Abstract
Obesity is a serious public health problem. There is a need for scalable weight loss interventions that can help people lose weight and decrease their risk of obesity related chronic disease development. Self-monitoring is a key component of successful weight loss. The Eat Less, Move More (ELMM) device is wrist-worn, and is capable of counting bites by detection of a wrist-roll motion that is specific to eating. The device can also measure seconds between bites, as a proxy to eating rate (ER) measurement, as well as the number of steps taken by the user. The aim of this body of research was to explore the effects of the ELMM device within a weight loss intervention focused on decreasing the size and number of bites, reducing ER, and increasing physical activity, as well as increasing awareness of physiological cues to eating. The first chapter focuses on the examination of the ELMM device-assessed proxy to ER, seconds between bites, with self-reported eating rate (SRER). The average number of seconds between bites as measured by the ELMM device is referred to in this body of work as the bite count interval (BCI). Data from the first three days of participants’ use of the ELMM to track bites and BCI were examined, and results showed a significant difference in BCI as measured by the ELMM among SRER categories. These findings suggest that the ELMM is capable of measuring BCI in free-living eating situations, an important first step in establishing the validity of this device in its ability to reflect free-living eating rate. The second chapter explores the effects of a workbook-based weight loss intervention on body weight change (primary outcome), and energy intake (EI), ER, and energy expenditure (secondary outcomes), with (workbook plus device or WD group) and without (workbook only or WO group) the addition of the self-monitoring ELMM device. There was a strong main effect of time on weight change, but there was no significant difference between groups in body weight change. No significant differences were seen between groups in ER, EI or energy expenditure. At the end of the intervention, participants were dichotomized into a weight loss group (WL) or a weight stable/gainers group (WSG). A strong overall main effect of time, and a significant time by WL/WSG group interaction was seen in scores from the validated weight-related eating questionnaire (WREQ). Post hoc univariate analyses showed a significant effect of time
Highlights
Obesity remains highly prevalent in the United States, with approximately 67%of adults classified as overweight, and 35% as obese [1, 2]
Conclusion no significant differences were seen between groups in the primary outcome of resting metabolic rate (RMR), we found that small changes in secondary outcomes of body fat percent and estimated physical activity energy expenditure were associated with increased fat oxidation
That study is important because it was the first to examine associations between eating rate and body mass index (BMI) in a sample of type 2 diabetic participants; this is an important addition to the eating rate research because the findings from this study suggest that the associations that have been identified to exist between eating rate and BMI may be replicated in other populations, including those with chronic metabolic disease such as diabetes
Summary
Obesity remains highly prevalent in the United States, with approximately 67%of adults classified as overweight, and 35% as obese [1, 2]. Achieving a modest weight loss of 5% may reduce many risk factors associated with overweight and obesity [37, 38], but weight loss can be difficult due to the increased accessibility of highly palatable foods that are low in nutrient density and high in energy, which has increased dramatically over the last 30 years [39-41]. Metabolic adaptation is defined as a reduction in resting metabolic rate (RMR) as a result of weight loss, which is greater than would be expected based on the amount of weight lost [87, 88] This phenomenon has been well documented in the literature; in the presence of a negative energy balance, RMR decreases further than would be expected from reductions in body mass and changes in body composition [87-89]. The potential effects of weight loss through the use of this device on metabolic adaptation, or the reduction of RMR that is not attributable to changes in body weight or in body composition, has not been tested to date
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