Table 2

Synopsis of reviewed studies on self-weighing and weight management.

REFERENCE, SAMPLE, DESIGN, & FOCUS

PREDICTORS OR CONDITIONS

OUTCOME MEASURES

FINDINGS

EVIDENCE GRADE & COMMENTS


Butryn, et al. (2007) 23

3,003 participants enrolled in the U.S. National Weight Control Registry for at least one year. The mean age was 48 years and 75% of the sample was female. Mean baseline BMI was 25 kg/m2.

Prospective cohort

Weight maintenance

To be included as part of the National Weight Control Registry, participants had to have maintained at least a 30 pound weight loss over one year. Predictors included:

1) Self-weighing frequency (At least daily, At least weekly, Less than weekly)

2) Change in self-weighing frequency (Increase, No change, Decrease)

Outcomes were assessed at baseline and 12-months follow-up.

1) ΔBody weight (kg)

2,462 (82%) participants had complete data from both the baseline and 12-month assessments. Compared to participants who increased (1.2) or did not change their self-weighing frequency (1.7), participants who decreased (3.7) their self-weighing frequency had significantly greater weight gain at the 12-month follow-up.

B2 – After adjustment for several potential confounders, there was benefit for weight maintenance by increasing the frequency of self-weighing over 12 months. Potential biases, however, may have been introduced by the self-reported weight measures and exclusion of 18% of the full sample due to missing data.


Qi, et al. (2000) 24

50 obese, postmenopausal female participants recruited in Maryland. The mean age was 60 years. Mean baseline BMI was approximately 32 kg/m2.

Prospective cohort

Weight loss

Participants completed a 6-month behavioral weight loss intervention. After the weight loss program, participants were then stratified by the predictors:

1) Weight loss (> 5 kg, ≤ 5 kg)

Outcomes were assessed at baseline and 6-months follow-up. They were reported as pre-post-scores (versus change scores)

1) Daily self-weighing score (1-less frequent to 5-more frequent)

50 (100%) participants were available for the 6-month follow-up. Participants who lost > 5 kg during treatment observed a significant pre-post increase in their daily self-weighing score (1.7 to 2.5).

C3 – Participants who lost > 5 kg had significantly increased their frequency of self-weighing, but post scores were statistically indistinguishable between groups. Interpretation of the findings was complicated because only the average scaled scores for self-weighing were reported (versus response distributions). Also, no multivariate adjustments were made in the analysis despite the small sample and several significant baseline differences between groups.


McGuire, et al. (2007) 25

500 participants recruited through a random-digit phone survey in the U.S. The mean age was 46 years and 59% of the sample was female. Mean BMI was between 25 and 30 kg/m2.

Cross-sectional

Weight maintenance

1) Weight loss maintainer – lost ≥ 10% of maximum weight and currently at this level for ≥ 1 year

2) Weight loss regainers – lost ≥ 10% of maximum weight, but not currently at this level

3) Controls – never lost ≥ 10% of maximum weight and never weighed ≥ 10% of current weight

Outcomes were assessed at survey completion.

1) At least weekly self-weighing (%)

The overall survey response rate was 57% and 238 participants had complete data for the analysis. Compared to Controls (34.5) and Weight loss regainers (35.7), a significantly greater proportion of Weight loss maintainers (55.1) self-weighed at least weekly.

C2 – After adjustment for several potential confounders, there were significantly more weight loss maintainers that reported weekly self-weighing. The cross-sectional nature of the study limited conclusions on cause-and-effect. Also, potential biases may have been present with the self-reported operational definition and measurement of weight maintenance, much of it being rather complex to recall.


Linde, et al. (2005) 26

Two separate samples were analyzed. Sample 1 consisted of 1,226 participants enrolled in the Pound of Prevention trial in Minnesota. The mean age was 35 years and 81% of the sample was female. Baseline BMI was 27 kg/m2. Sample 2 consisted of 1,800 participants enrolled in the Weigh to Be trial in Minnesota. The mean age was 51 years and 72% of the sample was female. Mean baseline BMI was 34 kg/m2.

Prospective cohort

Weight loss and weight maintenance

The Pound of Prevention trial involved a general population with an intervention focused on weight gain prevention. The Weigh to Be trial involved an overweight population with a telephone-based intervention focused on weight loss. Predictors included:

1) Self-weighing frequency (Never, Semi-monthly, Monthly, Weekly, Daily)

Outcomes were assessed at baseline, 12-, and 24-months follow-up for both samples.

1) ΔBMI (kg/m2)

In the Pound of Prevention sample, 992 (81%) participants were available for the 24-month follow-up. Participants who self-weighed daily (-0.8) lost significantly more body mass relative to participants who self-weighed weekly (0.3), monthly (0.8), semi-monthly (0.8), or never (1.1). Also, participants who self-weighed weekly gained significantly less body mass relative to participants who self-weighed monthly, semi-monthly, or never.

In the Weigh to Be sample, 1,000 (56%) participants were available for the 24-month follow-up. Participants who self-weighed daily (-1.9) lost significantly more body mass relative to participants who self-weighed weekly (-1.0), monthly (-0.2), semi-monthly (0.2), or never (0.8). Also, participants who self-weighed weekly lost significantly more body mass relative to participants who self-weighed monthly, semi-monthly, or never. Participants who never self-weighed gained significantly more weight relative to participants who self-weighed semi-monthly or monthly.

Note that findings were estimated from study graphs because precise means were not reported.

B1 – After adjustment for several potential confounders, there was clear benefit for both weight maintenance and weight loss with more frequent self-weighing reported at the 24-month follow-ups. The long follow-up and large sample sizes were strengths in both samples, but attrition bias was especially concerning in the Weight to Be sample.


Linde, et al. (2007) 27

4,660 female participants recruited from a health plan in Washington. The mean age was 52 years and the mean BMI was 28 kg/m2.

Cross-sectional

Weight in general

1) Self-weighing frequency (Never, Monthly, Weekly, Daily)

Outcomes were assessed at survey completion.

1) BMI (kg/m2)

The overall survey response rate was 62% and 4,581 participants had complete data for the analysis. Compared to participants who self-weighed daily (29.2), participants who self-weighed weekly (30.1), monthly (30.6), and never (30.9) had significantly higher BMI's. Also, participants who self-weighed weekly had significantly lower BMI's relative to participants who never self-weighed.

C2 – After adjustment for several potential confounders, more frequent self-weighing was associated with significantly, though modestly, lower BMI. The cross-sectional nature of the study and the reliance on self-report measures limits validity and any conclusions on cause-and-effect. Also, the low response rate may hamper generalizability.


Levitsky, et al. (2006) 28

Two separate experiments were conducted. In experiment 1, the sample consisted of 32 female freshman students recruited from introductory college classes in New York. Age ranged between 18 and 21. Baseline BMI was not reported, but weight was 63 kg. In experiment 2, the sample consisted of 41 female freshman college students recruited via school advertisements and classroom announcements in New York. Age was greater than 18 years. Baseline BMI was not reported, but weight was 62 kg.

Randomized-controlled trials

Weight maintenance

In experiment 1:

1) Experimental -

• Basic nutrition information

• Home scale provided, as well as instruction to weigh daily and e-mail observed weight to study staff

• Daily e-mail feedback on body mass change

2) Control -

• Basic nutrition information

In experiment 2:

1) Experimental -

• Basic nutrition information

• Home scale provided, as well as instruction to weigh daily and e-mail observed weight to study staff

• Daily e-mail feedback on recommended calorie consumption to maintain weight

2) Control -

• Assessment only

Outcomes were assessed at enrollment (ie, first week of class) and post-semester (ie, last week of class; ~10 weeks) for both samples.

1) ΔBody weight (kg)

In experiment 1, 26 (81%) participants were available for the post-semester follow-up. Participants in the Experimental group (0.1) gained significantly less weight relative to Controls (3.1).

In experiment 2, 32 (78%) participants were available for the post-semester follow-up. Participants in the Control group (2.0) gained significantly more weight relative to the Experimental group (-0.8).

B1 – Groups that employed a frequent self-weighing treatment gained less weight relative to groups who received minimal contact. These results were essentially replicated in both experiments. The experimental designs were limited, however, by the samples, which were small, quite homogenous, and not particularly well described.


Kruger, et al. (2006) 29

4,345 respondents from the HealthStyles survey, recruited through a representative consumer database in the U.S. In the analytical sample, the median age was between 45 and 64 years, and 62% were female. Median BMI was between 30 and 35 kg/m2.

Cross-sectional

Weight maintenance

1) Weight loser – reported lost weight and kept it off (Successful, Non-successful)

Outcomes were assessed at survey completion.

1) Daily self-weighing (%)

The overall survey response rate was 70% and 1,958 participants had complete data for the analysis and fit into the predictor categories. A significantly greater proportion of Successful weight losers (20) reported self-weighing daily relative to non-successful weight losers (11).

C3 – After adjustment for potential confounders, there were significantly more successful weight losers that reported daily self-weighing. There were several potential biases, however, in regard to the vague measurement and definition of a successful weight loser, as well as the exclusion of many respondents who were not believed to fit this definition.


Wing, et al. (2006) 30

314 participants who lost at least 10% of their body weight over the previous two years. The sample was recruited through newspaper advertisements, brochures, and weight loss program contacts in Rhode Island. The mean age was 51 years and 81% of the sample was female. Mean baseline BMI was approximately 29 kg/m2.

Randomized-controlled trial

Weight maintenance

Study conditions included:

1) Internet -

• Tool kit with self-monitoring diaries, pedometer, and several cans of Slim-Fast meal replacements

• Home scale, laptop computer, and Internet connection and instructed to submit weight and physical activity monitoring data to the study website weekly

• Immediate Internet feedback based on submitted weight

• Monthly (weekly during the first month) web-based treatment lessons led by Master's or PhD level nutritionists, exercise physiologists, or clinical psychologists

• Offered additional individual e-counseling if desired (to return to goal weight)

• Access to message board on the website

2) Face-to-face -

• Same as the Internet group, but weight information was sent over an automated telephone system and weekly counselling sessions were face-to-face

3) Control -

• Quarterly newsletter with information on diet, exercise, and weight loss

Secondary analytical predictors:

1) Self-weighing frequency (Daily, Less than daily)

Outcomes were assessed at baseline, 6-, 12-, and 18-months follow-up.

1) ≥ 2.3 kg weight regain (%)

291 (93%) participants completed the 18-month follow-up. Secondary analyses revealed that, within the Internet group, a significantly smaller proportion of participants who self-weighed daily (40) regained ≥ 2.3 kg relative to participants who did not self-weigh daily (68). Within the Face-to-face group, a significantly smaller proportion of participants who self-weighed daily (26) regained ≥ 2.3 kg relative to participants who did not self-weigh daily (58).

A2 – Both treatment groups, which involved frequent self-weighing, decreased the proportion of participants who regained at least 2.3 kg, but only the Face-to-face group significantly reduced the amount of total weight regained after 18 months. Within both treatment groups, daily self-weighing in particular predicted a significantly smaller proportion of participants who regained at least 2.3 kg. This study had several strengths including random assignment, a large sample size, multiple comparison groups, and very clear measures. It also suggested that the benefits of self-weighing may depend on the accompanying level of programmatic support, but the effects of self-weighing could not be isolated given all the other treatment components.


Jeffery, et al. (1984) 31

89 obese male participants recruited in Minnesota. The mean age was 53 years. Mean baseline BMI was approximately 32 kg/m2.

Prospective cohort

Weight loss

Participants completed a 15-week, group-counseling based behavioral weight loss intervention. Predictors included:

1) Self-weighing frequency (Daily, Less than daily)

Outcomes were assessed at baseline, post-treatment, 1-year, and 2-years.

1) ΔBody weight (lb)

81 (91%) participants were available for the 2-year follow-up. Participants who self-weighed daily (-17.1) lost significantly more weight at the 2-year follow-up relative to participants who self-weighed less than daily (-6.7).

B2 – There was significant weight loss benefits to participants who self-weighed daily at 2-years follow-up. Strengths included the long follow-up period. The analysis of self-weighing was done in a univariate fashion, however, and it was not clear if self-weighing was beneficial beyond the 1-year follow-up in the multivariate analyses that accounted for confounders.


Heckerman, et al. (1978) 32

23 overweight participants recruited in Rhode Island. The mean age was 47 years and 87% of the sample was female. Mean baseline BMI was not reported, but participants averaged 72% overweight.

Randomized-controlled trial

Weight loss

Study conditions included:

1) Weigh-in -

• Weekly weigh-ins for 10 weeks, followed by monthly weigh-ins for 6 months

• Weekly group-based treatment sessions for 10 weeks followed by monthly treatment sessions for 6 months

• Treatment sessions included instruction in stimulus control, self-monitoring, and eating/exercise advice

• Instruction to self-weigh frequently between treatment sessions

2) No Weigh-in -

• Same as the Weigh-in group, but weigh-ins only conducted at baseline, as well as the end of the treatment and follow-up phases

• Instructed not to self-weigh between sessions

Outcomes were assessed at baseline, 10-, and 34-weeks follow-up.

1) ΔBody weight (lb)

7 (30%) participants completed the 34-week follow-up. No significant differences were observed.

B3 – Participants in the No Weigh-in group actually lost more weight and were more likely to attend the follow-up visits, but the study was severely limited by a small sample size and attrition bias.


Tanaka, et al. (2004) 33

262 overweight female participants recruited from a hospital weight loss program in Japan. From the analytical sample, the mean age was 49 years. Mean baseline BMI was 29 kg/m2.

Prospective cohort

Weight loss

Participants were offered a 16-week nutrition education program that recommended a 1400 kcal/d diet. During this program, participants were advised to self-graph weight 4 times daily on a week-long graph. Predictors included:

1) Time (0-, 16-weeks follow-up)

Outcomes were assessed at 0-, 4-, 8-, 12-, and 16-weeks follow-up.

1) Body weight (log kg)

98 (37%) participants had complete data for analysis (ie, completed adequate self-weighing and completed weight control program). Body weight at 16-weeks (4.17) was significantly lower than 0-weeks (4.24).

C3 – Participants who received the intervention, which included a very frequent self-weighing component, lost significant weight over 16 weeks. Potential biases, however, were likely as a result of high attrition and the exclusion from the analysis of participants who could have served as controls (ie, those who did not self-weigh enough or failed to complete the weight loss program). Also, participants served as their own controls.


Fujimoto, et al. (1992) 34

89 obese participants, recruited through a hospital treatment program in Japan. The mean age was approximately 43 years and 83% of the sample was female. Mean baseline BMI ranged between 31 and 34 kg/m2. The analytical sample was stratified by sex and those that completed two years of follow-up.

Randomized-controlled trial

Weight loss

Study conditions included:

1) Behavior Therapy plus Charting -

• Recommendation to self-graph weight 4 times daily on a week-long graph

• Complete regular food diary

• Weekly or biweekly interviews (~6 month duration) with hospital physician to review weight graphs, food diaries, and discuss food and fluid intake.

2) Behavior Therapy Alone -

• Same as above, but without the daily graphing component

Outcomes were assessed at enrollment, post-treatment, and 2-years follow-up.

1) ΔBody weight (kg)

59 (66%) of the 74 female participants were available for the 2-year follow-up. It was unclear how many males were available for the 2-year follow-up. In the female sub-sample, the Behavior Therapy plus Charting group (-14.9) lost significantly more weight relative to the Behavior Therapy Alone group (-7.8) after two years.

B2 – The intervention was beneficial over 2 years in that the group that included weight charting 4 times daily lost significantly more weight relative to the group that received behavior therapy alone. Strengths included the long follow-up period. Generalizability may be questionable, however, given the intensity of the self-weighing protocol and the lack of process data documenting the observed (versus assigned) frequency of self-weighing. Also, methodological weaknesses included the vague description of some treatment procedures and stratification of the sample that severely reduced power.


VanWormer et al. International Journal of Behavioral Nutrition and Physical Activity 2008 5:54   doi:10.1186/1479-5868-5-54

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