Examination of Nutrition Monitoring through Ecological Momentary Assessment during an Internet-based, Self-directed Weight Loss Intervention

Abstract

Internet and mobile health (mHealth) based interventions are promising potential options for increasing access to weight loss treatment for the general public (Payne et al., 2015). Many health-related internet and mobile phone applications are commercially available, free, and include features for nutrition self-monitoring which is a vitally important self-management strategy for weight loss. However, adherence to nutrition self-monitoring for internet and mHealth interventions is poor and research examining the mechanisms of nutrition self-monitoring behavior is limited (Lieffers & Hanning, 2012). The purpose of the present study is to improve understanding of self-monitoring behavior by examining the phenomenological experience of mobile application self-monitoring through ecological momentary assessment (EMA) during the first two weeks of an internet-based, self-directed weight loss intervention. Fifty-one participants (19.6% male, 43.1% non-white) were enrolled in a 16-week, self-directed, online weight loss intervention. Original methods included the use of two different nutrition monitoring applications; however, due to a technological failure only one application (MyFitnessPal) was utilized. Participants completed ecological momentary assessments of nutrition self-monitoring experiences during the first two weeks of the intervention and continued to use online materials and the nutrition monitoring mobile application for the remaining 14 weeks. Hierarchical Linear Modeling was utilized to examine within-subject differences in perceptions and experiences between instances of completed nutrition monitoring and instances of missed nutrition monitoring. The relationships between aggregated participant experiences during the EMA period and nutrition self-monitoring over 16 weeks as well as weight outcomes were examined using correlational analyses. Compliance for EMA event-continent responding and signaled random prompt responding was 58% and 70%, respectively. EMA responses immediately following a nutrition monitoring entry demonstrated increased participant perceptions of goal consistency, diet success, diet maintenance, less emotional eating, less monitoring burden, and greater negative affect as compared to random prompt responses related to a missed nutrition monitoring entry. Participants monitored nutrition for an average of 48.7 days and nutrition monitoring frequency was associated with EMA compliance as well as participant perceptions of goal consistency, diet success, and diet maintenance during the first 14 days. Frequency of nutrition monitoring and perceptions of diet success during EMA were associated with weight change in both completer-only analyses and intent-to-treat. The results of this study suggest that early nutrition monitoring experiences such as the perception of goal consistency and diet success are important factors for engagement in weight loss treatment. However, further research on monitoring experiences with larger and more diverse samples is needed to determine how these factors might be used to inform future assessment and intervention.