1. Tonya Turner, RD, LD MUSC Weight Management Center Sodexo Clinical Nutrition Update 2012

2. 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)

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. Study Design Randomization visit Participants were assigned to either 1 of 2 groups Feedback Non-feedback Assigned a 3 day food diary Completed questionnaires

10. 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

11. 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

12. 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

13. 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

14. Baseline Data Calories Bites Mean Caloric Intake (All Subjects) 1816 calories Mean Calorie Goal (No- Feedback) 1400 calories Mean Bites (Randomization) 184 Estimated Calories per Bite 9.9 calories per bite Mean Bite Goal (Feedback) 121

15. Week 12 Results Mean BMI 30.8 Changed by 0.6 BMI points Mean Weight Change (lbs.) No feedback- 4.29 Feedback – 4.55

16. Week 12 Results Mean Caloric Intake All Subjects - 1582 calories/day 234 Calories No-Feedback – 1488 calories/day (Mean Goal 1400) Feedback – 1687 calories/day Mean Bites All subjects – 123 bites/day Estimated Calories per Bite 12.9 calories per bite Feedback – 104 bites/day (Mean Goal 121) No-Feedback – 137 bites/day

17. Our Observations… 1 Serving = 17 Grapes = 17 Bites = 57 Calories 1 Serving = 1 Slice Pizza = 10 Bites = 272 Calories

18. Which do you prefer, completing and using the eating diaries or wearing and using the Bite Counter?

19. Usability and Tolerability In the past week how much did you like this approach to dieting? 1 2 3 4 5 6 7 Extremely Liked Extremely Disliked Baseline: 4.2 Week 12: 3.9

20. Usability and Tolerability In the past week how easy did you find it to follow this diet? 1 2 3 4 5 6 7 Extremely Liked Extremely Disliked Week 12: 4.2 Baseline: 3.9

21. 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

22. Bite Technologies http://www.icountbites.com/index.html