Abstract
Introduction: Dietary self-monitoring is essential for successful weight management. Tailored feedback messages delivered in real-time can enhance motivation and improve dietary adherence. This study examined the effect of daily, tailored feedback messages on dietary intake and adherence to energy and fat goals in the SMART Trial, a 24-month behavioral weight loss study. Methods: Participants (N=210) were randomly assigned to self-monitor via a paper diary, personal digital assistant (PDA), or PDA that provided daily feedback messages based on self-monitoring entries. The message library was changed at 12 months to limit desensitization. To assess the effect of feedback, changes in dietary intake and adherence to energy and fat goals were compared between the groups that did (FB, n=70) or did not (NFB, n=140) receive feedback. Dietary intake was assessed every 6 months and modeled as percent change from baseline using linear mixed modeling. Marginal modeling with generalized estimating equations was applied to examine the probability of being adherent to energy and fat goals. Results: Participants (78% White, 84% female) had a mean age of 46.8 years and BMI of 34.0 kg/m 2 . At baseline, mean energy intake was 2090 kcal, and 33.7% of calories were from fat. At 24 months, FB group achieved significantly greater reductions in energy (-23.4% vs. -14.1%, p=.02) and saturated fat intake (-9.3% vs. 3.4%, p=.03) compared to the NFB group. Overall, a higher percent of the FB group was adherent; however, adherence declined at 12 months and then rebounded (see Figure). Conclusions: Receiving daily, tailored feedback messages appeared to enhance reductions in energy and saturated fat intake. The decline and later improvements in adherence in the FB group suggest that the message library may need to be changed more often. Findings suggest that daily feedback can improve dietary and self-monitoring adherence, important strategies in weight management and CVD prevention.
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