Adding wearable technology to a behavioral program resulted in less weight loss than adding Web-based self-monitoring

Question In young adults with body mass index (BMI) 25.0 to <40.0 kg/m2, does adding wearable technology to a behavioral intervention improve weight loss? Methods Design Randomized controlled trial (Innovative Approaches to Diet, Exercise and Activity [IDEA] trial). ClinicalTrials.gov NCT01131871. Allocation Unclear allocation concealment. * Blinding Unblinded. * Follow-up period 2 years. Setting University of Pittsburgh, Pittsburgh, Pennsylvania, USA. Participants 471 volunteers for a free weight reduction program, 18 to 35 years of age (median age 31 y, 71% women) who had BMI 25.0 to <40.0 kg/m2, access to a cellular telephone to receive text messages, and a computer with Internet access. Exclusion criteria included 5% weight loss in the past 3 months, current participation in a weight loss program, weight loss surgery, use of prescription weight loss medication, or treatment for hypertension. Intervention All participants were prescribed weight-based calorie intake and physical activity. For the first 6 months, all participants received a group-based behavioral weight loss intervention and tracked diet and activity daily using diaries. At 6 months, telephone counseling sessions, text messages, and access to study materials on a Web site were added to both groups, which continued their behavioral weight loss programs. Also at this time, participants were randomly allocated to receive a commercially available wearable technology device (FIT Core; BodyMedia) for automatically tracking energy expenditure, with a Web-based interface that also provided for self-reporting dietary intake (n =237), or to Web-based, daily, self-entered, diet and exercise reporting (n =234). Study staff had access to the recorded data for both groups. Outcomes Primary outcome was weight loss over 2 years. Patient follow-up 75% at 2 years (79% excluding pregnant women). Main results Weight changed over time in both groups, but weight loss was less at 2 years in the FIT Core group (with automated exercise recording and Web-based self-recording of diet) than the Web-based self-reporting group (Table). Groups did not differ for exercise or self-reported daily calorie intake. Conclusion In young adults with body mass index 25.0 to <40.0 kg/m2 participating in a behavioral weight loss program, adding wearable technology to monitor exercise and Web-based self-reported diet resulted in less weight loss at 2 years than adding Web-based daily self-monitoring of both exercise and diet. FIT Core device vs Web-based self-monitoring added to a behavioral weight loss program Outcome Mean change from baseline At 2 y FIT Core for recording activity and Web-based self- reporting of diet Web-based self- monitoring of both activity and diet Mean difference (95% CI) P value Weight 3.5 kg 5.9 kg 2.4 kg (3.7 to 1.0) 0.003 CI defined in Glossary. Commentary Self-monitoringrecording one's behavioris perhaps the most important behavioral component of behavioral treatment (1). This is enhanced by feedback from an interventionist (2). In the trial by Jakicic and colleagues, why did participants lose less weight with the wearable activity tracker than with the Web-based self-monitoring? An activity tracker helps people to monitor their behavior. The trial was not a study comparing an activity tracker with no self-monitoring. Rather, it compared 2 different methods of self-monitoring. All participants recorded their dietary intake and activity daily and received weekly feedback for the first 6 months of the study. For the next 18 months, all participants were in contact with staff once per month, but the frequency of feedback to either group was not reported. Adherence to self-monitoring in the standard group was also not reported, and adherence in the wearable technology group was not good. Participants used the tracker for a median 170 days (less than one third of the time); 25% (47/191) tracked their diet, and 29% (55/191) tracked their activity 3 d/wk. The Web-based group may have lost more weight as a result of better self-monitoring and/or more frequent feedback. The wearable technology group reported an intake of 170 fewer calories per day at 18 and 24 months, yet this group lost less weight. Thus, this particular wearable technology may have given participants a false sense of reassurance about the number of calories they were consuming. For many persons (77% in this trial), wearable technology is easier than daily written self-monitoring of activity. It is not necessary to show that wearable technology is superior or even equal to intensive self-monitoring. However, this trial points out that promotors of wearable technology must show that their products will be used (it is unlikely that any product worn just one third of the time is going to work) for enough self-monitoring to lead to significant weight loss. Frequent feedback from a third party may be necessary for wearable technology to be effective.