NC: Behavior Change Strategies (2007-2008)

Study Design:
- Click here for explanation of classification scheme.
Quality Rating:
Research Purpose:
To evaluate the importance of self-monitoring for weight control during the high-risk holiday season.
Inclusion Criteria:
Had previously participated in a long-term cognitive-behavioural program for the treatment of obesity.
Exclusion Criteria:
Not stated in article.
Description of Study Protocol:

Recruitment:  Volunteers from a long-term cognitive-behavioural program for the treatment of obesity.

Design:  Assessment of self-monitoring and weight changes during 3 holiday versus 7 nonholiday weeks. 

Blinding used (if applicable):  Not applicable

Intervention (if applicable):  Participants were provided each week with a self-monitoring booklet and they were encouraged to record all food consumed during the week and to count the calories in these foods.

Statistical Analysis:  A Group (4 quartile groups) X Time (nonholiday vs holiday) analysis of variance (ANOVA) was computed using weekly weight change as the dependent variable.   


Data Collection Summary:

Timing of Measurements:  Weekly for 10 weeks

Dependent Variables

  • Variable 1: weight

Independent Variables:  Self-monitoring of all food consumed during the week including counting calories, fat grams, and exercise.

Control Variables- Not applicable


Description of Actual Data Sample:

Initial N: 38 (6 males, 32 females)

Attrition (final N): Not reported

Age: mean 43.60 years (SD=12.23)

Ethnicity: Caucasian: 32

                African American: 5

                Other ethnic background: 1

Other relevant demographics:

    Single:  51%

    Married:  44%

    Separated, divorced, or widowed:  5%


    Completed only high school:  21%

    Attended some college:  21%

    Completed college:    29%

    Obtained graduate degrees:  29%


    Employeed full time:  75%

    Unemployed:  13%

    Retired:  3%

    Homemakers:  3%

    Students:  3%

    Employed part-time:  3%


Anthropometrics:  Mean weight at beginning of study:  223.06 lbs (101.39 kg, SD=63.70 lbs (28.92 kg)

57.21% overweight (SD=37.76%)

Location: Not stated


Summary of Results:

Highly consistent self-monitors showed better weight control during the nonholiday weeks compared with the holiday weeks.  Highly consistent self-monitors lost substantially more weight (an average of 10 lbs more than the low self-monitors) than did each of the other 3 quartiles. 

The highly consistent self-monitors increased their self-monitoring to a degree that was almost significantly greater than that of the other groups during the high-risk holiday weeks.  In contrast, the least consistent self-monitoring quartile was the only group that averaged substantial weekly weight gains during both holiday and nonholiday weeks. 

Other Findings

All participants except those in the most consistent self-monitoring quartile gained approximately 500% more weight per week during the holiday weeks compared with the nonholiday weeks. 


Author Conclusion:

The impact of the holidays could dampen momentum for many weight controllers, leading to major lapses and perhaps premature termination of treatment.  Self-monitoring at a highly consistent level may help weight controllers produce useful coping responses in high-risk situations. 

The proposed buffering effects of self-monitoring cannot be established by the current study.  It is unknown whether increased self-monitoring led to improved weight control, whether improved weight control led to positive psychological states that led to increased monitoring, or whether other variables not measured affected both weight control and self-monitoring.

Funding Source:
University/Hospital: OSF-St Francis Medical Center, Center for Behavioral Medicine
Reviewer Comments:
Quality Criteria Checklist: Primary Research
Relevance Questions
  1. Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies) Yes
  2. Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about? Yes
  3. Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice? Yes
  4. Is the intervention or procedure feasible? (NA for some epidemiological studies) Yes
Validity Questions
1. Was the research question clearly stated? Yes
  1.1. Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified? Yes
  1.2. Was (were) the outcome(s) [dependent variable(s)] clearly indicated? Yes
  1.3. Were the target population and setting specified? Yes
2. Was the selection of study subjects/patients free from bias? No
  2.1. Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study? No
  2.2. Were criteria applied equally to all study groups? N/A
  2.3. Were health, demographics, and other characteristics of subjects described? Yes
  2.4. Were the subjects/patients a representative sample of the relevant population? Yes
3. Were study groups comparable? N/A
  3.1. Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT) N/A
  3.2. Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline? N/A
  3.3. Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.) N/A
  3.4. If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis? N/A
  3.5. If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.) N/A
  3.6. If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")? N/A
4. Was method of handling withdrawals described? N/A
  4.1. Were follow-up methods described and the same for all groups? N/A
  4.2. Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.) N/A
  4.3. Were all enrolled subjects/patients (in the original sample) accounted for? ???
  4.4. Were reasons for withdrawals similar across groups? N/A
  4.5. If diagnostic test, was decision to perform reference test not dependent on results of test under study? N/A
5. Was blinding used to prevent introduction of bias? N/A
  5.1. In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate? N/A
  5.2. Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.) N/A
  5.3. In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded? N/A
  5.4. In case control study, was case definition explicit and case ascertainment not influenced by exposure status? N/A
  5.5. In diagnostic study, were test results blinded to patient history and other test results? N/A
6. Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described? Yes
  6.1. In RCT or other intervention trial, were protocols described for all regimens studied? N/A
  6.2. In observational study, were interventions, study settings, and clinicians/provider described? Yes
  6.3. Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect? Yes
  6.4. Was the amount of exposure and, if relevant, subject/patient compliance measured? Yes
  6.5. Were co-interventions (e.g., ancillary treatments, other therapies) described? N/A
  6.6. Were extra or unplanned treatments described? N/A
  6.7. Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups? N/A
  6.8. In diagnostic study, were details of test administration and replication sufficient? N/A
7. Were outcomes clearly defined and the measurements valid and reliable? Yes
  7.1. Were primary and secondary endpoints described and relevant to the question? Yes
  7.2. Were nutrition measures appropriate to question and outcomes of concern? Yes
  7.3. Was the period of follow-up long enough for important outcome(s) to occur? N/A
  7.4. Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures? Yes
  7.5. Was the measurement of effect at an appropriate level of precision? Yes
  7.6. Were other factors accounted for (measured) that could affect outcomes? No
  7.7. Were the measurements conducted consistently across groups? Yes
8. Was the statistical analysis appropriate for the study design and type of outcome indicators? Yes
  8.1. Were statistical analyses adequately described and the results reported appropriately? Yes
  8.2. Were correct statistical tests used and assumptions of test not violated? Yes
  8.3. Were statistics reported with levels of significance and/or confidence intervals? Yes
  8.4. Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)? N/A
  8.5. Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)? N/A
  8.6. Was clinical significance as well as statistical significance reported? No
  8.7. If negative findings, was a power calculation reported to address type 2 error? N/A
9. Are conclusions supported by results with biases and limitations taken into consideration? Yes
  9.1. Is there a discussion of findings? Yes
  9.2. Are biases and study limitations identified and discussed? Yes
10. Is bias due to study's funding or sponsorship unlikely? ???
  10.1. Were sources of funding and investigators' affiliations described? No
  10.2. Was the study free from apparent conflict of interest? ???