This paper describes a study to test the accuracy of a method that tracks wrist motion during eating to detect and count bites. The purpose was to assess its accuracy across demographic (age, gender, ethnicity) and bite (utensil, container, hand used, food type) variables. Data were collected in a cafeteria under normal eating conditions. A total of 271 participants ate a single meal while wearing a watch-like device to track their wrist motion. Video was simultaneously recorded of each participant and subsequently reviewed to determine the ground truth times of bites. Bite times were operationally defined as the moment when food or beverage was placed into the mouth. Food and beverage choices were not scripted or restricted. Participants were seated in groups of 2–4 and were encouraged to eat naturally. A total of 24,088 bites of 374 different food and beverage items were consumed. Overall the method for automatically detecting bites had a sensitivity of 75% with a positive predictive value of 89%. A range of 62–86% sensitivity was found across demographic variables, with slower eating rates trending towards higher sensitivity. Variations in sensitivity due to food type showed a modest correlation with the total wrist motion during the bite, possibly due to an increase in head-towards-plate motion and decrease in hand-towards-mouth motion for some food types. Overall, the findings provide the largest evidence to date that the method produces a reliable automated measure of intake during unrestricted eating.

Background Current methods of self-monitoring kilocalorie intake outside of laboratory/clinical settings suffer from a systematic underreporting bias. Recent efforts to make kilocalorie information available have improved these methods somewhat, but it may be possible to derive an objective and more accurate measure of kilocalorie intake from bite count. Objective This study sought to develop and examine the accuracy of an individualized bite-based measure of kilocalorie intake and to compare that measure to participant estimates of kilocalorie intake. It was hypothesized that kilocalorie information would improve human estimates of kilocalorie intake over those with no information, but a bite-based estimate of kilocalorie intake would still outperform human estimates. Method Two-hundred eighty participants were allowed to eat ad-libitum in a cafeteria setting. Their bite count and kilocalorie intake were measured. After completion of the meal, participants estimated how many kilocalories they consumed, some with the aid of a menu containing kilocalorie information and some without. Using a train and test method for predictive model development, participants were randomly divided into one of two groups: one for model development (training group) and one for model validation (test group). Multiple regression was used to determine if height, weight, age, gender, and waist-to-hip ratio could predict an individual’s average kilocalories-per-bite for the training sample. The model was then validated with the test group, and the model-predicted kilocalorie intake was compared to human estimated kilocalorie intake. Results Only age and gender significantly predicted average kilocalories-per-bite, but all variables were retained for the test group. The bite-based measure of kilocalorie intake outperformed human estimates with and without kilocalorie information. Conclusions Bite count may serve as an easily measured, objective proxy for kilocalorie intake. A tool that can monitor bite count may be a powerful assistant to self-monitoring.

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Background: Conclusions regarding bite count rates and body mass index (BMI) in free-living populations have primarily relied on self-report. The objective of this exploratory study was to compare the relationship between BMI and bite counts measured by a portable sensor called the Bite Counter in free-living populations and participants eating in residence. Methods: Two previously conducted studies were analyzed for relationships between BMI and sensor evaluated bite count/min, and meal duration. Participants from the first study (N = 77) wore the bite counter in a free-living environment for a continuous period of 14 days. The second study (N = 214) collected bite count/min, meal duration, and total energy intake in participants who consumed one meal in a cafeteria. Linear regression was applied to examine relationships between BMI and bite count/min. Results: There was no significant correlation in the free-living participants average bite counts per second and BMI (R 2 = 0.03, p = 0.14) and a significant negative correlation in the cafeteria participants (R 2 = 0.04, p = 0.03) with higher bite count rates observed in lean versus obese participants. There was a significant correlation between average meal duration and BMI in the free-living participants (R 2 = 0.08, p = 0.01). Total energy intake in the cafeteria participants was also significantly correlated to meal duration (R 2 = 0.31, p < 0.001).Conclusions: With additional novel applications of the Bite Counter, insights into free-living eating behavior may provide avenues for future interventions that are sustainable for long term application.