Most people would like to lose weight and have a healthy lifestyle. As simple as these goals sound, they require commitment and organization. This is where wearable devices like Fitbits and Jawbones can potentially be helpful. Aside from recording activity, these devices estimate caloric expenditure (please see my previous post for more information on this topic), encourage activity by giving feedback, and offer, through apps and websites, a host of additional information and support. But, what is the evidence? Can the use of Fitbit-like devices really lead to weight loss and a healthy lifestyle?
There was a nice review published in August, 2014 about the “behavior change techniques” that current research about Social Cognitive Theory have shown to be effective and whether electronic lifestyle activity monitors (like the Fitbit and Jawbone) utilize these techniques. The “behavior change techniques” that are supported by research are as follows: prompt practice, prompt self-monitoring of behavior, goal-setting/intention formation, barrier identification/problem solving, provide feedback on performance, prompt review of behavioral goals, provide information on consequences of behavior in general, action planning, prompt rewards contingent on effort of progress towards behavior, facilitate social comparison, provide instruction, self-talk, self-rewards, social support, and teach to use prompts/cues. The authors of this review then evaluated 13 devices, and their supporting apps and websites, with regard to which of these techniques were employed. All 13 had goal-setting, feedback on behavior, and self monitoring of behavior. 10 used the technique of reviewing behavior goals, while 8 used social support and social comparison. 6 used information about health consequences and 5 used action planning. There was minimal use of any of the other techniques and, certainly, no Fitbit-like device, with supporting apps and websites, used all of the techniques listed. This does not mean that Fitbit-like devices are destined to fail but, instead, that the manufacturers of Fitbit-like devices have a considerable opportunity to improve if these devices.
For those individuals who are trying to lose weight and improve their lifestyles, and for their coaches and physicians, the most important question about Fitbit-like devices is “do they work to help reach these goals?” There is some limited research on this topic. For example, Pellegrini et al recently published the results of a study in which three groups of subjects were compared over 6 months. One group attended weekly meetings about weight loss, the second group attended weekly meeting as well, but also used a wearable Fitbit-like armband, and the third group only used the Fitbit-like armband. As part of the protocol of the trial, all three groups reduced caloric intake and progressively increased physical exercise of “moderate” intensity. The researchers found that the three groups collectively lost an average of 6.4 kg (more than 14 pounds), decreased hip and waist circumference, decreased percentage of body fat, became more physically fit, increased physical activity, and ate less calories at the end of the 6 months, but that there were no statistically significant differences between the three groups. This means that using a Fitbit-like device can lead to the same improvement in weight, fitness, and lifestyle as can be achieved by attending weekly meetings. In another study, by Shuger et al, subjects were divided into four groups over 9 months: self directed weight loss with a manual, a group-based weight loss program, a Fitbit-like armband alone, and group-based weight loss plus a Fitbit-like armband. The researchers found significant weight loss from baseline in all three intervention groups (between about 4 and 14.5 pounds), but not in the self-directed group. However, only the group that used the combination of the group program and the Fitbit-like device achieved significant weight loss compared to the self-directed group. These results suggest that a variety of interventions can lead to weight loss, but that, at least in this study, only the combination of a group-based weight loss program and a Fitbit-like armband is more effective than reading and following a manual. Taken together, these two studies showed that the use of Fitbit-like devices can lead to weight loss and can be as effective as in-person interventions.
The research literature, therefore, has shown that Fitbit-like devices use some, but not all, techniques that are supported by Social Cognitive Theory and can be useful in efforts to lose weight and achieve a healthy lifestyle. However, there does not appear to be research about the duration of these benefits beyond 9 months. Ideally, the use of Fitbit-like devices will lead to lifelong improvements in lifestyle and won’t be a passing fad.
Lyons, EJ, Lewis, ZH, Mayrsohn, BG, et al. Behavior change techniques implemented in electronic lifestyle activity monitors: a systematic content analysis. J Med Internet Res 2014 Aug 15; 16(8):e192
Pellegrini, CA, Verba, SD, Otto, AD, et al. The comparison of a technology-based system and an in-person behavioral weight loss intervention. Obesity (Silver Spring) 2012 Feb; 20(2):356-363.
Shuger, SL, Barry, VM, Sui, X, et al. Electronic feedback in a diet- and physical activity-based lifestyle intervention for weight loss: a randomized controlled trial. Int J Behav Nutr Phys Act 2011 May 18; 8:41.