Baker_R_C_-_Self-Monitoring May Be Necessary for Successful Weight Control

7/30/2019 Baker_R_C_-_Self-Monitoring May Be Necessary for Successful Weight Control

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BEHAVIOR THERAPY 24, 377-394, 1993

Self-Monitoring May Be Necessary forSuccessful W eigh t ControlRAYMOND C. BAKER

Illinois Institute of TechnologyAssociated Internal Medicine Physicians o f Central IllinoisDANIEL S. KIRSCHENBAUM

Rock Creek Center for Behavioral MedicineNorthwestern University Medical School

The relationship between self-monitoring and weight control was examined closelyby analyzing 18 weeks of data for 56 participants in a long-term cognitive behavioralweight-loss program. The percentage of subjects who monitored consistently, whichmoni toring variables were most related to weight change, and the effect of variabilityin monitoring on weight change were examined. Approximately 2A of the subjects moni-tored food consumption for the entire day more than ha lf of the days; approximately did not monitor on most days. M on it ori ng -an y food eaten, all foods eaten, timefood was eaten, quantity of food eaten, and grams of fat cons um ed-wa s positivelycorrelated with weight change. Not monitoring at all was negatively associated withweight change. More consistent monitors lost more weight and participants lost muchmore weight during thei r best, compared to their worst, weeks of monitoring. Theseresults support the notions that self-monitoring, and perhaps "obsessive-compulsiveself-regulation," are necessary for successful weight control.

S e l f - mo n i t o ri n g i s t h e s y s t ema t i c o b s e r v a t i o n an d r eco r d in g o f t a r g e t b e -hav io r s (Kanfer , 1970) . Se l f -m oni to r ing i s som et ime s descr ibe d as t he "co r -ner s ton e" (W adden , 1993 , p . 201) and the m os t e f fec t ive t echn ique used in be-hav io ra l t rea tm en t s o f obe s i ty (Ki r sche nbau m , 1987 ; Per r i , Nezu , & Viegener ,1992 , p . 60; Wa dde n & Fos t e r, 1992) . Dra m at i c sup po r t fo r t he e f fec tivenessThis study was conducted as a doctoral dissertation by the first autho r under the direction

of the second author. It was supported, in part, by grants to the second author from the NationalInstitute of Mental Health (R44 MH41663) and the Sandoz Nutrition Corpora tion. The authorswish to thank Kim Chupurdia and M. Ellen Mitchell for their help on this project. Portions ofthis study were presented at the annual conferences of the Associat ion for Advancement of Be-havior Therapy, November, 1991, and the American Psychological Association , August, 1992.

Requests for reprints should be sent to Dr. Raymond Baker, Associated Internal Medicine Phy-sicians o f Central Illinois, 200 Pennsylvania Ave., Suite 102, Peoria, IL 61603 or to Dr. Dan Kirsch-enbaum, Center for Behavioral Medicine, 676 North St. Clair, Suite 1790, Chicago, IL 60611.

377 0005-7894/93/0377-039451.00/0Copyright 1993 by Association for Advancementof Behavior TherapyAll rights of reproduction in any form reserved.


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378 BAKER AND KIRSCHENBAUMof self-monitoring was obtained by Fisher, Lowe, Jeffrey, Levenkron, andNewman (1982). Fisher et al. found that their clients who discontinued self-monitoring during a 3-week holiday season gained 57 times as much weightas their counterparts who sustained self-monitoring. Flanery and Kirschen-baum (1986) found that of 10 eating-habit changes assessed, self-monitoringwas the only one that significantly correlated with maintenance of weight losses11/2 years posttreatment. In another study, 73 %0 of the clients reported "alwaysor most always" recording their food intake at posttreatment, but only 8%recorded at this level at 1 year (Guare, Wing, Marcus, Epstein, Burton, &Gooding, 1989). Self-monitoring was one of four behaviors related to weightloss. Similarly, Rosenthal and Marx (1981; cited in Sternberg, 1985) found that89% of"nonrelapsers" reported relying on record keeping and calorie countingas a means of controlling posttreatment regain.These studies suggest part o f the rationale for increasing treatment dura-tion and argue for the corresponding conceptualization of obesity as a chroniccondition (Brownell & Jeffery, 1987; Jeffery, 1987; Kirschenbaum, 1988; Perri,1987). In fact, length of treatment has emerged as a significant factor in weightcontrol based on correlational analyses within treatment programs (e.g., Bel-iard, Kirschenbaum, & Fitzgibbon, 1992; Sandifer & Buchanan, 1983), meta-analyses (Bennett, 1986; Lindorff, 1987), and an experimental comparison of20- versus 40-week treatments (Perri, Nezu, Patti, & McCann, 1989). Despitethe efficacy of longer term treatment, the active elements responsible for im-provement remain poorly understood. For instance, Perri, Shapiro, Ludwig,Twentyman, and McAdoo (1984) speculated that the "content" of client-therapist interactions may have been the critical factor in posttreatment success.However, empirically based models of self-regulatory processes (e.g., Carver,1979; Kanfer, 1971; Kanfer & Gaelick-Buys, 1991; Kanfer & Karoly, 1972; Kirsch-enbaum, 1987) suggest that the content of therapist-client interactions mayhave less impact on weight control than the process of their interactions. Thatis, frequent contact between therapists and weight controllers probably en-gages and reinforces self-monitoring, self-evaluation, and related cognitiveprocesses that sustain behavior change. Recent research by Perri and his co-workers also supports this assertion (Perri & Nezu, 1993).The maintenance of consistent self-monitoring despite competing internaland external demands seems particularly critical (Kirschenbaum & Karoly,1977). Kirschenbaum and Tomarken (1982, p. 181) suggested that the term"obsessive-compulsive self-regulation" was necessary to describe the degreeof persistence at self-monitoring that seems necessary to prevent self-regulatoryfailure. When people self-monitor a variety of behaviors, such as fingernailbiting (Maletzky, 1974), academic performance (Broden, Hall & Mitts, 1971;Heffernan & Richards, 1981), and effort during athletic training (Hume, Martin,Gonzalez, Cracklen, & Genthon, 1985), they self-regulate effectively. Whenpeople discontinue self-monitoring, self-regulatory failure often follows (Kirsch-enbaum, 1987, 1992; Kirschenbaum et al., 1992).

Research on the effects of self-awareness on eating behaviors provides fur-ther support for the critical role of self-monitoring in self-regulated behaviorchange (Heatherton & Baumeister, 1991); that is, simply placing a mirror in


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SELF-MONITORING AND WE IGHT CHANGE 379front of restrained eaters and /or overweight subjects can decrease consump-tion o f food compared to conditions in which a mirror is not present (Pliner& Iuppa, 1978). Similar effects are observed when other procedures are usedto decrease self-awareness (Polivy, Herman, Hackett, & Kuleshnyk, 1986;Schotte, Cools, & McNally, 1990; Wardle & Beales, 1988; Williamson, 1990).Self-monitoring, by definition, heightens self-awareness. Thus, as describedin current models of self-regulation (see Carver & Scheier, 1981; Kanfer &Gaelick-Buys, 1991; Kirschenbaum, 1987), self-awareness and, perhaps, self-monitoring seem critical as promoters of effortful behaviors emitted in orderto achieve meaningful goals.Despite direct empirical evidence and indirect theoretical evidence frommodels o f self-regulation, self-monitoring has not been treated by researchersor clinicians as a necessary component of effective weight control. For instance,Sternberg (1985) noted that "no studies have succeeded in demonstrating arelationship between changes in target behaviors, such as record keeping orslowing down rate of eating, and reduction of weight" (p. 522). Self-monitoringhas been viewed as a process that may mediate weight change instead of asa vitally important outcome o f clinical intervention. The extent to which self-monitoring affects weight control requires further investigation in at least threeareas.First, at a purely descriptive level, it would be helpful to know what percen-tages of people in weight control treatment programs monitor consistently.Clearly, not all persons in treatment, particularly current treatments that lastfor many months or even for years, will monitor simply because they are en-couraged to do so. Without a clearer understanding of monitoring behavior,therapist and client expectations regarding monitoring behavior are likely tobe misaligned (Goldstein & Higginbotham, 1991). This may result in low efficacyand outcome expectancies, poorer therapist-client relationships, and less effec-tive treatment (Bernier & Avard, 1986; Stotland & Zuroff, 1991). We hypothe-sized that the consistency of participants' self-monitoring would vary con-siderably in a long-term obesity treatment program but that a substantialnumber of participants would monitor very completely and consistently.Second, it would be helpful to know whether the monitoring of certain vari-ables is more clearly related to weight control than is the monitoring of othervariables. For instance, is simply monitoring any food eaten during a givenday sufficient, or must food be monitored continuously for the entire day?Is it helpful to monitor addit ional weight-related variables such as mood? Per-haps there is an optimal number of variables to monitor. Clients may becomeburdened by the monitoring process, and disengage from it prematurely, whenthey attempt to attend to too many variables (Kanfer & Stevenson, 1985; McFall,1976). It may not matter which variables are monitored, because monitoringanything may serve as an attentional prompt toward effortful behavior. Wesuspected that the monitoring of variables that are most critical physiologi-cal ly - factors such as food, fat, exercise, and quanti ty of food con su me d-would be related to weight change. The monitoring of less critical variables -those such as water intake, situations, and companions with whom the foodwas consu med- wa s not expected to be as directly related to weight change.


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380 BAKER AND KIRSCHENBAUMT h i r d , t h e i s su e o f c a u s a l i t y re m a i n s u n c l e a r. D o e s s e l f - m o n i t o r i n g c a u s e

w e i g h t lo s s, o r a r e t h o s e w h o c o n s i s t e n t l y s e l f - m o n i t o r m o r e l i k e ly to s u c c e e da t w e i g h t c o n t r o l f o r o t h e r r e a s o n s ( e .g ., s t ro n g e r c o m m i t m e n t s , b e t t e r c o p i n gs k il ls )? O n e w a y to c o n s i d e r t h e d e g r e e t o w h i c h s e l f - m o n i t o r i n g c a n c a u s eb e h a v i o r c h a n g e is to c o n c e p t u a l i z e s e l f - m o n i t o r i n g a s e i t h e r a s t a te o r a t r a it .A t r a i t p e r s p e c ti v e s u g g e s ts t h a t s o m e p e o p l e u s u a l l y m o n i t o r v e r y c o n s i st e n tl y ,w h e r e a s o t h e r s t y p i c a l l y m o n i t o r i n c o n s is t e n tl y . A s t a te p e r s p e c t iv e e m p h a -s iz e s t h e v a r i a b i l it y w i t h i n i n d i v i d u a l s ' m o n i t o r i n g b e h a v i o r s . T h a t is , u n d e rs o m e c o n d i t i o n s ( o r s ta t es ) m o s t p e o p l e m a y m o n i t o r c o n s i st e n tl y , w h e r e a st h e i r m o n i t o r i n g m a y b e c o m e m o r e i n c o n s is t e n t w h e n t h e y a re , f o r e x am p l e ,s i c k o r e m o t i o n a l l y d i s t r a u g h t .M i l le r ( 1 98 7 ) d e v e l o p e d a t r a it l i k e c o n c e p t t h a t a p p l i e s p a r t i c u l a r l y w e l l t ot h e p r e s e n t f o c u s o n s e l f - m o n i t o r i n g . T h i s m e a s u r e h a s b e e n d e m o n s t r a t e dt o d i f f e r e n t i a t e i n d i v i d u a l s i n t o c o p i n g s t y l e c a t e g o r i e s b a s e d o n t h e i r s e lf -r e p o r t e d p r e f e r e n c e s f o r i n f o r m a t i o n a n d d i s t r a c t io n i n a v a r i e ty o f i m a g i n e ds t r e s s f u l s i t ua t i ons ( Mi l l e r, 1987). M i l l e r ( 1990) de s c r i b ed monitors a s t h o s ei n d i v i d u a l s w h o a r e s e n s it iv e t o t h r e a t - re l e v a n t i n f o r m a t i o n a n d w h o u t i li z et h is i n f o r m a t i o n i n t h e i r c o p i n g e f f o rt s. Blunters w e r e d e s c r ib e d a s t h o s e i n d i-v i d u a l s w h o a v o i d t h r e a t - re l e v a n t s o u r c e s o f i n f o r m a t i o n u n d e r s t r e ss f u l c o n -d i t io n s . W e sp e c u l a t e d t h a t m o n i t o r s m a y l o s e m o r e w e i g h t t h a n b l u n t e r s b e -c a u s e m o n i t o r s w o u l d b e m o r e l ik e ly t o s u s t a in s e l f- m o n i t o r in g a n d a t t e n t io n a lf o c u s i n g u n d e r s t re s s fu l c o n d i t i o n s ( a t r a it h y p o t h e s i s ) t h a n t o a t t e m p t t o e s-c a p e p e r c e p t i o n s o f f a il u r e o r p e r s o n a l i n a d e q u a c y ( C a r v e r & S c h ei e r, 1 98 1;H e a t h e r t o n & B a u m e i s t e r , 1 9 91 ; K a n f e r & S c h e f ft , 19 88 ; K i r s c h e n b a u m , 1 98 7).W e h y p o t h e s i z e d , h o w e v e r , t h a t r e g a r d le s s o f s u b j e c t s ' c o p i n g s t y le , th e y w o u l dl o se m o r e w e ig h t d u r i n g w e e k s in w h i c h t h e y m o n i t o r e d m o r e c o n s i s t e n tl y t h a nt h e y w o u l d d u r i n g w e e k s i n w h i c h t h e y m o n i t o r e d l e s s c o n s i s t e n t l y ( a s t a t eh y p o t h e s i s ) .T h e p u r p o s e o f t h e p r e s e n t s t u d y w a s t o e x a m i n e t h e e ff ec t o f s e l f- m o n i t o r in gw i t h a g r e a t e r le v e l o f s p e c i f ic i t y t h a n h a s p r e v i o u s l y c h a r a c t e r i z e d t h e w e i g h t -l o ss l i te r a tu r e . O u r g o a l w a s t o i n v e st ig a t e t h e i m p o r t a n c e o f s e l f - m o n i t o r i n ga n d t h e r e b y g u i d e f u t u r e r e se a r ch a n d t r e a t m e n t t o w a r d a b e t t e r u n d e r s t a n d i n go f t h e r o l e o f s e l f - m o n i t o r i n g i n e f fe c ti ve w e i g h t c o n t r o l .

MethodSubjects

F i f ty - s i x i n d i v i d u a ls ( 4 8 w o m e n a n d 8 m e n ) w h o h a d b e e n p a r t i c ip a t i n gi n a l o n g - t e r m c o g n i t i v e b e h a v i o r a l t r e a t m e n t p r o g r a m ( t h e P e o p l e A t R i s k[ P A R ] W e i g h t C o n t r o l P r o g r a m ; K i r s c h e n b a u m , 1 98 8, 1 9 9 2) v o l u n t e e r e d tos e rv e as s u b j e c ts . T h e s u b j e c ts h a d p a r t i c i p a t e d i n P A R f o r a n a v e r a g e o f 4 0.1 1w e e k s (SD = 6 0 . 9 9 ) a n d h a d l o s t a n a v e r a g e o f 21 .1 0 p o u n d s ( 9 .6 0 k g ; SD= 2 6 . 3 7 l b ) p r i o r t o b e g i n n i n g th i s s t u d y . F o r t y - o n e s u b j e c t s w e r e i n v o l v e di n g r o u p t r e a t m e n t a n d 15 i n i n d i v i d u a l t r e a t m e n t . ( F o r d e s c r i p t io n s o f s u b -j e c t s e l e c ti o n , t h e P A R p r o g r a m , a n d i ts e f fi ca c y s ee B e l ia r d , K i r s c h e n b a u m ,& F i t z g i b b o n , 1 99 2; C o n v i s e r , F i t z g i b b o n , & K i r s c h e n b a u m , i n p r e s s; F i t z -g i b b o n & K i r s c h e n b a u m , 1 9 92 ; K i r s c h e n b a u m , 1 98 8, 1 99 2).


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S E L F - M O N I T O R I N G A N D W E I G H T C H A N G E 381

S u b j e c t s ' m e a n w e i g h t a t t h e b e g i n n i n g o f t h i s s t u d y w a s 2 4 6 . 5 0 p o u n d s(112.05 kg, SD = 56 .41 l b ) w i t h a m ea n o f 75 .54070 ov e r w e i gh t (SD = 35.18) .T h e m e a n p e r c e n t o v e r w e i g h t w a s c a l c u l a t e d u s in g t h e 1 98 3 M e t r o p o l i t a n L i f eI n s u r a n c e C o m p a n y ' s S t a n d a r d H e i g h t- W e i g h t T a bl es . F o r t y -e i g h t o f t h e s u b -j e c ts w e r e C a u c a s i a n , 6 w e r e A f r i c a n - A m e r i c a n , a n d 2 w e r e o f o t h e r e t h n i cb a c k g r o u n d s . S u b j e c t s ' m e a n a g e w a s 4 3 . 8 2 y e a r s ( S D = 1 2.6 7). F o r t y - f i v ep e r c e n t o f t h e s a m p l e w e r e s i n g le ; 46 7 o w e r e m a r r i e d , a n d 9070 w e r e s e p a r a t e d ,d i v o r c e d , o r w i d o w e d . T h e y w e r e w e l l e d u c a t e d (1607o c o m p l e t e d o n l y h i g hs cho o l , 23 070 ha d a t t e nd ed s o m e co l l ege , 30070 ha d co m pl e t ed co l l ege , and 30070h a d o b t a i n e d g r a d u a t e d e g r ee s ). S e v e n ty - fi v e p e r c e n t o f t h e s a m p l e w e r e e m -pl oy ed fu l l t im e, 1107ower e u nem pl oy ed , 5 7o we r e r e t i r ed , 507o wer e ho m em ak e r s ,2~70 w e r e s t u d e n t s , a n d 2070 w e r e e m p l o y e d p a r t t im e . A l l s u b j e c t s n o t c u r -r e n t l y u s in g O p t i f a s t o r p l a n n i n g t o d o s o w e r e e l ig i b le f o r th i s s t u d y a n d w e r ee n c o u r a g e d t o p a r t ic i p a t e f o r a m i n i m u m o f 12 c o n s e c u ti v e w e e ks .Procedure

E a c h w e e k e a c h p a r t i c i p a n t w a s p r o v i d e d w i t h a n e w s e l f- m o n i t o r i n g b o o k l e ti n w h i c h h e o r s h e w a s s t ro n g l y e n c o u r a g e d t o r e c o r d al l f o o d c o n s u m e d d u r i n gt h e w e e k a n d t o c o u n t t h e c a l o r i e s i n t h e s e f o o d s . T h e b o o k l e t c o n s i s t e d e s -s e n t ia l ly o f b l a n k p a g e s w i t h c o l u m n s f o r ti m e , f o o d , a n d c a l o ri e s; t h is a l -l o w e d p a r t i c i p a n t s t o r e c o r d d a t a i n a re l a ti v e l y f r e e f o r m a t . E a c h p a g e o ft h e b o o k l e t w a s a p p r o x i m a t e l y 4 in c h e s w i d e b y 6 in c h e s lo n g ; t h e b o o k l e tw a s k e p t s m a l l t o m a k e i t e a s il y p o r t a b l e . T h e c o n t e n t s o f t h e b o o k l e t s w e r ed i s c u s s e d w i t h p a r t i c i p a n t s d u r i n g e a c h o f th e i r s e ss io n s . T h u s , s e l f - m o n i t o r i n gw a s a n i n t e g r al p a r t o f t r e a t m e n t ( i n a d d i t i o n t o b e h a v i o r a l c o n t r a c t i n g a n dt r a i n in g i n d e c i si o n m a k i n g , p r o b l e m s o l v i n g , p l a n n i n g , a n d r e la p s e p re v e n -t i o n ) . S u b j e c t s w e re e n c o u r a g e d t o u s e th e b o o k l e t s i n t h e s a m e m a n n e r d u r i n gt h i s s t u d y a s t h e y h a d p r i o r t o b e c o m i n g i n v o l v e d i n t h is p r o j e c t ; t h u s , s u b -j e ct s w e r e e n c o u r a g e d t o m o n i t o r o t h e r v a r i a b l e s - s u c h a s f a t g r a m s a n de x e r c i s e - b a s e d o n t h e i r sp e c if ic i n d i v i d u a l t r e a t m e n t i s su e s.E a c h s u b j ec t 's d a l l y m o n i t o r i n g w a s r e c o r d e d a s t o t h e o c c u r r e n c e o f t h ev a r i o u s t y p e s a n d q u a l i t y o f v a r i a b l e s m o n i t o r e d . T h e s e v a r i a b l e s i n c l u d e d(1 ) w h e t h e r s u b j e c t s m o n i t o r e d o n a g i v e n d a y a n d ( 2) w h e t h e r m o n i t o r i n gi n c l u d e d th e w h o l e d a y o r o n l y a p o r t io n . O t h e r v a r ia b le s m o n i t o r e d a n dr e c o r d e d i n c l u d e d ( 3 ) f o o d , ( 4 ) c a l o r i e s , ( 5) w e i g h t , ( 6 ) t y p e o f s i t u a t i o n , ( 7 )w h e r e f o o d w a s c o n s u m e d , ( 8) t im e f o o d w a s c o n s u m e d , ( 9 ) w i t h w h o m f o o dw a s c o n s u m e d , (1 0) w a t e r c o n s u m p t i o n , ( 11 ) e v e n t o r ( 12 ) s i t u a t i o n i n w h i c hf o o d w a s c o n s u m e d , ( 1 3 ) e x e r c i s e , ( 1 4 ) m o o d , ( 1 5 ) f a t c o n s u m p t i o n , ( 1 6 ) c a -l o r i c t o t a l , a n d (1 7) " o t h e r . " R e l i a b il it y f o r r e c o r d i n g o f b e h a v i o r s m o n i t o r e dw a s c a l c u l a t e d b y c o u n t i n g t h e n u m b e r o f a g r e e m e n t s / a g r e e m e n t s + d i sa g r ee -m e n t s . T o t a l r e l ia b i li ty , f o r 2 r a t e r s w i t h n o t r a i n i n g r e g a r d i n g s p e c i fi c r u l e s,was . 94 f o r a l l 17 va r i ab l e s .P a r t i c i p a n t s ' w e i g h ts w e r e re c o r d e d b y t h e r a p i st s a t e a c h w e e k l y m e e t in g .W h e n p a r t i c i p a n t s m i s s e d a s e ss io n , t h e m e a n d i f fe r e n c e b e t w e e n k n o w n w e i g h t sw a s r e c o r d e d . S i x t y - th r e e p e r c e n t o f t h e p a r t i c i p a n t s r e g u l a r l y w e i g h e d a t t h et r e a t m e n t s it e i n v i ew o f t h e i r t h e ra p i s ts . I n o r d e r t o ~ m p r o ve t h e a c c u r a c yo f w e i g h t d a t a , w e i g h ts w e r e v e ri f ie d b y t h e r a p i s ts v i a q u e s t i o n i n g d u r i n g s es -


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382 BAKER AND KIRSCHENBAUMs io n s . T h e r a p i s t s p r o v i d e d r e t ri e v a l c u e s, i n q u i r e d a b o u t w e e k l y w e i g h t c h a n g e s ,a n d e n s u r e d p r i v ac y . T h e s e p r o c e d u r e s h a v e b e e n s u g g e s te d a s m e a n s o f im -p r o v i n g t h e a c c u r a c y o f s e l f - r e p o r t e d w e i g h t d a t a ( C a m e r o n & E v e r s, 1 99 0).F u r t h e r m o r e , t h e i n v e s t i g a to r s c o r r o b o r a t e d a n y w e i g h t d i s c r ep a n c i e s w i t h s u b -j e c t s ' t h e r a p i s t s . S u b j e c t s a l s o c o m p l e t e d t h e M i l l e r B e h a v i o r a l S t y l e S c a l e( M i l le r , 1 98 7) a t t h e b e g i n n i n g o f th e i r i n v o l v e m e n t in t h e s t u d y .Data Analyses

T h e c e n t r a l f o c u s o f t h is s t u d y w a s t h e r e l a ti o n s h i p b e t w e e n s e l f - m o n i t o r i n ga n d w e i g h t c h a n g e. T h i s w a s e x a m i n e d b y c a l c u la t i n g th e c o r r e l a ti o n s b e t w e e nt h e m o n i t o r i n g v a r i a b l e s a n d b o t h w e i g h t c h a n g e a n d c h a n g e i n p e r c e n t o v e r-w e i g h t a t b o t h 1 2 a n d 18 w e e k s. T h e c o r r e l a t i o n s b e tw e e n w e i g h t c h a n g e a n dc h a n g e i n p e r c e n t o v e r w e i g h t w e r e a ls o c a l c u l a t e d w i t h i d e a l w e i g h t , in i t ia lw e i g ht u p o n e n t e ri n g th e p r o g r a m , n u m b e r o f p r e v io u s w e e ks in t h e p r o g r a m ,a n d a m o u n t o f w e i g h t l o s t d u r i n g t h e p r o g r a m .

R e s u l t sDescriptions of Weight Change and Self-Monitoring

Weight ChangeB y w e e k 1 2, p a r t i c i p a n t s ( N = 5 6 ) h a d l o s t a n a v e r a g e o f 4. 0 3 l b (1 .8 3 k g ;SD = 1 3.1 0 l b ) in a d d i t i o n t o t h e 2 1 . 0 1 l b t h e y h a d l o s t p r i o r t o b e g i n n i n gt h i s s t udy . B y we ek 18 , pa r t i c i p an t s ( n = 36 ) ha d l o s t 2. 81 l b (1 .28 kg ,SD = 17 .51 l b ). Al l bu t on e s ub j ec t bega n t h i s s t udy wi t h i n a th r ee - we ek pe r i od .T h e 2 0 - p e r s o n d i f f e re n c e i n s a m p l e s i ze b e t w e e n w e e k s 1 2 ( N = 5 6 ) a n d 18( n = 3 6 ) w a s d u e t o s u b j e c t s ' e n t e r i n g t h e s t u d y a t d i f f e r e n t t i m e s . A l l 2 0 s u b -j e c t s w e re s ti ll in v o l v e d at t h e t i m e d a t a c o l l e c t i o n w a s c o m p l e t e d b u t h a d n o ty e t c o m p l e t e d 18 c o n s e c u t i v e w e e k s, a l t h o u g h m o s t s u b j e c ts h a d a c t u a l l y c o m -p l e t e d m o r e t h a n 1 2 c o n s e c u t i v e w e e k s o f m o n i t o r i n g .

Self-Monitoring BehaviorD i v e r si ty in m o n i t o r i n g b e h a v i o r w a s c l ea r ly d e m o n s t r a t e d i n t h e p e r c e n t a g eo f s u b j e c ts w h o a c t u a l ly m o n i t o r e d a n d i n t h e t y p e a n d f r e q u e n c y o f t h e v ar i-

a b l e s m o n i t o r e d . S p e c i fi c a ll y , a s s h o w n i n F i g u r e 1 , a t 1 2 w e e k s 2 7 7 o o f t h es u b je c t s m o n i t o r e d a ll f o o d s e a te n o n b e t w e e n 5 1 % a n d 7 5 % o f t h e d a ys , a n d397o o f t h e s u b j e c t s m o n i t o r e d a ll f o o d s e a t e n o n 7 6 % o f t h e d a y s o r m o r e ;1670 o f t h e s u b j e c t s m o n i t o r e d a l l f o o d s e a t e n o n b e t w e e n 2 6 % a n d 5 07 0 o ft h e d a y s, a n d 1 8 % m o n i t o r e d o n f e w e r t h a n 2 5 % o f t h e d a y s. S i m i la r ly , a t18 w e e k s 7 2 % o f t h e s u b j e c t s m o n i t o r e d a l l f o o d s e a t e n 5 1% o f t h e t im e o rm o r e , a n d 1 4 % m o n i t o r e d a l l f o o d s e a t e n o n f e w e r t h a n 2 5 % o f t h e d ay s .Relationship Between Self-Monitoring and Weight Change

C o r r e l a t i o n a l a n a l y s e s w e r e c o n d u c t e d t o d e s c r i b e t h e r e l a t io n s h i p s b e t w e e nt h e m o n i t o r i n g o f 1 7 s p e ci fi c v a r i a b le s a n d w e i g h t c h a n g e ( se e t h e M e t h o ds e c t i o n f o r a c o m p l e t e l is t o f v a r ia b l e s) . T h e s e a n a l y s e s w e re c o n d u c t e d b ys u m m i n g t h e n u m b e r o f t im e s e a c h v a ri a b le w a s m o n i t o r e d a c r o ss b o t h 12


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38340

.oo 30tD"6m 2 0 ,cq )on 10 ,

SELF-MONITORING AND WEI GHT CHANGE

FIG. 1.

0 0-25% 26-50% 51-75%P e r c e n t a g e o f D a y s

Percentage of days on which all foods were monitored.

76-100%

and 18 weeks. As shown in Table 1, six variables correlated significantly withweight change after 12 weeks: (1) monitoring of any food consumed, (2)monito ring all foods eaten for the entire day, (3) monit oring time food waseaten, (4) monitor ing quantity of food eaten, (5) monitor ing grams of fat con-sumed, and (6) not monitoring. These same variables were also highly cor-related with weight change after 18 weeks, rs range = .54-.65, ps < .001). Thecorrelation between weight change during this study and amount of weightlost prior to beginnin g this study, r(56) = -.31, as well as the correl ation be-tween weight change and numbe r of prior weeks in treatment, r(56) = -.28,bot h failed to rea ch significance. Analyses using change in percent overweight

TABLE 1INTERCORRELATIONS AMONG SIGNIFICANT MONITORING

VARIABLES AND WE IGHT CHANGE AT 12 WEEKSVariable 1 2 3 4 5 61 Weight change2 Any food .42**3 All foods eaten .44** .98**4 Time .44** .90** .89**5 Quantity .41"* .84** .85**6 F a t . 3 5 * .36* .39*7 No monitoring -.41" -.99** -.97**

.78"*.40 .37"- . 9 0 " * - . 8 4 * * - . 3 5 *

* p < .01** p < .001


8/18

384 BAKER AND KIRSCHENBAUMr a t h e r t h a n w e i g h t c h a n g e i n p o u n d s r e v e a le d t h e s a m e f i n d in g s ; w e i g h t c h a n g ea n d c h a n g e i n p e r c e n t o v e r w e i g h t w e r e h i g h l y c o r r e la t e d , r (5 6 ) = .9 9, p < ,0 01 .Group Analyses

T h e p r e c e d i n g c o r r e l a t i o n a l a n a l y s e s c le a r l y d e m o n s t r a t e d s i g n if i ca n t r el a -t i o n s h i p s b e t w e e n m o n i t o r i n g a n d w e i g h t c h a n g e w h e n d a t a w e r e s u m m e da c r o s s a l l t h e w e e k s o f t h e s t u d y . A monitoring index u t i l i z i ng t he s i x va r i -a b l es t h a t c o r r e l a t e d s i g n if i c an t ly w i t h w e i g h t c h a n g e w a s c a l c u l a t e d t o p r o -v i d e a m o r e c o m p r e h e n s i v e a n d s t ri n g e n t m e a s u r e o f s u b j ec t s ' m o n i t o r i n g .T h e i n d e x w a s c a lc u l a te d b y s u m m i n g t h e n u m b e r o f t i m e s e a c h v a ri a b le o c -c u r r e d d u r i n g e a c h w e e k. T h e f o ll o w i n g f o r m u l a w a s u s e d to c o m p u t e t h em o n i t o r i n g i n d e x : m o n i t o r i n g a ll f o o d s e a t e n + m o n i t o r i n g o f a n y f o o d e a t e n+ m o n i t o r i n g ti m e f o o d w as e a t e n + m o n i t o r i n g q u a n t i t y o f f o o d e a t e n +m o n i t o r i n g g ra m s o f fa t c o n s u m e d - n o t m o n i t o r i n g . S u b j e c ts w e re d i v i d edi n t o t w o g r o u p s u t i l i z i n g a m e d i a n - s p l i t p r o c e d u r e b a s e d o n t h e i r i n d i v i d -u a l m o n i t o r i n g i n d e x e s a c r o s s 1 2 w e e k s, c r e a t in g a b e t w e e n - s u b j e c t s f a c t o r( O v er al l Le v el o f C o n s i s te n c y a n d C o m p l e te n e s s o f M o n i t o r i n g - H i g h V e rs usL o w ) .T h e e f f e ct o f i n d i v id u a l s u b j e c ts ' v a r i a b il i ty i n m o n i t o r i n g o n w e i g h t c h a n g ewas a l s o o f i n t e r e s t. To accom pl i s h t h i s wi t h i n - s ub j ec t s ana l ys i s, s ub j ec t s ' "be s t "a n d " w o r s t " w e e k s o f m o n i t o r i n g w e r e c al c u la t e d u s in g t h e m o n i t o r i n g i n de x ,c r e a t in g a w i t h in - s u b j e c t s f a c t o r ( B e s t V e rs u s W o r s t W e e k s o f M o n i t o r i n g ) .T h e b e s t a n d w o r s t w e e k s w e r e d e t e r m i n e d u s i n g t h e u p p e r a n d l o w e r q u a r -t il e s ( c f . Fe l d t , 1961) o f i ndexe s f o r 12 week s ( 3 be s t a nd 3 w or s t ) . A p r i o r ic r i te r i a w e r e s e t s o th a t w h e n m o r e o r f e w e r t h a n t h e e x p e c t e d n u m b e r o f b e s to r w o r s t w e e ks o f m o n i t o r i n g w e r e o b t a i n e d , a s in t h e c a s e o f ti es , th e m e a nw a s u s e d . F o r i n s t a n c e , i f t h e r e w e r e 5 w e e k s t h a t a l l m e t t h e c r i t e r i a f o r " w o r s tw e e k " d u r i n g t h e 1 2 -w e e k a n a ly s is , t h e m e a n w e i g h t c h a n g e f o r t h e 5 w e e k sw a s u se d . W h e n f ew e r t h a n t h e n e c e s s a ry n u m b e r o f b e s t a n d w o r st w e ek sw e re o b s e r v e d - o n l y 2 w e ek s, f o r i n s t a n c e - t h e m e a n w a s u se d . B e ca u se o ft ie s , a ll 1 2 w e e k s w e r e u s e d i n d e t e r m i n i n g t h e b e s t a n d w o r s t w e e k s o f t h em o n i t o r i n g i n d e x f o r 2 0 % o f t h e s u b je c ts .A t w o - w a y a n al y s is o f v a r i a n c e ( A N O V A ) w a s c o m p u t e d w i th t w o l e ve lso f a b e t w e e n - s u b je c t s f a c to r ( O v e ra ll L e v el o f M o n i t o r i n g - H i g h , L o w ) a n do n e w i t h in - s u b j e c t s f a c t o r ( B e s t V e r su s W o r s t W e e k s o f M o n i t o r i n g ) . A v e r-a g e w e e k l y w e i g h t c h a n g e s e r v e d a s t h e d e p e n d e n t v a r i ab l e . T h e g r o u p w i t ht h e h i g h e s t o v e r a l l l ev e l o f c o n s i s t e n c y a n d c o m p l e t e n e s s o f m o n i t o r i n gl o s t s i g n i f ic a n t l y m o r e w e i g h t t h a n t h e g r o u p w i t h th e l o w e s t o v e r a ll l e v elo f m on i t o r i n g , F ( 1 ,54 ) = 12 . 11 , p < . 01 . Su b j ec t s l o s t s ign i f i c an t l y m or ew e i g h t d u r i n g t h o s e w e e k s i n w h i c h t h e y m o n i t o r e d t h e i r b e s t c o m p a r e d t ow e e k s in w h i c h t h e y m o n i t o r e d th e i r w o r s t , F ( 1 , 5 4 ) = 8 . 6 0 , p < .0 1. T h e in t e r -a c t i o n e f f ec t b e t w e e n s u b j e c t s ' o v e ra l l l ev e l o f m o n i t o r i n g a n d t h e i r b e s t v e r s u sw o r s t w e e k s o f m o n i t o r i n g w a s n o t s i g n if i c a n t, F ( 1 , 5 4 ) = . 2 2, p = . 6 44 .F i g u r e 2 in d i c a t e s t h a t p a r t i c i p a n t s a t t h e h i g h e s t l ev e l o f t h e m o n i t o r i n g i n -d e x l o s t s ig n i f ic a n t ly m o r e w e i g h t th a n t h o s e a t t h e l o w e r l ev e l o f m o n i t o r -i ng , r e g a r d le s s o f w h e t h e r t h e i r b e s t o r w o r s t w e ek s o f m o n i t o r i n g w e r ec o m p a r e d .


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S E L F - M O N I T O R I N G A N D W E I G H T C H A N G E 385

- 1e-. ~0e-r"

10 .5

0

W o r s t W e e k s[ ] B e s t W e e k s

Low Monitors H i g h M o n i to r sFIG. 2. Mean weight change or groups of low and high monitors, comparing their best o w orstweeks o f m oni tor ing (based on m oni tor ing index data).

Comparisons Between Subjects at VariousLevels of Self-MonitoringT o e x a m i n e f u r t h e r t h e m a i n e f fe c ts d e m o n s t r a t e d i n th e A N O V A , m o r ed e t a i l e d d e s c r i p t i v e a n a l y s e s w e r e c o n d u c t e d r e g a r d i n g t h e r e l a t i o n s h i p b e -

t w e e n s e l f - m o n i t o r i n g a n d w e i g h t c h a n g e. A l l s u b j ec t s w e r e d iv i d e d i n t o q u a r -t il e s b a s e d o n t h e d i s t r i b u t i o n o f t h e p o p u l a t i o n ' s a c t u a l m o n i t o r i n g i n de x es .A t 12 w e e k s , 3270 a n d 7070 o f t h e s u b j e c t s m o n i t o r e d a t t h e 3 r d a n d 4 t h q u a r -t i le s , r e spec t ive ly , wh i l e 307o an d 3170 m on i to red a t t h e 1st and 2n d qua r t i l e s ,r e spec tive ly . S im i la r ly , a t 18 weeks 2507o an d 8070 m on i to red a t t he 3 rd an d4 th qua r t i l e s , r e spec t ive ly , wh i l e 2507o an d 4107o m on i to red a t t he 1s t an d 2n dqua r t i l e s , r e spec t ive ly . Th us , be tw een 3370 an d 39070 o f the sub jec t s m on i -t o r e d a t t h e 5 0 t h p e r c e n t il e o r h i g h e r o f t h e d i s t r i b u t i o n o f s u b j e c t s ' m o n i t o r i n gindexes ac ross the 18 weeks .F i g u r e 3 in d i c a te s t h e p e r c e n t a g e o f p e r s o n s w h o l o s t w e i g h t a t e a c h q u a r -t il e o f t h e m o n i t o r i n g i n d e x . G r e a t e r p e r c e n ta g e s o f s u b j e c ts l o s t w e i g h t i nt h e q u a r t i l e s t h a t r e f le c t e d g r e a t e r le v e ls o f c o n s i s t e n c y a n d c o m p l e t e n e s s o fm o n ito ri n g. Sp ecifica lly, 41070, 47070, 72070, an d 10070 los t w eig ht a t t he resp ec-t i v e q u a r t i l e s a t 1 2 w e e k s . F i g u r e 4 in d i c a t e s t h e c o r r e s p o n d i n g m e a n w e i g h tcha nge s o f + 1 .58 , - 1 .24 , - 7 .90, an d - 22 .13 po un ds , r e spec tive ly . A t week18, 33070, 60070, 78070, a n d 100070 los t w eig ht, res pe ctiv ely ( Fi gu re 3). F ig ur e4 i n d i c a te s t h e c o r r e s p o n d i n g m e a n w e i g h t c h a n g e s o f + 9 .3 1, - 1 . 7 3 , - 5 . 8 6 ,a n d - 3 1 . 1 7 p o u n d s , r es p ec ti ve ly . A o n e - w a y A N O V A d e m o n s t r a t e d s ig n i f ic a n td i ff e re n c es i n w e i g h t c h a n g e a m o n g t h e s u b j e c t s a t t h e v a r i o u s q u a r t i l es o ft h e m o n i t o r i n g i n d e x a t b o t h 1 2 w e e k s , F ( 3 , 5 5) = 5 .4 8 , p < . 01 , a n d 18 w e e k s ,F ( 3, 3 2) = 6 .1 6, p < . 0 1 . N e w m a n - K e u l s m u l t i p l e c o m p a r i s o n s r e v e a le ds i g n i f i c a n t d i f fe r e n c e s o n l y b e t w e e n s u b j e c t s a t t h e 4 t h q u a r t i l e a n d t h e f i r s t3 qua r t i l e s a t bo th 12 an d 18 week s (p < .05 ).A n o t h e r i ll u s tr a t io n o f t h e i m p o r t a n c e o f c o n s is t en c y o f s e l f - m o n i t o ri n g


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386

6" )

"--iO9~6t ~t- -

# _

FIG. 3.

100

B A K E R A N D K I R S C H E N B A U M

8 0

6 0

4 0

2 0

1 2 3 4Q u a r t i l e s

Percentage of subjects who lost w eight per quartile o f monitoring index.

w a s o b t a i n e d b y e x a m i n i n g w e ig h t c h a n g e s f o r t h e 7 su b j e ct s w h o h a d a b s o -l u t e l y n o v a r i a b i l i ty i n t h e c o m p l e t e n e s s o f t h e ir m o n i t o r i n g ( e. g. , m o n i t o r e da ll f o o d s e a t e n e v e r y d a y ) . S p e c i fi c a ll y , s ix s u b j e c t s m o n i t o r e d a ll f o o d s e a t e nw h i le o n e n e v e r m o n i t o r e d a ll f o o d c o n s u m p t i o n f o r a n e nt ir e d ay . T h e s u b -j e c ts w h o m o n i t o r e d a l l f o o d s e a t e n e v e r y d a y ( n = 6 ) l o s t 1 9. 86 p o u n d s ( m e a n )

10

.o 0. . .JC

0 3"- -10. -o~ -20C - 3 00 ,) 1 2 W e e k s

[ ] 18 W e e k s-4 0

Fic. 4.

1 2 3Q u a r t i l e s

Mean weight change per quartile of m onitoring index.


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SELF-MONITORING AND WE IGHT CHANGE 387c o m p a r e d t o t h e o t h e r s u b j e c t s w h o a l s o lo s t w e i g h t b u t h a d v a r i a b i l it y i nm o n i t o r i n g a l l f o o d s e a t e n ; t h o s e o t h e r s u b j e c t s ' a v e r a g e l o ss w a s 9.4 1 p o u n d s ,t (3 0 ) = - 2 . 2 1 ; p < . 05 . I n te r e st in g l y , t h e o n e s u b j e c t w h o n e v e r m o n i t o r e da l l f o o d s e a t e n g a i n e d 6 p o u n d s .

Regression AnalysesR e g r e s s i o n a n a ly s e s w e r e c o m p u t e d i n a n a t t e m p t t o i d e n t i f y t h e r e l a ti v ec o n t r i b u t i o n o f e a c h o f t h e s ix m o n i t o r i n g v a r i a b le s a s s o c i a te d w i t h w e i g htc h a n g e . E a c h o f t h e s ix v a r i ab l e s i n d i v id u a l l y a c c o u n t e d f o r s i g n if ic a n t a m o u n t so f v a r i a n c e : m o n i t o r i n g o f a n y f o o d c o n s u m e d , 1807o, F ( 1, 54 ) = 1 2.9 8, p


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388 BAKER AND KIRSCHENBAUMm e a s u r e is t h e s u m o f a l l o f t h e i te m s e n d o r s e d o n t h e m o n i t o r i n g s u b s ca l e;i n d i v i d u a ls s c o r i n g a b o v e t h e m e d i a n a r e c o n s i d e r e d h i g h m o n i t o r s a n d t h o s es c o r i n g b e l o w t h e m e d i a n a r e l o w m o n i t o r s . ( 2 ) T h e b l u n t i n g m e a s u r e i s t h es u m o f a l l o f t h e i t e m s e n d o r s e d o n t h e b l u n t i n g s u b s c al e ; s u b j e ct s s c o r i n ga b o v e t h e m e d i a n a r e c o n s i d e r e d h ig h b l u n t e r s a n d s u b j e c ts s c o r i n g b e l o w th em e d i a n a re l ow b l u n t er s . ( 3) T h e m o n i t o r / b l u n t e r m e a s u r e is o b t a i n e d b y s u b -t r ac t in g t h e t o t a l n u m b e r o f i te m s e n d o r s e d o n t h e b l u n t i n g s u b s ca l e f r o mt h e t o t a l n u m b e r o f i t e m s e n d o r s e d o n t h e m o n i t o r i n g s u b s c a l e . T h i s d i f f e r -e n c e s c o r e i s u s e d t o d i v i d e s u b j e c t s i n t o m o n i t o r s a n d b l u n t e r s .T h e m o n i t o r / b l u n t e r m e a s u r e d i d n o t d i f fe r e n t ia t e w e i g h t c h a n g e , t (5 6 ) =- . 8 2 , p = . 4 2, o r t h e m o n i t o r i n g o f a l l f o o d s e a t e n , t ( 5 6) + - 1 . 1 8 , p =. 2 4 , b e t w e e n m o n i t o r s a n d b l u n t e r s . T h e b l u n t i n g m e a s u r e d i d n o t d i f f e r e n -t i a t e w e i g h t c h a n g e , t ( 5 6) + - . 2 4 , p - - . 8 2 , o r th e m o n i t o r i n g o f a l l f o o d se a t e n , t ( 5 6 ) = - . 0 4 , p = . 97 , b e t w e e n h i g h a n d lo w b l u n t e r s . T h e m o n i t o r i n gm e a s u r e a l s o f a i l e d t o d i ff e r e n t i a t e w e i g h t c h a n g e , t ( 5 6 ) + - 1 . 3 0 , p = . 20 ,o r m o n i t o r i n g o f a l l f o o d s e a t e n , t ( 5 6 ) = - . 3 3 , p = . 7 4, b e t w e e n h i g h a n dl o w m o n i t o r s .

DiscussionS e l f - m o n i t o r i n g c o n s i s t e n t ly e m e r g e d a s a v i ta l c o m p o n e n t o f e f fe c ti v e w e i g h tc o n t r o l i n t h i s s t u d y . F i r s t , t h e p r e d i c t i o n t h a t s u b j e c t s w o u l d d e m o n s t r a t ec o n s i d e r a b l e v a r i a b i l i ty in l ev e ls o f s e l f - m o n i t o r i n g , w i t h a s u b s t a n t i a l n u m b e r

m o n i t o r i n g a t r e l a ti v e ly h i g h l ev e ls , w a s c o n f i r m e d . S e c o n d , a s e x p e c t e d ,t h e m o n i t o r i n g o f c e r t a i n v a r i a b l e s w a s r e l a t e d t o w e i g h t c h a n g e . S p e c i f ic a l ly ,t h e m o n i t o r i n g o f : (1 ) a n y f o o d e a t e n , ( 2) al l f o o d s e a t e n , ( 3 ) t i m e f o o d w a se a t e n , ( 4) q u a n t i t y o f f o o d e a t e n , a n d ( 5) g r a m s o f f a t c o n s u m e d w a s p o s i-t iv e l y c o r r e l a t e d w i t h w e i g h t c h a n g e , w h i l e ( 6 ) n o t m o n i t o r i n g a t a l l w a s n e g a -t i v e ly a s s o c i a t e d w i t h w e i g h t c h a n g e . I n c o n t r a s t , m o n i t o r i n g o f v a r i a b l e s su c ha s w a t e r i n ta k e , s i tu a t i o n s i n w h i c h f o o d w a s e a t e n , a n d w i t h w h o m t h e f o o dw a s c o n s u m e d w a s u n r e l a t e d t o w e i g h t c h a n g e . T h i r d , t h e p r e d i c t i o n t h a t s u b -j e c t s ' d i s p o s i t i o n a l m o n i t o r i n g s t y le a s as s e ss e d b y t h e M i l l e r B e h a v i o r a l S t y l eS c a l e w o u l d b e r e l a te d t o s e l f- m o n i t o r in g a n d w e i g h t c h a n g e w a s n o t c o n f i r m e d .H o w e v e r , r e g a r d l e s s o f d i s p o s i t i o n a l s t y l e , s u b j e c t s l o s t m o r e w e i g h t d u r i n gt h o s e w e e k s t h a t t h e y s e l f - m o n i t o r e d a t t h e i r h i g h e s t l ev e ls o f c o n s i s te n c y a n dc o m p l e t e n e s s .T h e p r e s e n t s t u d y s u b s t a n t ia t e s t h e r o l e o f s e l f - m o n i t o r in g a s a c r u c i a l c o m -p o n e n t i n t h e t r e a t m e n t o f o b e s i t y ( B r o w n e l l & F o r e y t , 19 85 ; K i r s c h e n b a u m ,1987 ; Pe r r i e t a l ., 1992 ; Wa dd en , 1993). A t a de s c r i p t i v e l eve l, be t w een 62070a n d 72 7 0 o f t h e s u b j e c ts m o n i t o r e d a ll f o o d s e a t e n m o s t o f t h e t i m e . T h e s el ev e ls o f m o n i t o r i n g a r e g e n e r a l ly h i g h e r t h a n l ev e ls r e p o r t e d i n o t h e r s t u d ie s( G ua r e e t a l ., 1989 ; S t r e i t , S t evens , S t evens , & Ro s s ne r , 1991). Sc h l u nd t 098 8)r e p o r t e d s i m i la r f in d i n g s w i t h s u b j e c t s u s in g t h e S e l f - M o n i t o r i n g A n a l y s i sS y s t e m ( S M A S ) . D u r i n g a p e r i o d o f b e t w e e n 8 a n d 1 2 w e e k s , 15070 o f s u b j e c t sd i d n o t s e l f - m o n i t o r , 10070 p r o v i d e d r e c o r d s a ll o f t h e t im e , a n d t h e r e m a i n i n g7 5 % p r o v i d e d d a t a b e t w e e n 6 5 % a n d 8 5 % o f th e ti m e . T h e P e o p l e A t R i sk( P A R ) P r o g r a m ' s c o n s i s te n t e m p h a s i s o n s e l f - m o n i t o r i n g ( se e K i r s c h e n b a u m ,


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SELF-MONITORING AND W EIGH T CHANGE 3891988, 1992) and Schlundt's (1988) similar emphasis may partially explain whysubjects in these studies monitored at higher than usual levels. Despite thisprogrammatic attention to the vital role of self-monitoring, more than 2570of the clients did not monitor on most days, and 14070 to 18070 of them aver-aged monitoring only 2 days or less per week. Given the effectiveness of thePAR program (see Beliard et al., 1992; Conviser et al., in press; Kirschenbaum,1988) and the emphasis placed on self-monitoring, these data suggest that asurprisingly substantial percentage of obese individuals in treatment can beexpected to monitor at relatively low levels.Differences between those who consistently monitor a t relatively high levelsand those who are poor and/o r inconsistent monitors require further investi-gation. In the PAR program, obese individuals who were older (Rosendahl& Kirschenbaum, 1988), more financially secure (Beliard et al., 1992), and lesspsychologicallydistressed (Beliard et al., 1992) have tended to lose weight andmaintain weight losses more effectively (see also Keefe , Wyshogrod, Weinberger,& Agras, 1984; Marcus, Wing, & Hopkins, 1988). Perhaps such "stabilizing"factors enable individuals to tolerate the inevitable imperfections of their effortsand thereby to sustain self-monitoring more consistently. Heartherton and Bau-meister (1991) suggested that the desire to "escape from self awareness" (e.g.,by discontinuing self-monitoring) may occur because people sometimes adoptunreasonably high standards and expectations. Perhaps many obese individ-uals disengage from self-monitoring in an attempt to escape perceptions offailure or personal inadequacy (Carver & Scheier, 1981; Kanfer & Schefft, 1988;Kirschenbaum, 1987).The monitoring of specific variables was clearly related to weight loss.Monitoring of the 5 variables positively correlated with weight change andnot monitoring accounted for 28070 of the variance in weight change. How-ever, significant amounts of variance were not contributed by the other vari-ables beyond the variance accounted for by the monitoring of any food. Thefrequency of monitoring certain variables, such as exercise or mood, may haveincreased if participants had been specifically instructed to monitor them orif the monitoring booklets had been structured differently. However, par-ticipants did monitor some variables consistently (e.g., grams of fat consumed)without being specifically instructed or prompted to so do. The high degreeof intercorrelation among the variables indicates that people may tend to mon-itor a certain set of variables when a fairly unstructured format is used. Forinstance, when subjects monitored any food, they almost always monitoredseveral other key variables for the whole day (e.g., any food/al l foods eaten,r (56) = .98). This clearly suggests that monitoring often occurs in an "allor none" fashion; that is, participants seemed to initiate and then maintainself-monitoring all day or they did not self-monitor at all that day. Thus, inaccord with self-regulatory heory (e.g., Carver & Scheier, 1981; Kirschenbaum,1987), attention may be more crucial than the actual information obtainedvia self-monitoring (cf. Perri et al., 1984). Clinically, it may be important towork on initiating and maintaining monitoring by helping clients maintainpositive self-attributions and expectations (Carver & Scheier, 1981, 1990;Heatherton & Baumeister, 1991; Kanfer & Gaelick-Buys, 1991).


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390 BAKER AND KIRSCHENBAUMSubjects who monitor at the highest levels lost the most weight. In fact,

as monitoring quality improved, so did the likelihood that subjects lost weight,particularly those monitoring at the highest levels (Figure 2). Other studieshave demonstrated that self-monitoring was related to weight loss (e.g., Guareet al., 1989; Sandifer & Buchanan, 1983; Stalonas & Kirschenbaum, 1985) andthat clients who completed the greatest number of weekly food records lostthe most weight during a 12-month period (Streit et al., 1992). It is noteworthythat in the present study, at both 12 and 18 weeks, subjects at the lowest quar-tile of monitoring quality actually gained weight (Figure 3). Although studieswith more power are needed to examine differences between quartile groups(Wing & Jeffery, 1984), the most consistent monitors (divided by the medianor the quartiles) lost more weight than their less consistent peers. Moreover,the 6 subjects who monitored all o f the foods they ate for 12 weeks lost twiceas much weight as other subjects who lost weight but had more variabilityin their monitoring. These findings underscore the importance of consistentmonitoring of key variables at relatively high levels to ensure successful weightcontrol. The findings support the suggestion that an "obsessive-compulsiveself-regulatory" style may be necessary for effective weight control (Kirschen-baum, 1987; Kirschenbaum & Tomarken, 1982).Although consistent with both the extant self-regulatory and obesity litera-tures, these findings only begin to address the issue of causality. Perhaps thosewho monitored at higher levels were better at weight loss because of otherfactors not measured in this study, such as commitment to losing weight (e.g.,greater self-efficacy), better coping skills, or some other dispositional charac-teristic. The Miller Behavioral Style Scale (Miller, 1987) did not predictmonitoring behavior. This scale was designed to assess coping style understressful conditions. Therefore, it may not have been relevant to the self-regulatory behaviors assessed in the present study. However, monitoring be-havior across all weeks was predicted reliably from monitoring during the firstweek. Similarly, Hartman, Wapner, and Saxton (1990, cited in Wadden & Foster,1992, p. 311) found that consistency of self-monitoring in the init ial weeksof treatment predicted weight loss over a 6-month period. This degree of con-sistency across time suggests that participant monitoring behaviors may beinfluenced by dispositional or trait factors. Some empirical and clinical ob-servations (Kirschenbaum et al., 1992) lead the authors to believe that certaincharacteristics such as obsessiveness, achievement orientation, and lack of psy-chopathology are associated with an enhanced ability to sustain self-awarenessvia self-monitoring. Perhaps individuals who sustain self-monitoring effortshave better frustration tolerance, are better able to make adaptive attributionsregarding their monitoring, or are less likely to be disrupted by cognitive oraffective factors (cf. Heatherton & Baumeister, 1991; Kanfer & Gaelick-Buys,1991). In accord with this trait-oriented perspective, high monitors lost weighteven during their worst weeks of monitoring (Figure 2). In contrast, the leastconsistent quartiles of monitors gained weight at both 12- and 18-week as-sessments.Not only did those subjects who self-monitored at higher levels consistently


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SELF-MONITORING AND WEIGH T CHA NGE 391lose more weight, but subjects lost more weight during those weeks they self-monitored more completely as compared to weeks in which they monitoredpoorly (i.e., best vs. worst weeks of monitoring). This suggests that variabilityin subjects' overall consistency and completeness of monitoring may beinfluenced by "state factors." One such state factor may be monitoring weightloss. When weight controllers lose weight for whatever reason (e.g., becauseof stressful life events or illness), they may improve their self-monitoring, whichin turn could improve other weight control behaviors (e.g., exercising; Holdenet al., 1992). Other psychological or emotional states may more directly im-prove self-monitoring and thereby improve weight control. These probablyinclude calm and positive moods, positive accomplishments, and strong en-couragement from therapists and other significant people in their lives(Heatherton & Baumeister, 1991; Kanfer & Schefft, 1988; Kirschenbaum, 1987).It is clear that consistent self-monitoring, regardless of dispositional styleor overall level of monitoring, is beneficial. Therefore, it would certainly beworthwhile for clinicians to help poor monitors achieve higher levels ofmonitoring. Educating weight control participants about the rationale andefficacy of self-monitoring early in the treatment process may be very usefulin this regard (e.g., by showing them Figures 2, 3, and 4). The positive treat-ment effect of role preparation has been demonstrated in a number of studies(Orlinsky & Howard, 1986). Evaluation of various strategies to initiate verystrong commitments to self-monitoring early in treatment would be worth-while because quality of monitoring early in treatment predicts monitoringacross many weeks (Wadden & Foster, 1992).It is unknown to what degree subjects' records of their self-monitoring wereaccurate. However, assuming this group is representative of obese persons intreatment, accuracy may not be as impor tant as previously suggested (Lansky& Brownell, 1982; Rapp, Dubbert, Burkett, & Buttross, 1986; Todd, Hudes,& Calloway, 1983). Participants' weight losses were clearly related to theirreports o f monitoring independent o f the objective veracity of their records.From a self-regulatory perspective, self-monitoring influences weight loss viaenhancement of attent ional focusing (e.g., Carver & Scheier, 1981; Kanfer &Karoly, 1972), and accuracy may be beneficial only to the extent that it im-proves self-focused attention.The current findings may prove useful in guiding the focus of therapeuticinterventions during the treatment of obesity. It is important to view self-monitoring not only as a process that mediates weight control but as an im-portant outcome as well. The relationship between weight change and behaviorchange is an imperfect one at best. Interventions focused exclusively on weightloss rather than on the behaviors that produce weight loss are misguided. Rein-forcement of weight loss rather than self-monitoring may also promote faultyattributions, inappropriate expectations, and ineffective weight control be-haviors. If we can develop creative and effective means of sustaining self-monitoring (and "obsessive-compulsive self-regulation"), we may help morepeople persist at changing refractory behaviors more effectively.


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39 2 BAKER AND KIRSCHENBAUM

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RECEIVED: No vem ber 30, 1992ACCEPTED: A pr il 15, 1993

Baker_R_C_-_Self-Monitoring May Be Necessary for Successful Weight Control

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