Abstract 1174: Self-monitoring Influences Diet Quality Among Obese Adults in a Weight Loss Trial
Self-monitoring, the cornerstone of behavioral treatment for weight management, has traditionally been done using paper diaries (PD), which can be tedious and burdensome. A personal digital assistant (PDA) with a food and exercise database may provide an alternative to a PD, reducing the burden of self-monitoring. We hypothesized that use of the PDA would improve the quality of dietary intake compared to the PD. Here we describe the differences in changes in dietary intake between PD and PDA groups at 6 months during a 24-month behavioral intervention that emphasized restricting calories and replacing total fat intake, especially saturated fatty acids, with increased intake of fruit, vegetables and whole grain products. Data were obtained from the SMART Trial, a randomized clinical trial that compared the effect of using a PD vs. a PDA for self-monitoring on weight loss. Dietary intake was measured with two 24-hour recalls guided by the Nutrition Data System for Research program and food group serving counts were used. The sample (N=191) had a mean BMI of 34.1±4.5 kg/m2 and was predominantly female (84%) and White (78%) with a median age of 49 years. At baseline, the groups did not differ in energy (kcal), % calories from fat and the number of servings of the examined food groups. At 6 months, both groups had significant reductions in energy (p<0.0001) and % calories from total fat (p<0.0001) and saturated fat (p<0.0001), but no between-group differences were found. Compared to the PD group, the PDA group significantly increased servings of fruit (p= 0.023) and vegetables (p=0.044) and decreased servings of refined grains (p=0.024). Interactions between self-monitoring and the 2 groups were found in relation to changes in % calories from total fat (p=0.020), monounsaturated fat (p=0.002) and trans-fatty acids (p=0.049). Using multivariate analysis, we found that frequent self-monitoring was significantly associated with decreased calories from fat (p=0.036) and increased total sugar (p=0.025) and added sugar (p=0.013) in both groups (p=0.006). Our findings suggest that adherence to self-monitoring is more important than the method of self-monitoring for improving diet quality through reduced fat intake.