A randomised controlled trial of the effectiveness of self-weighing as a weight loss intervention

Small Monetary Incentives Lead to Greater Adherence in a Weight Loss Program

PURPOSE

Understand how weekly monetary incentives for dietary tracking and/or weight loss impact 6-month weight loss behavioral adherence.

DESIGN

Secondary analysis of participants randomized to one of four conditions in a behavioral weight loss intervention: incentives for dietary tracking, incentives for weight loss, both, or none.

SETTING

Participants were asked to self-weigh at least twice weekly, log food and drink in a mobile application five days weekly, and attend bi-weekly, group-based classes.

SAMPLE

Data from (n = 91) adults with obesity who completed a 24-week behavioral weight loss intervention of whom 88% were female and 74% Non-Hispanic White, were analyzed.

MEASURES

Non-adherence to weight and dietary self-monitoring was defined as the second week of not meeting criteria. Class attendance was also tracked.

ANALYSIS

Kaplan-Meier analyses were used to examine differences across the four conditions.

RESULTS

Participants incentivized for dietary self-monitoring had an average 15.8 weeks (SE:1.2) until the first non-adherent week compared to 5.9 weeks (SE:0.8) for those not incentivized for dietary self-monitoring (P < .01). Those incentivized for weight loss had an average 18.0 weeks (SE:1.02) of self-weighing until the first non-adherent week compared to 13.5 weeks (SE:1.3) for those not incentivized for weight loss (P = .02). No difference in class attendance was observed.

CONCLUSIONS

Incentivizing behaviors associated with weight loss improved adherence to those behaviors and does not appear to spill over to non-incentivized behaviors.

Practice nurse-supported weight self-management delivered within the national child immunisation programme for postnatal women: a feasibility cluster RCT

BACKGROUND

Pregnancy is a high-risk time for excessive weight gain. The rising prevalence of obesity in women, combined with excess weight gain during pregnancy, means that there are more women with obesity in the postnatal period. This can have adverse health consequences for women in later life and increases the health risks during subsequent pregnancies.

OBJECTIVE

The primary aim was to produce evidence of whether or not a Phase III trial of a brief weight management intervention, in which postnatal women are encouraged by practice nurses as part of the national child immunisation programme to self-monitor their weight and use an online weight management programme, is feasible and acceptable.

DESIGN

The research involved a cluster randomised controlled feasibility trial and two semistructured interview studies with intervention participants and practice nurses who delivered the intervention. Trial data were collected at baseline and 3 months later. The interview studies took place after trial follow-up.

SETTING

The trial took place in Birmingham, UK.

PARTICIPANTS

Twenty-eight postnatal women who were overweight/obese were recruited via Birmingham Women's Hospital or general practices. Nine intervention participants and seven nurses were interviewed.

INTERVENTIONS

The intervention was delivered in the context of the national child immunisation programme. The intervention group were offered brief support that encouraged self-management of weight when they attended their practice to have their child immunised at 2, 3 and 4 months of age. The intervention involved the provision of motivation and support by nurses to encourage participants to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. The role of the nurse was to provide regular external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a record card in their child's health record ('red book') or using the online programme. The behavioural goal was for women to lose 0.5-1 kg per week. The usual-care group received a healthy lifestyle leaflet.

MAIN OUTCOME MEASURES

The primary outcome was the feasibility of a Phase III trial to test the effectiveness of the intervention, as assessed against three traffic-light stop-go criteria (recruitment, adherence to regular self-weighing and registration with an online weight management programme).

RESULTS

The traffic-light criteria results were red for recruitment (28/80, 35% of target), amber for registration with the online weight loss programme (9/16, 56%) and green for adherence to weekly self-weighing (10/16, 63%). Nurses delivered the intervention with high fidelity. In the qualitative studies, participants indicated that the intervention was acceptable to them and they welcomed receiving support to lose weight at their child immunisation appointments. Although nurses raised some caveats to implementation, they felt that the intervention was easy to deliver and that it would motivate postnatal women to lose weight.

LIMITATIONS

Fewer participants were recruited than planned.

CONCLUSIONS

Although women and practice nurses responded well to the intervention and adherence to self-weighing was high, recruitment was challenging and there is scope to improve engagement with the intervention.

FUTURE WORK

Future research should focus on investigating other methods of recruitment and, thereafter, testing the effectiveness of the intervention.

TRIAL REGISTRATION

Current Controlled Trials ISRCTN12209332.

FUNDING

This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 49. See the NIHR Journals Library website for further project information.

The experiences of postnatal women and healthcare professionals of a brief weight management intervention embedded within the national child immunisation programme

BACKGROUND

After childbirth, most women do not lose the extra weight gained during pregnancy. This is important because postnatal weight retention contributes to the development of obesity in later life. Research shows that postnatal women living with overweight would prefer to weigh less, are interested in implementing weight loss strategies, and would like support. Without evidence for the benefit of weight management interventions during pregnancy, postnatal interventions are increasingly important. Research has focused on intensive weight loss programmes, which cannot be offered to all postnatal women. Instead, we investigated the feasibility of a brief intervention delivered to postnatal women at child immunisation appointments. This qualitative study explored the views of women who received the intervention and healthcare professionals who delivered it.

METHODS

The intervention was delivered within the context of the national child immunisation programme. The intervention group were offered brief support encouraging self-management of weight when attending general practices to have their child immunised at two, three and four months of age. The intervention involved motivation and support from practice nurses to encourage women to make healthier lifestyle choices through self-monitoring of weight and signposting to an online weight management programme. Nurses provided external accountability for weight loss. Women were asked to weigh themselves weekly and record this on a weight record card. Nested within this trial, semi-structured interviews explored the experiences of postnatal women who received the intervention and nurses who delivered it.

RESULTS

The intervention was generally acceptable to participants and child immunisation appointments considered a suitable intervention setting. Nurses were hesitant to discuss maternal weight, viewing the postnatal period as a vulnerable time. Whilst some caveats to implementation were discussed by nurses, they felt the intervention was easy to deliver and would motivate postnatal women to lose weight.

CONCLUSIONS

Participants were keen to lose weight after childbirth. Overall, they reported that the intervention was acceptable, convenient, and, appreciated support to lose weight after childbirth. Although nurses, expressed concerns about raising the topic of weight in the early postnatal period, they felt the intervention was easy to deliver and would help to motivate women to lose weight.

The daily Self-Weighing for Obesity Management in Primary Care Study: Rationale, design and methodology

Background Daily self-weighing (DSW) may be an effective harm-reduction intervention to disrupt continued weight gain. Self-Weighing for Obesity Management in Primary Care (SWOP) is a 24-month randomized controlled trial in 400 adults with obesity (BMI: kg/m² ≥ 30) receiving primary care through a clinical network affiliated with an academic medical center. Objective To test DSW as a potentially scalable way to deter age-related weight gain among primary care patients with obesity. Methods Randomized-controlled trial with two conditions: DSW (instruction to weigh daily and provision of a web-enabled digital scale with graphical weight feedback) or Standard Care (receive a monetary gift card equivalent to value of the scale). Both groups receive standardized weight management educational material. SWOP will test the causal effect of assignment to DSW (Aim 1) and adherence to DSW (Aim 2) on weight (primary outcome) and adoption of weight management practices (secondary outcomes), as well as evaluate the cost-effectiveness of DSW compared to standard care (Aim 3). Findings may inform clinical guidelines for weight management by providing evidence that DSW attenuates continued age-related weight gain among adults with obesity. This trial is registered with ClinicalTrials.gov (NCT04044794).

Effectiveness of a self-regulation intervention for weight loss: A randomized controlled trial

OBJECTIVES

To evaluate effectiveness and acceptability of a novel intervention, based on self-regulation theory, for weight loss.

DESIGN

A two-arm parallel group design was employed.

METHODS

Adult participants with a BMI ≥ 30 kg/m² and the aim to lose weight were recruited and randomized to either a control or intervention group. Both groups were asked to weigh themselves daily for eight weeks. The intervention group was encouraged to use a weight tracking app, and complete daily and weekly questionnaires to prompt action planning, reflection, and evaluation of actions. Participants chose daily actions from a menu of 53 behaviours. The primary outcome was weight change after 8 weeks, assessed using linear mixed effects models. At follow-up, 20 intervention group participants were interviewed regarding their experiences in the trial.

RESULTS

100 participants were recruited, and 98% were followed up at 8 weeks. Mean weight loss was -4.18 kg (SD = 3.84) in the intervention compared to -1.01 kg (SD = 2.67) in the control group; the adjusted difference was -3.20 kg (95% CI -4.49, -1.92). Participants rated the intervention's usefulness as 8.25 (SD = 2.04) on a scale from 1 to 10. Adherence was a significant independent predictor of weight loss success (-1.54 kg per one SD, 95% CI -2.16, -0.93), but not a mediator of the intervention effect. Participants reported that the intervention enabled them to experiment with and identify effective weight loss actions.

CONCLUSIONS

Guiding participants through the self-regulation process was feasible, acceptable to participants, and led to significantly greater short-term weight loss than unguided self-weighing.

Testing the effectiveness of a weight loss intervention to enhance self-regulation in adults who are obese: protocol for a randomised controlled trial

INTRODUCTION

Previous trials finding an effect of self-monitoring on weight loss have considered the effect to be mediated by self-regulatory processes. However, a qualitative think-aloud study asking people to record thoughts and feelings during weighing showed that self-regulation occurs only rarely without further instruction. The aim of this trial is to test a novel intervention guiding people through the self-regulatory processes to see whether it facilitates weight loss.

METHODS AND ANALYSES

A parallel group, randomised controlled trial will be conducted to test the concept that a self-regulation intervention for weight loss increases weight loss compared with daily self-weighing without further support. One hundred participants with a body mass index ≥30 kg/m² will be randomised to either the control or intervention group. The control group will be asked to weigh themselves daily for 8 weeks, the intervention group will be encouraged to follow the self-regulation intervention. They will be prompted to weigh daily, track their weight using an app, plan daily actions for weight loss and reflect on their action plans on a weekly basis. This self-regulation cycle will allow them to experiment with different weight loss strategies and identify effective and sustainable actions. Primary and process outcomes will be measured at baseline and 8 weeks' follow-up. Linear regression analysis of the primary outcome, weight change, will assess the early effectiveness of the intervention. The process outcomes liking, perceived effectiveness, as well as usage and barriers with regard to the self-regulation intervention, will be assessed through qualitative analysis of follow-up interviews and quantitative analysis of adherence rates and responses to a final questionnaire.

ETHICS AND DISSEMINATION

This trial was reviewed and approved by the NHS National Research Ethics Committee and the Health Research Authority (reference number: 18/SC/0482). The findings of the trial will be published in peer reviewed journals and presented at conferences.

TRIAL REGISTRATION NUMBER

ISRCTN14148239, prerecruitment.

PROTOCOL VERSION

Version 1.1, 7 December 2018.

Experiences of Self-Monitoring in Self-Directed Weight Loss and Weight Loss Maintenance: Systematic Review of Qualitative Studies

The experience and role of self-monitoring in self-directed weight loss attempts may be distinctly different from that within formal interventions, and has yet to be fully explored. We systematically reviewed qualitative studies to examine experiences of self-monitoring as an aid to self-directed weight loss. Thematic synthesis was used to construct descriptive and analytical themes from the available data. In all, 22 studies (681 participants) were included, in which the uses of self-monitoring ranged from an aid to increase adherence to a tool for facilitating analysis. Self-monitoring also influenced and was influenced by self-perception and emotions. Feelings of shame were linked with abandonment of efforts. Findings highlight the centrality of interpretation of self-monitored data, the implications this interpretation has on sense of self, and the impact of broader discourses. Explicitly framing self-monitoring as a positive tool with which to aid analysis may encourage helpful use of this technique.

Role of the family doctor in the management of adults with obesity: a scoping review

OBJECTIVES

Obesity management is an important issue for the international primary care community. This scoping review examines the literature describing the role of the family doctor in managing adults with obesity. The methods were prospectively published and followed Joanna Briggs Institute methodology.

SETTING

Primary care. Adult patients.

INCLUDED PAPERS

Peer-reviewed and grey literature with the keywords obesity, primary care and family doctors. All literature published up to September 2015. 3294 non-duplicate papers were identified and 225 articles included after full-text review.

PRIMARY AND SECONDARY OUTCOME MEASURES

Data were extracted on the family doctors' involvement in different aspects of management, and whether whole person and person-centred care were explicitly mentioned.

RESULTS

110 papers described interventions in primary care and family doctors were always involved in diagnosing obesity and often in recruitment of participants. A clear description of the provider involved in an intervention was often lacking. It was difficult to determine if interventions took account of whole person and person-centredness. Most opinion papers and clinical overviews described an extensive role for the family doctor in management; in contrast, research on current practices depicted obesity as undermanaged by family doctors. International guidelines varied in their description of the role of the family doctor with a more extensive role suggested by guidelines from family medicine organisations.

CONCLUSIONS

There is a disconnect between how family doctors are involved in primary care interventions, the message in clinical overviews and opinion papers, and observed current practice of family doctors. The role of family doctors in international guidelines for obesity may reflect the strength of primary care in the originating health system. Reporting of primary care interventions could be improved by enhanced descriptions of the providers involved and explanation of how the pillars of primary care are used in intervention development.

The Effect of Different Types of Monitoring Strategies on Weight Loss: A Randomized Controlled Trial

OBJECTIVE

To determine the effectiveness of various monitoring strategies on weight loss, body composition, blood markers, exercise, and psychosocial indices in adults with overweight and obesity following a 12-month weight loss program.

METHODS

Two hundred fifty adults with BMI ≥ 27 were randomized to brief, monthly, individual consults, daily self-monitoring of weight, self-monitoring of diet using MyFitnessPal, self-monitoring of hunger, or control over 12 months. All groups received diet and exercise advice, and 171 participants (68.4%) remained at 12 months.

RESULTS

No significant differences in weight, body composition, blood markers, exercise, or eating behavior were apparent between those in the four monitoring groups and the control condition at 12 months (all P ≥ 0.053). Weight differences between groups ranged from -1.1 kg (-3.8 to 1.6) to 2.2 kg (-1.0 to 5.3). However, brief support and hunger training groups reported significantly lower scores for depression (difference [95% CI]: -3.16 [-5.70 to -0.62] and -3.05 [-5.61 to -0.50], respectively) and anxiety (-1.84, [-3.67 to -0.02]) scores than control participants.

CONCLUSIONS

Although adding a monitoring strategy to diet and exercise advice did not further increase weight loss, no adverse effects on eating behavior were observed, and some monitoring strategies may even benefit mental health.

Aggressive clinical approach to obesity improves metabolic and clinical outcomes and can prevent bariatric surgery: a single center experience

BACKGROUND

The number of bariatric procedures has exponentially increased in the past decade, as a result of the lack of successful clinical weight-loss interventions. The main reasons for the failure of clinical obesity management are: (1) anti-obesity medications are administered as monotherapies (or pre-combined drugs); (2) lack of combination between pharmacotherapy and non-pharmacological modalities; (3) short duration of pharmacotherapy for obesity; (4) lack of weight-loss maintenance strategies; (5) misunderstanding of the complex pathophysiology of obesity; and (6) underprescription of anti-obesity medications. We developed a protocol that can potentially overcome the drawbacks that may lead to the failure of clinical therapy for obesity. The aim of this study is therefore to report the clinical and metabolic effects of our proposed obesity-management protocol over a 2-year period, and to determine whether this more intensive approach to obesity management is feasible and a possible alternative to bariatric surgery in patients with moderate-to-severe obesity.

METHODS

This retrospective study involved 43 patients in whom bariatric surgery was indicated. Patients underwent an intensive anti-obesity protocol that included pharmacotherapy with multiple drugs; intense surveillance with monthly body analysis by air-displacement plethysmography, electrical bioimpedance, and 3D body scans; weekly psychotherapy; diet planning with a dietician every 2 months; and exercises at least 3 times a week with exercises prescribed by a personal trainer at least once a month. Body weight (BW), total weight excess (TWE), obesity class, body mass index, fat weight, muscle weight, waist circumference, and visceral fat were analyzed. Markers of lipid and glucose metabolism, liver function, and inflammation were also evaluated. Therapeutic success was defined as >20% BW loss or >50% decrease in TWE after 1 year.

RESULTS

Significant improvements were observed in all clinical and metabolic parameters. Thirty-eight (88.4%) patients achieved 10% BW loss, and 32 (74.4%) achieved 20% BW loss. TWE decreased by >50% in 35 (81.4%) patients. Forty (93.0%) patients were able to avoid bariatric surgery.

CONCLUSION

An intensive clinical approach to obesity management can be an effective alternative to bariatric surgery, although further randomized controlled studies are necessary to validate our findings.

Using patient self-reports to study heterogeneity of treatment effects in major depressive disorder

BACKGROUNDS

Clinicians need guidance to address the heterogeneity of treatment responses of patients with major depressive disorder (MDD). While prediction schemes based on symptom clustering and biomarkers have so far not yielded results of sufficient strength to inform clinical decision-making, prediction schemes based on big data predictive analytic models might be more practically useful.

METHOD

We review evidence suggesting that prediction equations based on symptoms and other easily-assessed clinical features found in previous research to predict MDD treatment outcomes might provide a foundation for developing predictive analytic clinical decision support models that could help clinicians select optimal (personalised) MDD treatments. These methods could also be useful in targeting patient subsamples for more expensive biomarker assessments.

RESULTS

Approximately two dozen baseline variables obtained from medical records or patient reports have been found repeatedly in MDD treatment trials to predict overall treatment outcomes (i.e., intervention v. control) or differential treatment outcomes (i.e., intervention A v. intervention B). Similar evidence has been found in observational studies of MDD persistence-severity. However, no treatment studies have yet attempted to develop treatment outcome equations using the full set of these predictors. Promising preliminary empirical results coupled with recent developments in statistical methodology suggest that models could be developed to provide useful clinical decision support in personalised treatment selection. These tools could also provide a strong foundation to increase statistical power in focused studies of biomarkers and MDD heterogeneity of treatment response in subsequent controlled trials.

CONCLUSIONS

Coordinated efforts are needed to develop a protocol for systematically collecting information about established predictors of heterogeneity of MDD treatment response in large observational treatment studies, applying and refining these models in subsequent pragmatic trials, carrying out pooled secondary analyses to extract the maximum amount of information from these coordinated studies, and using this information to focus future discovery efforts in the segment of the patient population in which continued uncertainty about treatment response exists.

Qualitative analysis of the role of self-weighing as a strategy of weight control for weight-loss maintainers in comparison with a normal, stable weight group

Self-weighing seems to have a primary role in weight-loss maintenance. The use of this strategy may help correct even slight weight regain and contribute to long-term weight stability. However, self-weighing has also been associated with negative psychological health consequences in specific subgroups. This study aimed to explore the use and the behavioral and psychological consequences of self-weighing in a group of weight-loss maintainers (WLoMs). We chose a qualitative design to conduct this investigation. Eighteen WLoMs were interviewed and compared to a matched comparison group of 18 participants with a lifelong normal stable weight (NSW). Analyses showed that most WLoMs needed regular self-weighing to be aware of their weight. The weight displayed on the scale helped WLoMs sustain the continuous efforts needed to maintain weight loss and also at times triggered corrective actions that were sometimes drastic. Weight changes generated both negative and positive affect among WLoMs, who could experience anxiety because of self-weighing or have their self-esteem impaired in the case of weight gain. In comparison, the NSW group rarely used self-weighing. They relied on a conscious way of living to control their weight and needed fewer strategies. NSW participants simply went back to their routine when they felt a slight increase in their weight, without experiencing consequences on their mood or self-esteem. Regular self-weighing as a component of weight-loss maintenance should be encouraged to help WLoMs regulate their food and physical activity, provided that potential consequences on psychological well-being, including self-esteem, are screened and addressed when needed.

Patterns of self-weighing behavior and weight change in a weight loss trial

BACKGROUND/OBJECTIVES

Regular self-weighing has been associated with weight loss and maintenance in adults enrolled in a behavioral weight loss intervention; however, few studies have examined the patterns of adherence to a self-weighing protocol. The study aims were to (1) identify patterns of self-weighing behavior; and (2) examine adherence to energy intake and step goals and weight change by self-weighing patterns.

SUBJECTS/METHODS

This was a secondary analysis of self-monitoring and assessment weight data from a 12-month behavioral weight loss intervention study. Each participant was given a scale that was Wi-Fi-enabled and transmitted the date-stamped weight data to a central server. Group-based trajectory modeling was used to identify distinct classes of trajectories based on the number of days participants self-weighed over 51 weeks.

RESULTS

The sample (N=148) was 90.5% female, 81.1% non-Hispanic white, with a mean (s.d.) age of 51.3 (10.1) years, had completed an average of 16.4 (2.8) years of education and had mean body mass index of 34.1 (4.6) kg m(-2). Three patterns of self-weighing were identified: high/consistent (n=111, 75.0% self-weighed over 6 days per week regularly); moderate/declined (n=24, 16.2% declined from 4-5 to 2 days per week gradually); and minimal/declined (n=13, 8.8% declined from 5-6 to 0 days per week after week 33). The high/consistent group achieved greater weight loss than either the moderate/declined and minimal/declined groups at 6 months (-10.19%±5.78%, -5.45%±4.73% and -2.00%±4.58%) and 12 months (-9.90%±8.16%, -5.62%±6.28% and 0.65%±3.58%), respectively (P<0.001). The high/consistent group had a greater mean number days per week of adherence to calorie intake goal or step goal but not higher than the moderate/declined group.

CONCLUSIONS

This is the first study to reveal distinct temporal patterns of self-weighing behavior. The majority of participants were able to sustain a habit of daily self-weighing with regular self-weighing leading to weight loss and maintenance as well as adherence to energy intake and step goals.

Self-weighing in weight management interventions: A systematic review of literature

BACKGROUND

Self-weighing increases a person's self-awareness of current weight and weight patterns. Increased self-weighing frequency can help an individual prevent weight gain. Literature, however, is limited in describing variability in self-weighing strategies and how the variability is associated with weight management outcomes.

AIM

This review analyzed self-weighing in weight management interventions and the effects of self-weighing on weight and other outcomes.

METHODS

Twenty-two articles from PubMed, CINAHL, Medline, PsychInfo, and Academic Search Premier were extracted for review.

RESULTS

These 22 articles reported findings from 19 intervention trials, mostly on weight loss or weight gain prevention. The majority of the reviewed articles reported interventions that combined self-weighing with other self-monitoring strategies (64%), adopted daily self-weighing frequency (84%), and implemented interventions up to six months (59%). One-half of the articles mentioned that technology-enhanced or regular weight scales were given to study participants. Of the articles that provided efficacy data, 75% of self-weighing-only interventions and 67% of combined interventions demonstrated improved weight outcomes. No negative psychological effects were found.

CONCLUSIONS

Self-weighing is likely to improve weight outcomes, particularly when performed daily or weekly, without causing untoward adverse effects. Weight management interventions could consider including this strategy.

Weight loss methods and changes in eating habits among successful weight losers

BACKGROUND

Changes in several lifestyle related factors are required for successful long-term weight loss. Identification of these factors is of major importance from a public health point of view.

METHODS/SUBJECTS

This study was based upon findings from the Finnish Weight Control Registry (FWCR), a web-based registry. In total, 316 people were recruited and 184 met the study inclusion criteria. The aims of this study were to assess means and typical changes in eating habits associated with successful long-term weight loss.

RESULTS

Half of the participants (48%) reported that they lost weight slowly primarily with dietary changes. Self-weighing frequency was high, 92% was weighing themselves at least once a week during the weight loss phase, and 75% during the maintenance phase. Dietary aspects associated with successful weight loss and weight maintenance included an increase in intake of vegetables, a reduction in frequency of eating candies and fast food, regular meal frequency and application of the Plate model.

CONCLUSIONS

Both slow and fast weight loss may lead to successful long-term results and weight maintenance. A decrease in energy intake was achieved by reducing intake of energy-dense food, applying the Plate model and by regular meal frequency. Key messages Successful long-term weight loss is associated with a reduction in intake of energy-dense food. A more regular meal frequency and a high frequency of self-weighing seem to be helpful.

Efficacy of water preloading before main meals as a strategy for weight loss in primary care patients with obesity: RCT

OBJECTIVE

To investigate the efficacy of water preloading before meals as a weight loss strategy for adults with obesity.

METHODS

A two-group randomized controlled trial was conducted in Birmingham, England. Eighty-four adults with obesity were recruited from general practices. All participants were given a face-to-face weight management consultation at baseline (30 min) and a follow-up telephone consultation at 2 weeks (10 min). At baseline, participants were randomized to either drinking 500 ml of water 30 min before their main meals or an attention control group where participants were asked to imagine their stomach was full before meals. The primary outcome was weight change at 12-week follow-up. Several measures of adherence were also used, including 24 h total urine collections.

RESULTS

41 participants were randomized to the intervention group and 43 to the comparator group. The water preloading group lost -1.3 kg (95% CI -2.4 to -0.1, P = 0.028) more than comparators at follow up. Adjusting for ethnicity, deprivation, age, and gender resulted in the intervention group losing -1.2 kg (95% CI -2.4 to 0.07, P = 0.063) more than the comparator.

CONCLUSIONS

There is preliminary evidence that water preloading before main meals leads to a moderate weight loss at follow up. ISRCTN33238158.

Is self-weighing an effective tool for weight loss: a systematic literature review and meta-analysis

BACKGROUND

There is a need to identify effective behavioural strategies for weight loss. Self-weighing may be one such strategy.

PURPOSE

To examine the effectiveness of self-weighing for weight loss.

METHODS

A systematic review and meta-analysis of randomised controlled trials that included self-weighing as an isolated intervention or as a component within an intervention. We used sub groups to analyse differences in frequency of weighing instruction (daily and weekly) and also whether including accountability affected weight loss.

RESULTS

Only one study examined self-weighing as a single strategy and there was no evidence it was effective (-0.5 kg 95 % CI -1.3 to 0.3). Four trials added self-weighing/self-regulation techniques to multi-component programmes and resulted in a significant difference of -1.7 kg (95 % CI -2.6 to -0.8). Fifteen trials comparing multi-component interventions including self-weighing compared with no intervention or minimal control resulted in a significant mean difference of -3.4 kg (95 % CI -4.2 to -2.6). There was no significant difference in the interventions with weekly or daily weighing. In trials which included accountability there was significantly greater weight loss (p = 0.03).

CONCLUSIONS

There is a lack of evidence of whether advising self-weighing without other intervention components is effective. Adding self-weighing to a behavioural weight loss programme may improve weight loss. Behavioural weight loss programmes that include self-weighing are more effective than minimal interventions. Accountability may improve the effectiveness of interventions that include self-weighing.

Frequent Self-Weighing and Visual Feedback for Weight Loss in Overweight Adults

Evidence has suggested that self-weighing may be beneficial for weight control in adults, but few studies have independently assessed the contribution of this behavior to weight loss. This study experimentally tested daily self-weighing and visual feedback (the Caloric Titration Method (CTM)) as a weight loss and weight loss maintenance intervention over 2 years. 162 overweight individuals were randomized to the CTM intervention or delayed treatment control group. In year 1, weight change was compared between groups, and in year 2, the control group started using the CTM while the intervention group continued using the CTM for maintenance. A significant difference in weight loss over the first year (CTM n = 70; 2.6 ± 5.9 kg versus control n = 65; 0.5 ± 4.4 kg, p = 0.019) was qualified by a group × gender × time interaction (p = 0.002) such that men lost more weight using the CTM. In year 2, the CTM group maintained their weight and the control group lost an amount similar to the intervention group in year 1. Daily self-weighing and visual feedback facilitated a minimal amount of weight loss and maintenance of this loss. Future research investigating characteristics of those who benefit from this type of self-directed intervention is warranted.