The Behavioral Intervention with Technology for E-Weight Loss Study (BITES): Incorporating Energy Balance Models and the Bite Counter into an Online Behavioral Weight Loss Program

Abstract

This study evaluated feasibility and acceptability of adding energy balance modeling displayed on weight graphs combined with a wrist-worn bite counting sensor against a traditional online behavioral weight loss program. Adults with a BMI of 27-45 kg/m2 (83.3% women) were randomized to receive a 12-week online behavioral weight loss program with 12 weeks of continued contact (n = 9; base program), the base program plus a graph of their actual and predicted weight change based on individualized physiological parameters (n = 7), or the base program, graph, and a Bite Counter device for monitoring and limiting eating (n = 8). Participants attended weekly clinic weigh-ins plus baseline, midway (12 weeks), and study culmination (24 weeks) assessments of feasibility, acceptability, weight, and behavioral outcomes. In terms of feasibility, participants completed online lessons (M = 7.04 of 12 possible lessons, SD = 4.02) and attended weigh-ins (M = 16.81 visits, SD = 7.24). Six-month retention appears highest among nomogram participants, and weigh-in attendance and lesson completion appear highest in Bite Counter participants. Acceptability was sufficient across groups. Bite Counter use (days with ≥ 2 eating episodes) was moderate (47.8%) and comparable to other studies. Participants lost 4.6% ± 4.5 of their initial body weight at 12 weeks and 4.5% ± 5.8 at 24 weeks. All conditions increased their total physical activity minutes and use of weight control strategies (behavioral outcomes). Although all groups lost weight and the study procedures were feasible, acceptability can be improved with advances in the technology. Participants were satisfied with the online program and nomograms, and future research on engagement, adherence, and integration with other owned devices is needed. ClinicalTrials.gov Identifier: NCT02857595.

Keywords: Eating; Feeding behavior; Obesity management; Technology; Weight loss.

Conflict of interest statement

Conflict of Interest Drs. C. Goldstein, S. Goldstein, and Bond declare that they have no conflicts of interest. Dr. D. M. Thomas is the non-compensated co-inventor of a weight loss smartphone app (outside of the submitted work). Dr. Hoover reports non-financial support from Bite Technologies, LLC, outside the submitted work. In addition, Dr. Hoover has a patent A. Hoover, E. Muth and Y. Dong, “Weight Control Device Using Bites Detection”, US Patent no 8310368, filed January 2009, granted November 2012. issued, and a patent A. Hoover, E. Muth, Y. Dong and J. Scisco, “Device and Method for Detecting Eating Activities”, USA, Patent No. 9685097, filed July 2012, granted June 20, 2017, issued. Dr. A. Hoover provided the Bite Counters used in this study to Dr. C. Goldstein and Dr. J. G. Thomas. Dr. A. Hoover was not involved in analyzing the results. Dr. J. G. Thomas reports personal fees from Profile by Sanford and Slimming World (outside of the submitted work).

Figures

Fig. 1

BITES CONSORT participant flow

Fig. 2

A sample weight loss nomogram depicting the zone of adherence and weight loss plotted on the graph from baseline to week 24. Note. This is the nomogram for a 65” tall 60-year-old female. The starting weight is 270.00 lbs. and BMI is 44.9. The bite goal is provided in week 17 after suboptimal weight loss in weeks 15 and 16. Optimal weight in week 15 is 234.35–245.77 and in week 16 is 232.56–244.30. Week 15 weight is 246.50 and week 16 weight is 246.00. Although the weight in week 6 is above the upper limit, no bite goal is provided because there has not been two consecutive weeks of suboptimal weight loss. The 10% weight loss goal (270.00 lbs) should occur at week 17, but in actuality was achieved at week 18. However, the participant would be encouraged to continue losing weight as her BMI would be > 27