This study identified distinguishable characteristics by diet-related self-monitoring behaviors at the end of a year-long study and supports our hypothesis that key characteristics distinguish adopters and non-adopters of self monitoring behaviors. In this study, differences were observed by education status, race/ethnicity, and by binge eating score in some self-monitoring behaviors.
Few studies have reported on the demographic characteristics of individuals who frequently self weigh. Linde et al. found that older, non-Hispanic White adults were more likely to report frequent (weekly vs. < weekly) self-weighing at baseline in a weight loss trial; similar findings were observed by Butryn et al in their cohort study. Neither found an association of education with self-weighing behavior as observed in our study. The sample in this current study was limited to postmenopausal women, which likely diminished the role of age as a differentiating characteristic. Furthermore, compared to the aforementioned studies, this study assessed self-weighing at 12-months, rather than at baseline, which could have also contributed the difference in findings. Our findings suggest that lower education is not a barrier to daily self-weighing, and that more educated women may be more inclined to follow minimum recommendations (ie. “at least weekly”) when instructed in this manner.
In randomized controlled trials, dietary self monitoring (e.g. use of food journals and counting calories) tend to be good predictors of greater weight loss, particularly when individuals adhere to these behaviors early on in the intervention. Therefore, improving our recognition of baseline characteristics associated with greater adoption of these behaviors might help in our efforts to promote these behaviors in groups that experience greater difficulty with adherence to these behaviors. In this present study, non-White or Hispanic women were less likely to count calories and submit food journals compared to non-Hispanic Whites. This finding should be interpreted with caution since there were too few of non-White or Hispanic participants to be able to test associations within specific race/ethnic groups. However, the findings from the Weight-Loss Maintenance trial (N=1685; 44% African-American) found that the use of food records by African Americans was significantly less than their non-African American counterparts in the initial 6-month weight loss period and generally, minority groups, particularly Black women, generally lose less weight than non-Hispanic Whites in behavioral weight loss interventions. Nevertheless, future studies are needed to confirm these findings in African-Americans as well as other racial/ethnic groups.
Previous research has identified binge eating as a potential barrier to weight-loss success. In this sample, women who had higher baseline binge eating scores were less likely to count calories, suggesting that women with high scores in binge eating might have difficulty in counting calories. These findings differed from Smith et al. who reported a positive association between calorie-counting and overeating in a cross-sectional observational study. However, it is important to note that their study population consisted of both men and women and only 18% of their population was attempting to lose weight. In addition, binge eating in this study was assessed with the shortened version of the binge eating scale, whereas Smith et al based their assessment of overeating with the disinhibition scale from the original 51-item TFEQ.
In this current study, no significant differences were detected in baseline scores for restrained, uncontrolled and emotional eating by self-weighing or dietary self-monitoring behaviors (i.e. calorie counting and food journals). In the National Weight Loss Registry cohort, individuals who decreased their self-weighing frequency over one year had lower levels of cognitive restraint and higher levels of disinhibition. While this current study did not assess change in eating behaviors over time, the difference in findings might also be attributed the use of different measures to assess eating behaviors. The National Weight Loss Registry study assessed disinhibition and cognitive restraint with the original TFEQ; however, in this current study, the TFEQ-R18 was used. The use of this measure is appropriate since it has been validated in obese adults; however, the difference in measures limits the ability to make comparisons across studies.
There are several limitations to our study. While the submitted food journals were objectively assessed, self weighing and calorie counting were assessed by self-report. There is the potential that bias such as social desirability could impact a participant’s response such that behaviors promoted in the intervention might be over-reported, while the inverse would occur for behaviors that were discouraged. A single-item measure to assess self-weighing and calorie counting is also a limitation; therefore, more frequent assessments (e.g. weekly) and/or objective measures would improve assessment of these behaviors in future studies. Also, our small sample size and predominantly non-Hispanic White population limited our ability to fully examine differences by race or ethnicity and also limits the generalizability of these findings to other populations.
In summary, this study suggests that individuals who adopt self-monitoring behaviors may vary by baseline demographic characteristics such as educational status, race/ethnicity and binge eating score. Future studies are needed to confirm the findings in this study, particularly in various race/ethnic groups. Improved recognition of groups less likely to self monitor may be helpful in promoting these behaviors in future interventions.