Bite Counter Device Reduces Food Consumption

Becky McCall

July 05, 2016

Bite-count feedback, provided by a monitoring device worn on the wrist, reduces the number of bites taken and amount of food consumed. However, when given a restricted bite-count goal, participants were found to compensate by taking larger bites.

In addition, participants with a large plate of food were also found to eat more than those with a small plate, despite receiving bite-count feedback, show new findings published online June 21 in the Journal of the Academy of Nutrition and Dietetics.

"Bite-count feedback alone acts as its own cue to stop eating, just as other cues lead to overeating," said lead author, Phillip W Jasper, PhD candidate in human factor psychology, Clemson University, South Carolina.

"Large plates lead to overeating, but we found that bite-count feedback can help mitigate those effects. It helps people self-monitor better and avoid the mindless margin [lack of awareness of how much they are eating]," he added.

Mr Jasper highlighted that self-monitoring was key to lots of successful weight-loss programs, including calorie counting; however, he noted that the latter is time-consuming and relies on appropriate portion size among other complicating factors.

"Bite counting is more acceptable and is a method that people can more easily use to change their behavior than calorie counting, for example. It's easier, more accessible, and not as intimidating," he asserted.

He added that central to the modality is the fact that people easily eat more than needed without realizing it, which is detrimental to maintaining a healthy weight. "Over time, this extra calorific intake really does the damage. With bite counting, people are more aware of the extra bites they are taking with the aim of eliminating them. This makes you mindful."

The so-called "Bite Counter," as used in this study, is worn on the wrist and uses a gyroscope to track wrist motion. It detects a pattern of motion distinctive of hand-to-mouth gestures used to ingest foods and beverages, and displays bite count for the current eating activity in real-time.

Study Addressed Two Research Questions

The study investigated two research questions: first, how use of the bite counter and its feedback alters eating behavior compared with not using it; and second, how bite-count feedback coupled with either a low or high goal (number of bites per meal) alters eating behavior.

Each research question was studied using a two-by-two design. The first was addressed by crossing plate sizes (large or small) and feedback (yes or no). In this analysis, participants allocated to receive feedback wore the bite-counting device on their wrist.

The second question was addressed by crossing plate sizes with bite-count goal (high, 22 bites; low, 12 bites). In the second analysis, all participants wore the bite-counting device. A total of 193 participants were included, and all had a single meal. Results were analyzed according to plate size, with or without feedback; and according to bite-count goal crossed with plate size to answer each research question, respectively.

Nearly all participants were around 20 years of age and had a normal body mass index (BMI) of 23 kg/m2, on average. As adjunct measures, the effects of serving size, bite size (grams per bite), postmeal satiety, and satiety change were also assessed.

Not unexpectedly, Mr Jasper and colleagues found that participants consumed significantly more from a large plate than from a small plate, regardless of other interventions (P = .001). Those who ate off a large plate also took significantly more bites (P = .001).

The presence of bite-count feedback alone was enough to significantly reduce consumption compared with no feedback at all (151.6 g with feedback vs 167.0 g without feedback on a large plate; and 107.5 g with feedback vs 144.1 g without feedback on a small plate; P = .011). Participants who received feedback also took fewer bites (P < .001).

The second part of the study that paired feedback with bite-count goals explored whether participants would eat to their set goal and the impact on other behaviors.

Researchers found that those participants with the low goal bite count (12) ate to the goal, but surprisingly, they consumed comparable amounts to those who took 22 bites.

"This was stunning because people were compensating for the low goal by taking larger bites," Mr Jasper pointed out, adding that, "This shows us they will eat to a goal, but raises the question of what is driving this secondary behavior change. We think this is important in understanding how to get people to reduce [food] consumption."

Further research should explore how bite-count feedback ― that has been shown to work ― could be used "to set goals appropriately so that people do not change their bite size," he observed.

Asked how the principle of bite counting can be reconciled with the fact that a bite of cake is far less nutritious and higher in calories than a bite of salad, Mr Jasper explained that weight loss does not happen day-to-day but over weeks and months and that over the time a diet is effective, calorie density averages out.

"A reduction in bite count reduces the average energy intake per day. This makes it ... acceptable because people do not need to worry about each calorie eaten, but just take a few less bites per day, and over time it will lead to a significant reduction in intake."

Bite Counting Devices Relatively Novel; More Work to Do

Bite counting is relatively novel. Available technologies comprise the HapiFork (HapiLabs), Mandometer (Mandometer), and Bite Counter, now commercially available as the ELMM (Eat Less, Move More) (Bite Technologies). An earlier version of the latter device was used in this study.

Bite Counter [Source: Clemson University]

All these devices provide objective, real-time measurements while eating.

Asked to explain the differences between the devices, Mr Jasper said that older technologies tended to be relatively cumbersome, for example, they track the number of chews or require a special computerized eating station in a laboratory. "Our approach is automated with a wrist-worn monitor that makes it easier and more practical to capture the metrics. It is the first of its kind that sits on the wrist in this way."

Participants in the current study all had a healthy BMI, which obviously limits the generalizability of the findings. Mr Jasper says that in the future they are interested in looking at people who are overweight or obese, because these participants may have different motivations.

He also noted that based on results of the second part of the study, it appeared that a huge leap in bite count can be counterproductive.

"One approach we would like to look at is taking baseline bite counts over a longer period of time, then titrate this count by a few bites a day," he said, pointing out that "this should alter the feeding habits in such a way that people do not feel the need to take larger bites.

"We want people to eat less without necessarily knowing it," he concluded.

The study was funded by the National Institutes of Health. Mr Jasper has reported no relevant financial relationships. Disclosures for the coauthors are listed in the paper.

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J Acad Nutr Diet. Published online June 21, 2016. Abstract

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