Tonya Turner, RD, LD
MUSC Weight Management Center
Sodexo Clinical Nutrition Update 2012
12-week pilot study assessing the Bite Counter
as a tool for weight loss
MUSC Weight Management Center
Patrick O’Neil, PhD
Tonya Turner, RD
Laura Nance, RD, CDE
Robert Malcolm, MD
Suzanne Kuker, MA
Susan Pechon, RN
The Bite Study has been funded through South Carolina Clinical and Translational Research Center (SCTR)
Bite Counter
 The Bite Counter is worn on the wrist and functions like
a watch
 Automatically counts the number of bites taken at meals
and snacks
 Invented by two college professors from Clemson
University
 Dr. Eric Muth and Dr. Adam Hoover
 Manufactured in South Carolina
Study objectives
 To examine whether increases and decreases in bite
count are related to increases and decreases in caloric
intake
 To determine whether providing bite count feedback and
bite count reduction goals will lead to reductions in
numbers of bites and calorie intake
 To learn how users rate the Bite Counter’s acceptability
and tolerability
 To see if any changes in weight and body fat are related to
use of the Bite Counter
Study overview
 12-week pilot study
 2-week screening period with 1 or more visits before the
study began
 Participant visits occurred every 2 weeks for a total of 7
visits
 Participants were be required to keep a 3-day food diary
during the screening period, 2 3-day food diaries during
the first month, and 1 per month there after.
There were 9 visits over the course of 14 weeks
Study design
 20 participants were assigned to 1 of 2 conditions
 Feedback
 No-Feedback
 Subject Characterizations
 Generally Healthy Males and Females
 Ages 18 to 70
 Body Mass Indexes (BMIs)from 27 to 35
Study Design
 Screening visit
 Measured height, weight, and blood pressure
 Body composition using a bioelectrical impedance machine
 Medical history
 Questionnaires
 Instruction by WMC RD on how to keep a 3 day food diary
Study Design
 Baseline Visit
 Turned in screening 3 day food diary
 Began wearing a Bite Counter for 2 weeks without
feedback
 Assigned another 3 day food diary
 Completed questionnaires
Study Design
 Randomization visit
 Participants were assigned to either 1 of 2 groups


Feedback
Non-feedback
 Assigned a 3 day food diary
 Completed questionnaires
Study Design
 Study Visits (Weeks 4, 6, 8, and 10)
 Measured weights
 Completed 2 additional 3 day food dairies
 Uploaded Bite Counter data
 Completed questionnaires
 Final Visit (week 12)
 Measured weight, height, and blood pressure
 Ending body composition
 Uploaded Bite Counter data
 Completed questionnaires
Study Design
 Retention
 Frequent reminder calls and emails
 Bi-weekly follow up visits
 Compensation


$50.00 for completion of all study visits
$100.00 for successful return of bite counter and charger
Dietary Aims
 To provide subjects with an estimated reduction goal for
bites or calories to equal approximately 500 calories
 Estimated by 3-day food diaries and 2 week run-in of
wearing bite counter
Study demographics
 20 participants
randomized
 18 females, 2 males
 Mean age: 46.2
 Mean BMI: 31.4
 19 completed
 17 females, 2 males
 10 No-Feedback
 9 Feedback
 1 Lost to follow-up
Baseline Data
Calories
Bites
 Mean Caloric Intake (All Subjects)
 1816 calories
 Mean Bites (Randomization)
 184
 Estimated Calories per Bite
 9.9 calories per bite
 Mean Calorie Goal (NoFeedback)
 1400 calories
 Mean Bite Goal (Feedback)
 121
Week 12 Results
 Mean BMI
 30.8

Changed by 0.6 BMI points
 Mean Weight Change (lbs.)
 No feedback- 4.29
 Feedback – 4.55
Pounds Lost
10
9
8
7
6
5
4
3
2
1
0
No Feedback
Feedback
Week 12 Results
 Mean Caloric Intake
 All Subjects - 1582
calories/day
234 Calories
 Mean Bites
 All subjects – 123
bites/day
 Estimated Calories per
Bite

 No-Feedback – 1488 calories/day
(Mean Goal 1400)
 Feedback – 1687 calories/day
12.9 calories per bite
 Feedback – 104 bites/day
(Mean Goal 121)
 No-Feedback – 137 bites/day
Our Observations…
1 Serving = 17 Grapes
= 17 Bites = 57 Calories
1 Serving = 1 Slice
Pizza = 10 Bites = 272
Calories
Which do you prefer, completing and using the eating
diaries or wearing and using the Bite Counter?
Week 12
Baseline
30%
44%
55%
70%
Bite Counter
Food Diaries
Bite Counter
Food Diaries
Usability and Tolerability
In the past week how much did you like this approach
to dieting?
1
2
3
4
5
Extremely
Liked
6
7
Extremely
Disliked
Week 12: 3.9
Baseline: 4.2
Usability and Tolerability
 In the past week how easy did you find it to follow
this diet?
1
2
3
4
5
Extremely
Liked
6
7
Extremely
Disliked
Baseline: 3.9
Week 12: 4.2
Our Observations
 Limited success with use of bite counter as a tracking
method
 Comments from subjects
 To hard to remember to turn on and off
 Not attractive
 Not accurate
 Not waterproof
 Malfunctioned
Bite Technologies
http://www.icountbites.com/index.html