A smartphone based attentive eating intervention for energy intake and weight loss: results from a randomised controlled trial

Abstract

Background Laboratory studies suggest that eating more ‘attentively’ (e.g. attending to food being eaten and recalling eating episodes) can reduce food intake among participants with both healthy weight and overweight. The aim of this trial was to assess whether a smartphone application that encourages a more attentive eating style reduces energy intake and promotes weight loss. Methods In an open-label, single centre, parallel groups, individually randomised controlled trial, 107 adults with overweight/obesity in Merseyside, UK used an attentive eating smartphone application along with standard dietary advice (intervention group) or standard dietary advice only (control group) for 8 weeks. The primary outcomes were change in body weight at 8 weeks and energy intake at 4 and 8 weeks. Additional outcomes included self-reported eating behaviours measured at 8 weeks. Differences between groups were assessed with linear regression (adjusted) using multiple imputation for missing data. Study protocol registered prospectively at (10.17605/osf.io/btzhw). Results There was no significant difference between the intervention and control group in weight lost at 8 weeks, or change in self-reported 24 h or objective taste-test energy intake at 4 or 8 weeks. Mean weight loss in the intervention group ( n = 53) was 1.2 kg and 1.1 kg in the control group ( n = 54), adjusted difference of − 0.10 (− 1.6 to 1.3) kg. Self-reported eating behaviours at 8 weeks also did not differ across groups. The intervention was largely used as intended and a per protocol analysis confined to participants in the intervention group that used the attentive eating smartphone application regularly and as intended also showed no effect on energy intake or weight loss. Conclusions A smartphone based attentive eating intervention and standard dietary advice did not result in reduced energy intake or greater weight loss at 4 or 8 week follow-up than standard dietary advice alone. Trial registration ClinicalTrials.gov, NCT03602001 . Registered retrospectively on 26th July 2018. Prospectively registered on the Open Science Framework on 11th August 2017. Electronic supplementary material The online version of this article (10.1186/s12889-019-6923-x) contains supplementary material, which is available to authorized users.

User Experiences of a Smartphone-Based Attentive Eating App and Their Association With Diet and Weight Loss Outcomes: Thematic and Exploratory Analyses From a Randomized Controlled Trial

“…Participants also described eating more slowly and stopping eating before finishing their food due to greater awareness of hunger and fullness, most likely due to the attentive eating audio clip that encouraged listeners to eat slowly and pay attention to their hunger and fullness levels. These findings are in contrast to the results of our main trial analyses, which found no effects on trial outcomes at the 8-week assessment, including weight and energy intake in the full sample and among a subsample of participants that were categorized as having used the app as intended [ 20 ]. Our exploratory analyses reported here found that the frequency of recording food consumed was significantly associated with lower body weight at the 8-week assessment but was not significantly associated with body fat percentage.…”

“…The trial was prospectively registered on the Open Science Framework [ 21 ] and retrospectively registered at ClinicalTrials.gov (NCT03602001). A full description of the trial design and methods are reported elsewhere [ 20 ]. In brief, this was an 8-week randomized controlled trial.…”

“…In a feasibility trial, participants with overweight and obesity used the app and reported in qualitative interviews that they found the app easy and acceptable to use, and it increased their awareness of what they had been eating [ 19 ]. We subsequently conducted a randomized controlled trial testing the efficacy of the multicomponent, attentive eating smartphone app plus standard dietary advice, compared to standard dietary advice only, to support weight loss in adults with overweight and obesity [ 20 ]. We found no significant effect of using the attentive eating smartphone app, compared to the control condition, on weight loss (−0.10 kg, 95% CI −1.6 to 1.3) or energy intake after 8 weeks of usage.…”

Served Portion Sizes Affect Later Food Intake Through Social Consumption Norms

“…The effects of exposure to portion sizes on norm perceptions and expected satiety were potentially stronger (and in the predicted direction) among those participants who were able to correctly identify the portion size to which they were exposed to. This finding may suggest a potential role for making people aware of the portion size as a factor to moderate the relation between portion size exposure and later portion size evaluations, although recent research has failed to demonstrate that training attentive or mindful eating successfully reduces intake [33,34].…”

Eating Behavior as a New Frontier in Memory Research

“…Within these studies, there is also mixed evidence as to whether or not attentive eating manipulations enhances memory of eating (Higgs & Spetter, 2018). Additionally, more recent studies with attentive or mindful eating interventions have not reduced future snacking (Tapper & Seguias, 2020;Whitelock, Gaglione, Davies-Owen, & Robinson, 2019;Whitelock, Higgs, Brunstrom, Halford, & Robinson, 2018;Whitelock, Kersbergen, et al, 2019). Further research is needed to clarify the existence of this effect.…”