Dietary modifications are a common feature of lifestyle interventions; participants are encouraged to track their dietary intake through food journals and logs. However, it is unclear of what is the effect of increased dietary tracking on health outcomes. Participants in lifestyle management programs have cited the importance of self-monitoring dietary intake and physical activity to their success [9], yet limited studies have examined the benefits of increased self-monitoring. Participants in a 12-week weight loss program who tracked with their preferred method (e.g., pen and paper versus web-based service) were more adherent to tracking but did not significantly differ in weight loss [10]. A second study had participants track food intake with pen and paper, a memo pad on their phone, or with calorie tracking application on their phone [11]. Those who tracked with the application tracked significantly more days, but again, no difference in weight loss was noted between groups [11]. While neither study showed that better adherence to dietary tracking led to an increase in weight loss, the small sample sizes and lack of accounting of preprogram weight were limitations. However, in a 6-month study controlling for participant demographics, preprogram weight, program attendance, and physical activity for 1685 participants found increased adherence to dietary tracking-predicted weight loss [12]. Additional positive results were noted among participants who consistently adhered to dietary tracking with self-monitoring booklets over 8 weeks [13] and 12 weeks [14]; they lost more weight than those who were inconsistent in their tracking. While participants in lifestyle management programs report the importance of tracking in relation to improved outcomes, the research to date has shown mixed results.
The group sessions were participatory and interactive over 60 minutes, rather than didactic. Session activities fostered problem solving, group interactions and social support, skill development such as reading food labels, calculating calories and fat, and setting achievable goals for each week. Many sessions included guided physical activity, food demonstrations, or model meals. The intervention was tailored to the participants' preferences and readiness to change with careful attention to cultural appropriateness for the target populations. Each session program encouraged participants to set and develop reasonable short-term goals and behavioral action plans toward dietary modifications and moderate physical activity of 150 minutes per week. Food tracking booklets and pedometers were provided to monitor their dietary and physical activity levels.
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Participants were encouraged to do the following: (1) maintain daily food journals and physical activity records; (2) reduce portion sizes; (3) reduce foods high in calories, fat, and simple sugar; (4) increase consumption of fruits, vegetables, and low-fat dairy products; and (5) weigh themselves frequently and at least weekly. To promote accountability, participants weighed in at the beginning of each session and reported their minutes of physical activity and the number of daily diet records kept each week. Tracking of dietary intake included total calories and fat grams (using a 2016 CalorieKing book [17] provided to them) as well as a physical activity using step count from a pedometer provided to the participants each week. Participants turned in their food tracking books at each educational session and received feedback and individualized encouragement to improve lifestyle behaviors; they also received new blank booklets at each session to use for the following week.
While studies present equivocal benefit in weight outcomes with increased adherence to tracking, an 8-week study by Wharton et al. [11] found that those who tracked with mobile phone application tracked more days than those who tracked with either pen and paper or the memo pad on their phone, yet weight loss did not vary between the groups. However, those in the pen and paper and memo groups received nutritional counseling prior to the start of the program and received weekly emails to encourage healthy eating. The application group received no dietary advice outside the information from the nutritional software on total calories and macronutrient consumption. Hence, it is possible that the weekly emails or the nutritional counseling prior to the start of the program may have hidden the effect-increased adherence to dietary tracking of participants in the mobile phone application group on their final weight change. The results from the current study provide emerging evidence on the impact of increased adherence to dietary tracking on weight loss due to the standardized assessment of all participants in the program.
Our results suggest that consistent tracking had a significant impact on weight change over time. Tracking over 228 days did not have an effect on the linear, or instantaneous, rate of change. Early in the program weight change of consistent trackers did not differ from rare or inconsistent dietary trackers. However, rare or inconsistent trackers gained weight during the holidays but the consistent trackers' rate of weight loss did not change as they sustained their rate of weight loss from the first quarter. Hence, consistent dietary tracking seems to have a protective effect on participants' holiday eating challenges as they were able to survive the holiday parties and managed their holiday stress without adding extra pounds to their weight. Perhaps, consistent tracking helped these participants stay on track with programmatic goals and topics, such as planning healthy snacks and meals during the holiday season and being aware of fat, sugar, and calorie consumption. Thus, the rate of weight loss for consistent trackers closely followed the initial rate of change shown at the beginning of the program, as consistent tracking cancelled out the effect of the quadratic and cubic terms. This indicates that consistent tracking predicted more stable weight loss over time. However, future research should explore other factors that might impact weight loss to better understand both the process by which consistent tracking impacts weight loss as well as the outcome of sustainable weight loss. It is possible that consistent tracking allowed participants to be more mindful of their dietary habits and be motivated to avoid high calorie, fat, and sugary items (e.g., eating a cookie) during the holiday season to avoid writing it down in their tracking book. Additionally, the participants who consistently track may be more compliant and thus more likely to track and follow dietary recommendations of the program. Hence, it is possible that participant's personal characteristics could impact tracking adherence and weight outcomes.
Consistent tracking can also be viewed as a measure of resilience or ability to stay on track during challenging times (like the holiday season). As shown in the graph (Figure 3), the weight loss over time for a participant who consistently track followed a stable, negative linear trend. In contrast, weight loss over time for those who rarely or inconsistently track was unstable, as they lost weight in the first and last quarter of the program, while they gained weight during the middle, during the holiday seasons (Thanksgiving and Christmas), and during the winter months. The weight loss predicted during the second half of the program, that is, spring and summer months, may be explained by an increased motivation to change dietary habits in order to fit into beachwear and summer clothes for increased outdoor activities as the temperature warms up during this time of the year in West Virginia.
The reasons that someone is dieting may also play a role. As the previous section described, Muraven and colleagues found that your beliefs and attitudes may buffer you from the effects of depletion. In one example of this idea, he asked volunteers to resist eating from a plate of cookies placed before them. Then he tested their self-control strength by having them squeeze an exercise handgrip for as long as they could.
A few dietary supplements might enhance performance only when they add to, but do not substitute for, this dietary foundation. Athletes engaging in endurance activities lasting more than an hour or performed in extreme environments (e.g., hot temperatures or high altitudes) might need to replace lost fluids and electrolytes and consume additional carbohydrates for energy. Even with proper nutritional preparation, the results of taking any dietary supplement(s) for exercise and athletic performance vary by level of training; the nature, intensity, and duration of the activity; and the environmental conditions [13].
Studies have not adequately assessed the safety of deer antler velvet. The studies cited above found no side effects in participants taking deer-antler-velvet supplements. IGF-1 is available as a prescription medication, and its reported side effects include hypoglycemia, headache, edema, and joint pain [127]. An evaluation of six deer-antler-velvet dietary supplements that were commercially available in 2013 found that five of them contained no deer IGF-1, and four were adulterated with human IGF-1 [124]. Only one of the six supplements contained a low level of deer IGF-1.
Dimethylamylamine (DMAA) is a stimulant formerly included in some preworkout and other dietary supplements claimed to enhance exercise performance and build muscle. Studies have not evaluated DMAA in humans as a potential ergogenic aid. In 2013, FDA declared products containing this ingredient to be illegal after it received 86 reports of deaths and illnesses associated with dietary supplements containing DMAA. These reports described heart problems as well as nervous system and psychiatric disorders [202]. Furthermore, FDA had never approved DMAA as a new dietary ingredient that would reasonably be expected to be safe [202]. Although products marketed as dietary supplements containing DMAA are illegal in the United States, discontinued, reformulated, or even new products containing DMAA might still be found in the U.S. marketplace. The Department of Defense's Human Performance Resource Center maintains a list of currently available products that contain DMAA or are labeled as containing DMAA, 1-3-dimethylamylamine, or an equivalent chemical or marketing name (e.g., methylhexaneamine or geranium extract) [203]. be457b7860
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