Paying attention to what we eat while we eat it, and then carefully recording food consumption using a smart phone, helps people lose weight, according to a new study. The research is being presented at this year’s European Congress on Obesity (ECO), being held in Liverpool (12-15 May), and is by Dr Eric Robinson, University of Liverpool, UK, and and colleagues.The study was funded by the UK National Institute for Health Research (NIHR) National School for Primary Care Research (NSPCR).
A previous review of the evidence on attentive evidence by Robinson and colleagues concluded that distractions while eating (such as radio and television, computers) increased food intake by up to 50%, both during that particular meal and even more later in the day, thus increasing overall daily energy consumption. The review found that paying attention to what was eaten, and remembering it clearly, helped reduce energy intake. It is thought that actually remembering what we have eaten more clearly at previous meals acts to prevent taking in excess calories at future meals. Being distracted can also disrupt the ‘reward’ function in the brain, preventing memory of how good it felt to eat a certain food earlier, and thus seek more reward later, and increase intake at the current meal, probably because people lose track of what they are eating, as they eat it.
Following this review, the Robinson and colleagues designed a smart phone app that would help promote food memory in overweight or obese people, with three main parts:
Part 1: Photo: Prior to eating/drinking a food or beverage users access the ‘Snap’ function and select a meal (breakfast, lunch, evening meal, snack, drink, other). This selection loads up a camera view finder and users photograph the food/drink about to be consumed. The user then accepts the photo (or re-takes the shot) and the application relays a short text message reminding users to complete the ‘Most Recent’ function when they have finished their meal.
Part 2: Most Recent: After finishing the meal/drink users access the ‘Most Recent’function , and the photograph of the recently consumed food/drink is pictured, with information about the meal type and time consumed. With this image on the screen, users select drop down answers to questions about the consumption experience: ‘did you finish it all?’ ‘How full are you now?’
Part 3: I’ve Been Eating: Prior to deciding what and how much to eat for a consumption episode, users access the I’ve Been Eating Function. This function opens up an interactive chronological slide show of the consumption episodes recorded during that day (relaying the photograph and all information recorded from the Snap and Most Recent function for each entry on individual screens). A short text message instructs users to ‘remind themselves of what they have been eating’. Users can then navigate forwards and backwards through consumption episodes. After viewing the most recently recorded consumption episode, users are reminded to eat attentively and to snap their next meal.
Using the app, the researchers carried out a feasibility pilot study of 12 overweight and obese participants (7 women, 5 men). Participants were staff recruited from the University of Birmingham, UK, during August and September of 2012. Eligibility criteria were: ownership of an iphone (version 2.0 or later), a BMI (body mass index) > 25.0 kg/m2, wanting to lose some weight, no history of eating disorders and not being treated with insulin for diabetes. Twelve overweight (n=5) and obese (n=7) participants took part in the four week trial. The sample size was based on published feasibility studies testing mobile phone technology to promote behavioral change. At baseline, mean BMI was 32.1, mean weight = 96.3 kg, and mean age was 42 years. Participants were compensated with £30 (GBP) for their time (the equivalent of around $45 US dollars).
Over the four weeks of this pilot study, mean weight loss was -1.5kg. Half the participants (6/12) lost 1kg or more, four lost between 0 and 1kg and the remaining two participants gained between 0.1 and 0.4 kg. Participants accessed the application on average 5.7 times a day, and the mean number of eating and drinking episodes recorded each day was 2.7.
Dr Robinson says: “Adherence data suggested that overweight and obese participants in our four week trial used the application regularly, personalised the application based on their daily routine and were able to use the three main functions of the application.”
He adds: “Raising awareness of eating and weight loss achieved suggest this approach could be fruitful. The 1.5kg average weight loss observed is similar to a recent more intensive two month trial which investigated the impact of dietary/exercise advice and habit formation. Given that our trial was a very brief intervention with little contact time and no nutritional advice or support, this is a promising finding. A larger, randomised controlled trial testing proof of principle for an attentive eating intervention on weight loss is now warranted.”
The authors say further studies must also examine long-term feasibility of the application, important since long term maintenance of changes to the diet and weight can be hard to achieve.
Dr Robinson concludes: “Our study introduces a new attentive eating approach aimed at reducing dietary intake and promoting weight loss, supported by theoretical models of the role of memory on energy intake regulation. Results suggest that a simple smartphone based intervention based on these principles is feasible and could promote healthier dietary practices.”
Source: European Congress on Obesity (ECO)