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Introducing Dietary Self-Monitoring to Undergraduate Women via a Calorie Counting App Has No Effect on Mental Health or Health Behaviors: Results From a Randomized Controlled Trial

Published:August 02, 2021DOI:https://doi.org/10.1016/j.jand.2021.06.311

      Abstract

      Background

      Strong positive relationships between dietary self-monitoring and eating disorder risk are seen in population-based, observational studies. However, current evidence cannot establish causality. Furthermore, little is known about other mental and behavioral health consequences of dietary self-monitoring among college women, a population vulnerable to eating disorders.

      Objective

      To determine if introducing dietary self-monitoring via a popular smartphone app to undergraduate women impacts eating disorder risk, other aspects of mental health, or health behaviors including dietary intake and physical activity.

      Design

      Randomized controlled trial.

      Participants/setting

      Undergraduate women who had not engaged in dietary self-monitoring in the past year and who were at low-risk for an eating disorder participated between May and October 2019 (n = 200).

      Intervention

      Participants were randomly assigned to engage in dietary self-monitoring via MyFitnessPal for approximately 1 month or to receive no intervention.

      Main outcome measures

      Self-report data on eating disorder risk, other mental health outcomes, and health behaviors were collected at baseline and post-intervention.

      Statistical analyses performed

      Linear and logistic regressions were utilized to test hypotheses.

      Results

      Adherence to the intervention was high, with participants recording their dietary intake via MyFitnessPal on average 89.1% of days between baseline and post-intervention. Assignment to the intervention was not associated with changes in eating disorder risk, anxiety, depressive symptoms, body satisfaction, quality of life, nutritional intake, physical activity, screen time, or other forms of weight-related self-monitoring (all P > .05).

      Conclusions

      Among dietary self-monitoring naive undergraduate women with low-risk of an eating disorder, dietary self-monitoring via MyFitnessPal for 1 month did not increase eating disorder risk, impact other aspects of mental health, or alter health behaviors including dietary intake. The null results in our study may be due to the selection of a low-risk sample; future research should explore whether there are populations for whom dietary self-monitoring is contraindicated.

      Keywords

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      References

        • Jensen M.D.
        • Ryan D.H.
        • Apovian C.M.
        • et al.
        2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society.
        Circulation. 2014; 129: S102-S138
        • Harvey J.
        • Krukowski R.
        • Priest J.
        • West D.
        Log often, lose more: Electronic dietary self-monitoring for weight loss.
        Obesity (Silver Spring). 2019; 27: 380-384
        • Boutelle K.N.
        • Kirschenbaum D.S.
        Further support for consistent self-monitoring as a vital component of successful weight control.
        Obes Res. 1998; 6: 219-224
        • Bandura A.
        Health promotion from the perspective of social cognitive theory.
        Psychol Health. 1998; 13: 623-649
      1. MyFitnessPal—how an App got 165 Million Users. In: Jones D, ed. Mobile Engagement Podcast. iTunes2016.

        • Verto Analytics
        Most popular health and fitness apps in the United States as of May 2018, by monthly active users (in millions).
        • Neumark-Sztainer D.
        • van den Berg P.
        • Hannan P.J.
        • Story M.
        Self-weighing in adolescents: helpful or harmful? Longitudinal associations with body weight changes and disordered eating.
        J Adolesc Health. 2006; 39: 811-818
        • Ogden J.
        • Whyman C.
        The effect of repeated weighing on psychological state.
        Eur Eat Disord Rev. 1997; 5: 121-130
        • Berry R.
        • Rodgers R.
        • Campagna J.
        Outperforming iBodies: A conceptual framework integrating body performance self-tracking technologies with body image and eating concerns.
        Sex Roles. 2020; 85: 1-12
        • Galmiche M.
        • Déchelotte P.
        • Lambert G.
        • Tavolacci M.P.
        Prevalence of eating disorders over the 2000–2018 period: a systematic literature review.
        Am J Clin Nutr. 2019; 109: 1402-1413
        • Hudson J.I.
        • Hiripi E.
        • Pope Jr., H.G.
        • Kessler R.C.
        The prevalence and correlates of eating disorders in the National Comorbidity Survey Replication.
        Biol Psychiatry. 2007; 61: 348-358
        • Mitchell J.E.
        • Crow S.
        Medical complications of anorexia nervosa and bulimia nervosa.
        Curr Opin Psychiatry. 2006; 19: 438-443
        • Swanson S.A.
        • Crow S.J.
        • Le Grange D.
        • Swendsen J.
        • Merikangas K.R.
        Prevalence and correlates of eating disorders in adolescents. Results from the national comorbidity survey replication adolescent supplement.
        Arch Gen Psychiatry. 2011; 68: 714-723
        • Romano K.A.
        • Swanbrow Becker M.A.
        • Colgary C.D.
        • Magnuson A.
        Helpful or harmful? The comparative value of self-weighing and calorie counting versus intuitive eating on the eating disorder symptomology of college students.
        Eat Weight Disord. 2018; 23: 841-848
        • Simpson C.C.
        • Mazzeo S.E.
        Calorie counting and fitness tracking technology: Associations with eating disorder symptomatology.
        Eat Behav. 2017; 26: 89-92
        • Plateau C.R.
        • Bone S.
        • Lanning E.
        • Meyer C.
        Monitoring eating and activity: Links with disordered eating, compulsive exercise, and general wellbeing among young adults.
        Int J Eat Disord. 2018; 51: 1270-1276
        • Hahn S.L.
        • Sonneville K.R.
        • Kaciroti N.
        • Eisenberg D.
        • Bauer K.W.
        Relationships between patterns of technology-based weight-related self-monitoring and eating disorder behaviors among first year university students.
        Eat Behav. 2021; 42: 101520
        • Hahn S.L.
        • Bauer K.W.
        • Kaciroti N.
        • Eisenberg D.
        • Lipson S.K.
        • Sonneville K.R.
        Relationships between patterns of weight-related self-monitoring and eating disorder symptomology among undergraduate and graduate students.
        Int J Eat Disord. 2021; 54: 595-605
        • Levinson C.A.
        • Fewell L.
        • Brosof L.C.
        My Fitness Pal calorie tracker usage in the eating disorders.
        Eat Behav. 2017; 27: 14-16
        • Jebeile H.
        • Gow M.L.
        • Baur L.A.
        • Garnett S.P.
        • Paxton S.J.
        • Lister N.B.
        Treatment of obesity, with a dietary component, and eating disorder risk in children and adolescents: A systematic review with meta-analysis.
        Obes Rev. 2019; 20: 1287-1298
        • Gow M.L.
        • Tee M.S.Y.
        • Garnett S.P.
        • et al.
        Pediatric obesity treatment, self-esteem, and body image: A systematic review with meta-analysis.
        Pediatr Obes. 2020; 15e12600
        • Benn Y.
        • Webb T.L.
        • Chang B.P.
        • Harkin B.
        What is the psychological impact of self-weighing? A meta-analysis.
        Health Psychol Rev. 2016; 10: 187-203
        • Embacher Martin K.
        • McGloin R.
        • Atkin D.
        Body dissatisfaction, neuroticism, and female sex as predictors of calorie-tracking app use amongst college students.
        J Am Coll Health. 2018; 66: 608-616
        • Hahn S.L.
        • Lipson S.K.
        • Sonneville K.R.
        Dietary self-monitoring is associated with increased likelihood of problematic alcohol use among college students.
        J Am Coll Health. 2020; (In press): 1-6https://doi.org/10.1080/07448481.2020.1741592
        • Lipson S.K.
        • Sonneville K.R.
        Eating disorder symptoms among undergraduate and graduate students at 12 U.S. colleges and universities.
        Eat Behav. 2017; 24: 81-88
        • Kahan S.
        • Puhl R.M.
        The damaging effects of weight bias internalization.
        Obesity (Silver Spring). 2017; 25: 280-281
        • Christoph M.J.
        • Ellison B.
        A cross-sectional study of the relationship between nutrition label use and food selection, servings, and consumption in a university dining setting.
        J Acad Nutr Diet. 2017; 117: 1528-1537
        • Graham D.J.
        • Laska M.N.
        Nutrition label use partially mediates the relationship between attitude toward healthy eating and overall dietary quality among college students.
        J Acad Nutr Diet. 2012; 112: 414-418
        • Quick V.
        • Larson N.
        • Eisenberg M.E.
        • Hannan P.J.
        • Neumark-Sztainer D.
        Self-weighing behaviors in young adults: Tipping the scale toward unhealthy eating behaviors?.
        J Adolesc Health. 2012; 51: 468-474
        • Sarcona A.
        • Kovacs L.
        • Wright J.
        • Williams C.
        Differences in eating behavior, physical activity, and health-related lifestyle choices between users and nonusers of mobile health apps.
        Am J Health Educ. 2017; 48: 298-305
        • Fairburn C.G.
        • Beglin S.J.
        Eating Disorder Examination Questionnaire (6.0).
        in: Fairburn C.G. Cognitive Behavior Therapy and Eating Disorders. Guilford Press, 2008
        • Carter J.C.
        • Stewart D.A.
        • Fairburn C.G.
        Eating disorder examination questionnaire: norms for young adolescent girls.
        Behav Res Ther. 2001; 39: 625-632
        • Harris P.A.
        • Taylor R.
        • Minor B.L.
        • et al.
        The REDCap consortium: Building an international community of software platform partners.
        J Biomed Inform. 2019; 95: 103208
        • Harris P.A.
        • Taylor R.
        • Thielke R.
        • Payne J.
        • Gonzalez N.
        • Conde J.G.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Mifflin M.D.
        • St Jeor S.T.
        • Hill L.A.
        • Scott B.J.
        • Daugherty S.A.
        • Koh Y.O.
        A new predictive equation for resting energy expenditure in healthy individuals.
        Am J Clin Nutr. 1990; 51: 241-247
        • Gideon N.
        • Hawkes N.
        • Mond J.
        • Saunders R.
        • Tchanturia K.
        • Serpell L.
        Development and psychometric validation of the EDE-QS, a 12 item short form of the Eating Disorder Examination Questionnaire (EDE-Q).
        PLoS One. 2016; 11e0152744
        • Duffy M.E.
        • Calzo J.P.
        • Lopez E.
        • Silverstein S.
        • Joiner T.E.
        • Gordon A.R.
        Measurement and construct validity of the Eating Disorder Examination Questionnaire Short Form in a transgender and gender diverse community sample.
        Psychol Assess. 2021; 33: 459-463
        • Prnjak K.
        • Mitchison D.
        • Griffiths S.
        • et al.
        Further development of the 12-item EDE-QS: Identifying a cut-off for screening purposes.
        BMC Psychiatry. 2020; 20: 146
        • Irwin M.
        • Artin K.H.
        • Oxman M.N.
        Screening for depression in the older adult: criterion validity of the 10-item Center for Epidemiological Studies Depression Scale (CES-D).
        Arch Intern Med. 1999; 159: 1701-1704
        • Marteau T.M.
        • Bekker H.
        The development of a six-item short-form of the state scale of the Spielberger State-Trait Anxiety Inventory (STAI).
        Br J Clin Psychol. 1992; 31: 301-306
        • Cash T.F.
        • Fleming E.C.
        • Alindogan J.
        • Steadman L.
        • Whitehead A.
        Beyond body image as a trait: the development and validation of the Body Image States Scale.
        Eat Disord. 2002; 10: 103-113
        • Lindner P.
        • Frykheden O.
        • Forsstrom D.
        • et al.
        The Brunnsviken Brief Quality of Life Scale (BBQ): Development and Psychometric Evaluation.
        Cogn Behav Ther. 2016; 45: 182-195
        • Kann L.
        • McManus T.
        • Harris W.A.
        • et al.
        Youth Risk Behavior Surveillance—United States, 2015.
        MMWR Surveill Summ. 2016; 65: 1-174
      2. Youth Risk Behavior Surveillance: National College Health Risk Behavior Survey—United States, 1995.
        MMWR CDC Surveill Summ. 1997; 46: 1-56
        • Wiley D.C.
        • James G.
        • Furney S.
        • Jordan-Belver C.
        Using the Youth Risk Behavior Survey to compare risk behaviors of Texas high school and college students.
        J Sch Health. 1997; 67: 45-49
        • Quick V.
        • Loth K.
        • MacLehose R.
        • Linde J.A.
        • Neumark-Sztainer D.
        Prevalence of adolescents’ self-weighing behaviors and associations with weight-related behaviors and psychological well-being.
        J Adolesc Health. 2013; 52: 738-744
      3. Obesity: preventing and managing the global epidemic. Report of a WHO consultation.
        World Health Organ Tech Rep Ser. 2000; 894: 1-253
        • Linardon J.
        • Messer M.
        My fitness pal usage in men: Associations with eating disorder symptoms and psychosocial impairment.
        Eat Behav. 2019; 33: 13-17
        • McCaig D.
        • Elliott M.T.
        • Prnjak K.
        • Walasek L.
        • Meyer C.
        Engagement with MyFitnessPal in eating disorders: Qualitative insights from online forums.
        Int J Eat Disord. 2020; 53: 404-411
        • Boone L.
        • Soenens B.
        • Luyten P.
        When or why does perfectionism translate into eating disorder pathology? A longitudinal examination of the moderating and mediating role of body dissatisfaction.
        J Abnorm Psychol. 2014; 123: 412-418
        • Eikey E.V.
        • Reddy M.C.
        • Booth K.M.
        • et al.
        Desire to be underweight: Exploratory study on a weight loss app community and user perceptions of the impact on disordered eating behaviors.
        JMIR Mhealth Uhealth. 2017; 5: e150

      Biography

      S. L. Hahn is an NIMH T32 Eating Disorders Postdoctoral Fellow, Division of Epidemiology & Community Health, University of Minnesota School of Public Health, Minneapolis and Department of Psychiatry & Behavioral Sciences at the University of Minnesota Medical School. Minneapolis. At the time of the study, she was a doctoral candidate, Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.

      Biography

      N. Kaciroti is a research scientist, Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, and Department of Pediatrics, University of Michigan Medical School, Ann Arbor.

      Biography

      D. Eisenberg is a professor, Department of Health Policy and Management, University of California Los Angeles School of Public Health, Los Angeles.

      Biography

      H. M. Weeks is a senior statistician, Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.

      Biography

      K. W. Bauer is an Associate Professor from the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.

      Biography

      K. R. Sonneville is an Associate Professor from the Department of Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor.