the frequency of self-weighing and reactions to prescribed weekly weighing among individuals with eating disorder (ED) diagnoses, and to compare individuals weighing more or less frequently on mass index (BMI) and the Eating Disorder Examination (EDE) subscales.

METHOD

Baseline EDE and demographics from five studies (N = 758).

RESULTS

Self-weighing was most frequent among individuals with anorexia nervosa (AN), followed by those with bulimia nervosa (BN) and binge eating disorder (BED). On average, participants reacted moderately negative to prescribed weekly weighing. No relationship between weighing frequency and BMI was evident in any sample. There was indication of greater pathology (i.e., restraint, shape concern, weight concern, global) in AN with more frequent weighing. In BN, mixed evidence emerged to support a relationship between more frequent weighing and higher shape concern, weight concern, and global score. In BED, higher restraint was found in those who weighed versus those who did not.

DISCUSSION

Weighing frequency in each eating disorder (ED) sample was to some extent associated with greater ED severity, but not BMI. Future research should examine relationships between self-weighing, reactions to changing weighing frequency, and ED symptomatology in both ED and non-ED groups to understand the impact of self-weighing in heterogeneous populations. © 2016 Wiley Periodicals, Inc. (Int J Eat Disord 2016; 49:817-821).

Design and focus group evaluation of a bed-integrated weight measurement system for wheelchair users

Regular weight monitoring is known to help with weight management, which is an important part of maintaining a healthy, active lifestyle. Unfortunately, weight monitoring is challenging for wheelchair users because the few scales that are available are expensive and very large. Consequently, wheelchair users typically learn their weight at infrequent visits to their healthcare providers, which likely contributes to higher prevalence of obesity-related health risks among this population. In this article, we describe the design and development of the Embedded Scale, or E-Scale, which is a bed-integrated bodyweight measuring system that allows a user to measure and track their weight. The E-Scale team followed a standard product development approach to build the E-Scale prototype. Bench testing results indicate that the performance of the prototype is on par with commercially available wheelchair scales (capacity = 1,200 lbs, accuracy = 1.73 lbs, and precision = ± 0.35 lbs over one-fourth rated capacity). Institutional Review Board (IRB)-approved focus groups with 20 Veterans who use wheelchairs for mobility were conducted to gather feedback about the design, which was very positive. Development and testing results suggests the E-Scale technology is feasible and may provide a valuable tool to help wheelchair users manage their weight.

Experiences of Daily Weighing Among Successful Weight Loss Individuals During a 12-Month Weight Loss Study

The purpose of the study was to describe participants' experience of daily weighing and to explore factors influencing adherence to daily weighing among individuals who were successful in losing weight during a behavioral weight loss intervention. Participants completed a 12-month weight loss intervention study that included daily self-weighing using a Wi-Fi scale. Individuals were eligible to participate regardless of their frequency of self-weighing. The sample ( N = 30) was predominantly female (83.3%) and White (83.3%) with a mean age of 52.9 ± 8.0 years and mean body mass index of 33.8 ± 4.7 kg/m². Five main themes emerged: reasons for daily weighing (e.g., feel motivated, being in control), reasons for not weighing daily (e.g., interruption of routine), factors that facilitated weighing, recommendations for others about daily weighing, and suggestions for future weight loss programs. Our results identified several positive aspects to daily self-weighing, which can be used to promote adherence to this important weight loss strategy.

Self-Weighing Throughout Adolescence and Young Adulthood: Implications for Well-Being

OBJECTIVE

To describe the prevalence of self-weighing in the transition period from adolescence to young adulthood and examine cross-sectional and longitudinal associations between self-weighing and weight status, psychological, and behavioral outcomes.

DESIGN

Project Eating and Activity in Teens and Young Adults, a longitudinal cohort study that assessed variables 3 times over 10 years.

PARTICIPANTS

A total of 1,868 adolescents and young adults.

MAIN OUTCOME MEASURES

Weight, body mass index, weight disparity, body satisfaction, weight concern, self-esteem, depression, and unhealthy weight control behaviors.

ANALYSIS

Cross-sectional and longitudinal.

RESULTS

Significant positive correlations were found at each time point between self-weighing and weight concern for both genders. Self-weighing was significantly inversely related to self-esteem at each time point in female participants. Increases in endorsement of self-weighing were significantly related to decreases in body satisfaction and self-esteem and increases in weight concern and depression in female participants and to increases in weight concern in male participants.

CONCLUSIONS AND IMPLICATIONS

Findings suggest that self-weighing may not be an innocuous behavior for young people, particularly women. Interventions should assess potential harmful consequences of self-weighing in addition to any potential benefits. It may be appropriate for clinicians to ask about self-weighing, and if it is frequent, to explore motivations, perceived benefits, and potential adverse correlates or consequences.

Frequent self-weighing as part of a constellation of healthy weight control practices in young adults

OBJECTIVE

Frequent self-weighing is linked with weight management success, but concern has been raised about its possible association with unhealthy practices. This study examined the association of self-weighing with other weight control behaviors in a sample for whom frequent weighing might be questioned--namely, normal-weight or overweight (BMI of 21-29.9) young adults (age 18-35).

METHODS

Participants (N = 583; mean [SD] age = 27.7 [4.4]; BMI = 25.4 [2.6]) entering the Study of Novel Approaches to Weight Gain Prevention (SNAP) completed objective measures of weight and physical activity and self-reported weight history, use of healthy and unhealthy weight control strategies, depressive symptoms, and dietary intake.

RESULTS

Daily self-weighing was reported by 11% of participants, and 23% weighed several times per week. Frequent weighing was not associated with current BMI, gender, or age but was associated with being further below one's highest weight, history of dieting, and perceived difficulty maintaining weight. Frequent weighing was associated with healthy weight management strategies, but not with unhealthy practices or depressive symptoms.

CONCLUSIONS

In this sample, frequent self-weighing appears to be part of a constellation of healthy weight control behaviors used to counteract a perceived tendency toward weight gain. SNAP follow-up will determine whether frequent self-weighing helps prevent weight gain.

Weighing frequency among working adults: cross-sectional analysis of two community samples

OBJECTIVE

Self-weighing frequency is associated with lower body weight and less weight gain. This study describes self-weighing frequency in two samples of working adults from different fields: office-based and transit employees.

METHODS

Self-weighing frequency and demographic information were self-reported at baseline measurement of two worksite interventions. Data were collected from transit employees (n= 1479) enrolled in a worksite intervention between October and December of 2005 and office based employees (n=1747) in another worksite intervention between January 2006 and April 2007 in the Minneapolis, MN and St. Paul, MN metropolitan area. Trained staff measured height and weight. Multinomial logistic regression models examined associations between self-weighing frequency and body mass index, study sample, and gender adjusting for age, race, and education.

RESULTS

Odds ratios showed self-weighing frequency was significantly different between overweight and obese categories and between study samples. Office-based employees self-weighed more frequently than transit employees. Overweight employees self-weighed more frequently than obese employees.

CONCLUSION

While self-weighing outcomes and associations with obesity prevention and weight loss are still under investigation, these results may help in improving obesity intervention planning and informing worksite weight management programs by identifying how often working adults naturally engage in this behavior prior to weight loss interventions.

Daily Self-Weighing to Control Body Weight in Adults: A Critical Review of the Literature

The objective of this study is to review the history of daily self-weighing for weight control, discuss the possibility that self-weighing may cause adverse psychological symptoms, and propose mechanisms that explain how self-weighing facilitates weight control. A systematic forward (citation) tracking approach has been employed in this study. In the early literature, experimental tests did not demonstrate a benefit of adding daily self-weighing to traditional behavioral modification for weight loss. More recent studies have shown that daily self-weighing combined with personalized electronic feedback can produce and sustain weight loss with and without a traditional weight loss program. Daily self-weighing appears to be effective in preventing age-related weight gain. Apart from these experimental findings, there is considerable agreement that the frequency of self-weighing correlates with success in losing weight and sustaining the weight loss. The early literature suggested frequent self-weighing may be associated with negative psychological effects. However, more recent experimental trials do not substantiate such a causal relationship. In conclusion, daily self-weighing may be a useful strategy for certain adults to prevent weight gain, lose weight, or prevent weight regain after loss. More research is needed to better understand the role of different types of feedback, who benefits most from self-weighing, and at what frequency.

Regular self-weighing to promote weight maintenance after intentional weight loss: a quasi-randomized controlled trial

BACKGROUND

Many overweight people take action to lose weight but most regain this weight.

PURPOSE

To examine the effectiveness of a weight maintenance intervention focused on regular self-weighing after receiving a 12-week weight loss programme.

METHODS

Quasi-randomized controlled trial of 3768 obese or overweight men and women. The intervention group (n = 3290) received two telephone calls, the offer of free weighing scales, encouragement to weigh themselves weekly and record this on a card. The main outcome was change in weight between 3 and 12 months.

RESULTS

Using intention to treat analysis both groups regained weight; however, the intervention group on average regained 1.23 kg, whereas the control group regained 1.83 kg. Adjusting for covariates resulted in a mean difference of 0.68 kg (95% CI 0.12, 1.24) at 12-month follow-up.

CONCLUSIONS

Encouraging people who have recently lost weight to weigh themselves regularly prevents some weight regain.

Prevalence of adolescents' self-weighing behaviors and associations with weight-related behaviors and psychological well-being

PURPOSE

To examine the relationships between self-weighing frequency, and weight-related behaviors and psychological well-being in a population-based sample of adolescents.

METHODS

This study compared weight-related behaviors between infrequent and frequent self-weighers, stratified by weight status and gender. Data were from Project EAT 2010 (Eating and Activity in Teens), a population-based study of 2,778 adolescents.

RESULTS

Approximately 14% of girls and boys weighed themselves frequently (weekly or more). In comparison to girls who were infrequent self-weighers, girls who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and have lower self-esteem and greater body dissatisfaction. In comparison to boys who were infrequent self-weighers, boys who were frequent self-weighers were more likely to diet, engage in unhealthy and extreme weight control behaviors, use unhealthy muscle-enhancing behaviors, and report greater depressive symptoms. Among overweight adolescents, in addition to being associated with these harmful outcomes, frequent self-weighing was associated with the use of healthy weight control behaviors and with higher levels of moderate-to-vigorous activity.

CONCLUSIONS

Findings indicate that adolescents who frequently self-weigh themselves are at increased risk for a number of problematic health behaviors and poorer psychological outcomes. For overweight adolescents, frequent self-weighing was additionally associated with a number of positive outcomes. Based upon these findings, any recommendations for weight monitoring should be made cautiously; all adolescents, including overweight adolescents, should be advised not to engage in frequent self-weighing behaviors. Furthermore, any adolescents engaging in frequent self-weighing behaviors should be monitored for problematic outcomes.

Self-weighing behaviors in young adults: tipping the scale toward unhealthy eating behaviors?

PURPOSE

This study examined associations between frequency of self-weighing and healthy weight-control behaviors (WCBs), unhealthy WCBs, muscle-enhancing behaviors (e.g., steroid use, protein powders), and psychological well-being (i.e., self-esteem, depression, body satisfaction) in a community sample of young adults.

METHODS

Data were drawn from Project EAT-III (Eating and Activity in Teens and Young Adults), the third wave of a population-based study. Participants included young adults (n = 2,287, mean age = 25.3 years) from the Minneapolis/St. Paul metropolitan area.

RESULTS

Self-weighing a few times per week or more frequently was reported by 18% of young adult women and 12% of young adult men. Linear regression models, adjusted for body mass index and demographic characteristics, indicated that in both women and men, more frequent self-weighing was associated with a higher prevalence of dieting, both healthy and unhealthy WCBs, and muscle-enhancing behaviors. Additionally, young women who reported more frequent self-weighing were more likely to report binge eating. More frequent self-weighing was also associated with more depressive symptoms and lower self-esteem in women and lower body satisfaction in young men.

CONCLUSIONS

More frequent self-weighing is associated with healthy and unhealthy weight-control practices, muscle-enhancing behaviors, and poorer psychological well-being in young adults. Young adults engaging in self-weighing behaviors should be screened for these health indicators and counseled as appropriate. Before recommending self-weighing as a weight-monitoring tool, health care providers should ensure that young adults are not at risk for an unhealthy preoccupation with body weight or shape.

Self-monitoring in weight loss: a systematic review of the literature

Self-monitoring is the centerpiece of behavioral weight loss intervention programs. This article presents a systematic review of the literature on three components of self-monitoring in behavioral weight loss studies: diet, exercise, and self-weighing. This review included articles that were published between 1993 and 2009 that reported on the relationship between weight loss and these self-monitoring strategies. Of the 22 studies identified, 15 focused on dietary self-monitoring, one on self-monitoring exercise, and six on self-weighing. A wide array of methods was used to perform self-monitoring; the paper diary was used most often. Adherence to self-monitoring was reported most frequently as the number of diaries completed or the frequency of log-ins or reported weights. The use of technology, which included the Internet, personal digital assistants, and electronic digital scales were reported in five studies. Descriptive designs were used in the earlier studies whereas more recent reports involved prospective studies and randomized trials that examined the effect of self-monitoring on weight loss. A significant association between self-monitoring and weight loss was consistently found; however, the level of evidence was weak because of methodologic limitations. The most significant limitations of the reviewed studies were the homogenous samples and reliance on self-report. In all but two studies, the samples were predominantly white and women. This review highlights the need for studies in more diverse populations, for objective measures of adherence to self-monitoring, and for studies that establish the required dose of self-monitoring for successful outcomes.