The Behavioral Intervention with Technology for E-Weight Loss Study (BITES): Incorporating Energy Balance Models and the
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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 Carly M. Goldstein 1,2 J. Graham Thomas 1,2
&
Stephanie P. Goldstein 1,2 & Diana M. Thomas 3 & Adam Hoover 4 & Dale S. Bond 1,2 &
Received: 31 July 2020 / Revised: 9 October 2020 / Accepted: 20 November 2020 # The Author(s) 2020
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 Weight loss . Technology . Obesity management . Feeding behavior . Eating
Introduction Online behavioral weight loss programs, while not always as efficacious as gold standard in-person treatment, often produce clinically relevant weight losses and are increasingly
* Carly M. Goldstein [email protected] 1
The Weight Control and Diabetes Research Center, The Miriam Hospital, Providence, RI 02903, USA
2
Department of Psychiatry and Human Behavior, Alpert Medical School, Brown University, Providence, RI 02903, USA
3
Department of Mathematical Sciences, The United States Military Academy, West Point, NY 10996, USA
4
Holcombe Department of Electrical and Computer Engineering, Clemson University, Clemson, SC 29634, USA
utilized as a scalable means of intervention (Nev
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