Using a technology-based intervention to promote weight loss in sedentary overweight or obese adults: a randomized controlled trial study design

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress open access to scientific and medical research M e t h odolo g y Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 54.37.163.172 on 12-Jul-2018 For personal use only. Open Access Full Text Article Using a technology-based intervention to promote weight loss in sedentary overweight or obese adults: a randomized controlled trial study design This article was published in the following Dove Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 3 February 2011 Number of times this article has been viewed Vaughn W Barry 1 Amanda C McClain 1 Sara Shuger 1 Xuemei Sui 1 James W Hardin 2 Gregory A Hand 1 Sara Wilcox 1 Steven N Blair 1,2 Department of Exercise Science; Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC, USA 1 2 Correspondence: Vaughn W Barry Department of Exercise Science, Public Health Research Center, University of South Carolina, 921 Assembly Street, Columbia, SC 29063, USA Tel +1 803 777 7566 Fax +1 803 777 2504 Email submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/DMSO.S14526 Powered by TCPDF (www.tcpdf.org) Purpose: The SenseWear™ Armband is an activity monitor developed to improve lifestyle self-monitoring. Currently, few studies assess electronic self-monitoring and weight loss with a lifestyle intervention program. To our knowledge, only one study has used the SenseWear Armband in combination with a lifestyle intervention to improve weight loss, and no studies have evaluated whether a self-monitoring intervention based solely on the armband can promote weight loss. Consequently, the aims of the study were to assess weight loss from electronic self-monitoring, to compare these values to the lifestyle intervention and standard care groups, and to compare weight loss with lifestyle intervention with and without the armband. Patients and methods: We recruited 197 sedentary overweight or obese adults (age, 46.8 ± 10.8 years; BMI, 33.3 ± 5.2 kg/m2) to participate in the 9-month study. Participants were randomized into one of four weight loss groups: 1) the standard care group received a selfdirected weight loss program, complete with an evidence-based weight loss manual (standard care, n = 50); 2) a 14-week group-based behavioral weight loss program followed by weekly, biweekly, and monthly telephone counseling calls (GWL, n = 49); 3) the use of the armband to help improve lifestyle self-monitoring (SWA alone, n = 49); or (4) the group-based behavioral weight loss program and follow-up telephone counseling calls plus the armband (GWL + SWA, n = 49). All participants received the evidence-based weight loss manual at baseline. All measures were performed at baseline and months 4 and 9. The primary outcomes were weight loss and waist circumference reduction. Results: This study is a well-designed randomized controlled study powered to detect a 0.5-kg weight loss and 0.6-cm waist circumference reduction in overweight and obese sedentary adults. Conclusion: Innovative technologies are providing lifestyle self-monitoring and weight loss tools. Utilizing these technologies may be an important step in improving the current obesity epidemic. Keywords: lifestyle, energy balance, behavioral education, accelerometer, SenseWear™ Armband Introduction Approximately two-thirds of adults in the United States are overweight or obese.1 Excess weight is associated with many health conditions, including hypertension, dyslipidemia, type 2 diabetes mellitus, osteoarthritis, cardiovascular disease, stroke, and some cancers.2–4 Furthermore, the medical cost of excess weight for the United States Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011:4 67–77 © 2011 Barry et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. 67 Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 54.37.163.172 on 12-Jul-2018 For personal use only. Barry et al is estimated to be $147 billion per year.5 Clearly, effective weight loss solutions are needed to improve the country’s health profile. One strategy that has been proven effective for weight loss, at least in the short term, is group-based lifestyle intervention weight loss programs (GWL). 6 These programs target key features in weight loss, including healthy eating, increased physical activity, and behavioral therapy. Behavioral therapy incorporates behavior change strategies such as dietary and physical activity self-monitoring, goal setting, problem solving, and stress management, and many of these programs are grounded in behavioral science theory, including Social Cognitive Theory and the Transtheoretical Model.7 Individuals who effectively incorporate these key features may reduce their initial body weight by 8%–10% within 4–6 months of treatment.8 Unfortunately, there are limitations in using GWLs to reach large segments of the population efficiently and cost effectively, such as obtaining qualified staff, participant availability, and the need for smaller group sizes. The use of physical activity monitoring devices, such as pedometers and accelerometers, helps individuals increase their physical activity through self-monitoring, goal setting, and other behavioral strategies. Although these devices effectively encourage participants to increase their physical activity habits,9 they only marginally reduce weight when used alone.10 Both physical activity and energy intake selfmonitoring are needed for more effective weight loss.11,12 The SenseWear™ Armband (BodyMedia, Pittsburgh, PA, USA) is a physical activity monitor that includes software for selfmonitoring of daily energy expenditure and energy intake. The real-time feedback of these parameters can improve individual self-monitoring and therefore may improve weight loss outcomes. Research has shown that the armband is accurate when measuring resting energy expenditure13–15 and when measuring energy expenditure in laboratory13,15,16 (ie, treadmill and cycle ergometry exercise) and free-living conditions.17,18 Therefore, the armband may be an appropriate device in assessing energy expenditure for weight loss or weight maintenance purposes. In one recent study, the armband was used as a real-time self-monitoring device in conjunction with a GWL. This small study (n = 57) reported improved weight loss over 3 months when the armband was worn in conjunction with a GWL, beyond which weight loss was accomplished with a GWL alone.19 This small study did not include an armband-alone group and did not utilize a nonGWL control group. The purpose of the Lifestyle Education 68 Powered by TCPDF (www.tcpdf.org) submit your manuscript | www.dovepress.com Dovepress for Activity (...truncated)