Question 3
Patient’s food intake was measured using a 4-day food diary and physical activity was measured using a pedometer. What other methods (if any) could be used to measure intake and physical activity and in your opinion, did the researchers choose the best methods of measurement for this study?
posted by Anonymous @ 6:53 PM
23 comments
23 Comments:
Measuring dietary intake in and of itself is extremely tricky due to the fact that oftentimes individuals underreport the amount of food and/or beverages actually consumed. If a patient develops disordered eating patterns, such as binge-eating or night-eating syndrome, they are most likely not going to include this information within their food-diaries. Perhaps stressing the importance of personal honestly while filling out the diaries would result in greater reliability. Overall, I do not think that the researchers chose the best method of measuring physical activity, mainly because it was only measured at the last visit. Perhaps the patients increased their activity only when wearing the pedometers. I think that if the patients were asked to wear their pedometers on a daily basis or at least 4 times a week (over the course of the study) greater weight loss and weight maintenance may have resulted. In addition, the researchers would have been able to compare the changes in physical activity over time.
Food records or diaries can be issues in and of themselves if not done properly. I wonder if the researchers did some control with the records such as reviewing portion sizes/measuring cups periodically or taking the food record, but then doing a 24-recall of the last day with probing questions to make sure the participant really wrote down everything they ate. If, however, the participants were trained properly and had random skill checks to ensure accuracy, this might have been the best option for intake.
I think the pedometer doesn't always reflect what someone did for activity. For example, someone could be doing strength training exercise but not really moving their legs in the stepping motion, thus not increasing their count. I think activity logs with this information would have provided a better picture of activity.
Anna, that's a great point about the limited use needed for the pedometers for their data. Requiring the participants to wear it more often and record the data would make them be more active on a regular basis.
I think for the type of study being conducted, the researchers chose two of the best methods of measurement. However, the food diary could be extended to 7 days, to give a more extensive look into the subject's diet. Although a pedometer may not calculate all types of movement/exercise, I think it is the easiest and most honest method, as long as the patient uses it correctly. Other methods of measurement could be used in addition to those already used, such as food frequency questionnaires and exercise logs.
Like Anna and Rachel said, obtaining accurate food intake from patients can be difficult. For the purpose of this study, the food diary would be the best method. I think that it may have been more beneficial to have a food diary for a longer period of time, such as one week, instead of 4 days. It could have also been supplemented by a food frequency questionnaire to give a larger picture of the patient’s usual intake.
I think that using the pedometer was the best option for this study. It is the easiest way for the patient’s to accurately monitor their own physical activity. If the patient participated in other activities that were not reflected in the pedometer, it may be necessary to keep a separate exercise log.
I think Anna made a great point about the use of pedometers in this study. The patients may have increased their physical activity while wearing the pedometers, which would not accurately reflect their normal physical activity habits. On the other hand, if the patients were only asked to keep an exercise log it would be much easier to be dishonest. This is why I think that a combination of these two methods would be the most accurate for this study.
I think that the researchers chose reasonable methods of measurement for this study. They included 4 days of the patients recording their food intake and that is better than just doing a 24-hour recall. Using a pedometer is definitely a great way for the patients to track their physical activity however it may not always be accurate due to the fact that some patients may forget to put it on some days and would therefore be inaccurate. Pedometers are also not the best way to assess the type of physical activity that is performed. For example, lifting weights or even doing something as simple as gardening may not be taken into account since pedometers track the amount of steps that a person takes. The 4-day food diary, just as any self reported measurement has its flaws. Most people do not measure out their foods and often times misjudge the amount or portion of food that they are eating. Another method of ensuring accuracy would be for the patients to have access to a diet analysis software so that they can easily plug in brands and amounts of foods so that it is more accurate than trying to remember or just guessing (most diet software has tips and help options for portion sizes). Also for the physical activity, the patient could maybe keep a physical activity journal or use something like mypyramid.gov to keep track of their food intake and physical activity.
Anna you make a good point about how patients can often times withhold information because they know that what they are doing is not good/healthy (binge-eating etc.). I also agree with the pedometer not being the greatest choice for tracking their physical activity, especially since they were not really enforced to wear it at all times.
Dietary intake is always a hard thing to measure for research because their is no 100% way to know that the measurements are correct unless you have the resources to watch someone all day everyday to keep track of every move they make. If I were doing a study similar to this I would continue to use the pedometer and food diary.
Rachel.
I agree an activity log as well as wearing the pedometer all day would be an excellant judge of their activity. In addition to this there are new devices out there that are attached to your body (body bug) and read your calorie intake and output.
I believe that the researchers chose two great ways to assess physical activity and dietary intake for this study. Using a pedometer seems to be the best way to measure the activity of the patients in this setting, although, like many stated above, it doesn’t measure all types of physical activity. Also, a 7-day food diary could be used instead of the 4-day diary to get a better understanding of the patient’s dietary intake.
As everyone has mentioned, food diaries of whatever length (in days) are not the most reliable measurement tool. That being said, I do think it is probably the best tool for this purpose, regardless of inaccuracy. Pedometers are a good way to increase awareness of how many steps one is taking throughout the day, and provides a concrete measurement. I think pedometers provide a good teaching point for RD's, rather than the abstract 'increase physical activity,' they can see 'I need to walk more to get 3000 steps per day.' Pedometers can be unreliable if they are not fastened to the right spot on the hip, however provided the proper instruction, I do think that they are a good option for this study.
For the food diary, I agree with everyone else who mentioned that this really is the best method of measuring a person's intake, although it is flaud. I also agree with Rose and Meredith when they mentioned that the time period of 4 days should be extended however I do not think it should be extended to a whole week. As we all know from the Diabetic For A Week project that these logs are time consuming and tedious so giving the patients a break a few days a week may make them more willing to adhere to the plan. I would say extend the time to 5 days a week with 2 days to relax. As for the pedometers, I feel this was not the best choice. As many mentioned, these can be very inaccurate in determing someone's physical activity. I think that an exercise log, along with the food diary would be a better method. Since they are already doing the food diary why not have them jot down what their activity level was for the day. This way they are killing 2 birds with one stone and making things simplier usually is a good way to go. I also think heart rate monitors would be more beneficial in determining activity levels and this way they would have a goal to reach when performing these physical activities.
Shelby,
I thought it was very interesting that you mentioned a body bug because I have never heard of that before. I was curious while debating this particular question about the technology that we must have in order to make determining physical activity more accurate. I was thinking there must be something else out there with all the crazy gadgets we have today geared towards physical activity levels and the body bug reference answered my question. So I am going to have to agree that measuring someone's caloric input and output would be an excellent way to not only measure physical activity but food intake as well!
Food diaries are notorious for their inaccuracy. To strengthen the accuracy of this tool, I think the food diary should have been for 7 days instead of 4, as people often eat very differently on weekends than on weekdays. Additionally, subjects should have received some tools to help them estimate portion sizes before being asked to record their eating habits. Perhaps a food frequency questionnaire should also have been completed with an RD to increase the accuracy of the dietary intake measurements.
In terms of physical activity, I really don't think a pedometer was the way to go. First of all, pedometers do not work as well on higher weight individuals as they do on individuals with flatter waists. Secondly, there are so many kinds of physical activity besides those measureable with a pedometer. Lastly, wearing a pedometer is likely to affect the amount of certain activities an individual does. I think keeping track of physical activity via a food and exercise log might increase the accuracy of physical activity measurement.
Anna Taylor
Anna, that is an excellent point about the risk of disordered eating patterns not being recorded in the food journal. Also, I agree that expecting honest and accurate reporting of food intake can be problematic for a researcher (or for a RD!)
Anna Taylor
This is a tricky area. I personally feel that 4-day food diary is not enough, especially if a person isn’t being accurate or honest. Also, I feel like 4 days isn’t nearly long enough to make a sustaining change in one’s habits. If that was extended to a 2-week food diary, I think it would depict the participants’ eating behaviors and patterns better and it would show if they could handle eating well for more than a few days. I think using food frequency questionnaires would help to supplement. As for tracking activity, besides using the pedometer the only thing I can think to use additionally is an exercise log. When I want to watch what I’m eating, I use a free website to track my food intake and exercise, so something like that could definitely be helpful, especially for people who rather use a computer than write everything down.
Not only does the pedometer not monitor other types of physical activity besides the steps the individual takes, it was only worn for 5 days before the last visit. The patient could have walked more or less during those 5 days. This does not seem like a good representative of physical activity for the duration of this study. The positive side to a pedometer is that it is easy to use and requires little to no work and could produce less biased results. Regardless of the tool used to estimate activity, the tool should be used for more than 5 days to estimate their activity. I think the food diary is a good method for this study regardless of underreporting. I agree with Shelby, there is no method that will tell us the measurements are 100%. If I were to do a similar study, I would use this method as well.
I think a food and exercise log would be a good option, but only if the participants were dedicated to being honest with themselves when keeping the logs. I think that is the main problem with food logs. If the person really wants to know how much they are eating/burning off they will be honest with the logs. Otherwise, the pedometer would be a good backup for an exercise log.
Sarah U
As always, the use of food diaries is tricky and not always reliable, but it is probably the best method of measurement for a study like this. However, I think the participants should definately go through some basic training on how to keep a food diary before beginning the recording process. Also, the longer the participants can keep the diary, the more accurate the average results would be. As far as the measurement method for physical activity, I think the pedometers should be coupled with an activity log to form a complete picture.
Anna,
I think you are right that wearing the pedometers may have affected how much activity the participants were doing. Knowing that they were being held accountable may have influenced them to move a little bit more than they normally would have.
I think the researchers used standard techniques that are easy to use. For this study I think these measures are sufficient. No measurement is going to be perfect or as exact as it coud be, but for the purposes of this study pedometers and food diaries worked just fine.
Kara--
Do you think patients would be compliant with a two-week food diary? How would you encourage them to participate for that long? What information would you hope to gain from extending the diary to 14 days?
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