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

J Technol Behav Sci. 2021 Jun;6(2):406-418. doi: 10.1007/s41347-020-00181-4. Epub 2020 Nov 27.


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. Identifier: NCT02857595.

Keywords: Eating; Feeding behavior; Obesity management; Technology; Weight loss.

Associated data