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ASSESSING the BITE COUNTER AS a WEIGHT LOSS TOOL Michael Wilson Clemson University, [email protected]

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ASSESSING the BITE COUNTER AS a WEIGHT LOSS TOOL Michael Wilson Clemson University, Mlw2@G.Clemson.Edu Clemson University TigerPrints All Theses Theses 5-2014 ASSESSING THE BITE COUNTER AS A WEIGHT LOSS TOOL Michael Wilson Clemson University, [email protected] Follow this and additional works at: https://tigerprints.clemson.edu/all_theses Part of the Psychology Commons Recommended Citation Wilson, Michael, "ASSESSING THE BITE COUNTER AS A WEIGHT LOSS TOOL" (2014). All Theses. 1955. https://tigerprints.clemson.edu/all_theses/1955 This Thesis is brought to you for free and open access by the Theses at TigerPrints. It has been accepted for inclusion in All Theses by an authorized administrator of TigerPrints. For more information, please contact [email protected]. ASSESSING THE BITE COUNTER AS A WEIGHT LOSS TOOL A Thesis Presented to the Graduate School of Clemson University In Partial Fulfillment of the Requirements for the Degree Master of Science Applied Psychology by Michael Lee Wilson May 2014 Accepted by: Dr. Eric R. Muth, Committee Chair Dr. Adam W. Hoover Dr. Patrick J. Rosopa ABSTRACT Obesity is a growing health concern throughout the world. Health risks associated with obesity such as diabetes and heart disease result in obesity costing us over $170 million annually. Self-monitoring of Energy Intake (EI) is a critical element of a successful weight loss plan; however current methods to monitor EI are cumbersome and prone to under reporting. The primary purpose of the study was to develop and test an experimental diet protocol based on user feedback from the Bite Counter. A secondary purpose was to examine if this protocol would affect meaningful weight loss by device users. Data were collected from 30 participants (15 control) in a study where Bite Counter feedback was used to titrate daily bite count goals in order to meet a 1 to 2 pound per week weight loss goal measured against the control group which was only given weight loss literature. 77% of our participants were able to use the device to self-monitor a majority of the eating activities. Although weight loss was higher in the Bite Counter group, we determined that a diet protocol based solely on using the Bite Counter did not produce statistically significant weight loss over the ten-week study period. The Bite Counter was able to help the control group sustain their weight loss throughout the entire study period. The study determined that aggressive screening measures during study uptake is needed in order to ensure the recruitment of participants who are likely to complete future studies. User profile personas were developed to assist future researchers identify and classify users as successful or unsuccessful candidates for losing weight using the Bite Counter. ii ACKNOWLEDGEMENTS I would like to express my heartfelt thanks to all of the people who helped me complete this project. First, I would like to thank my advisor Dr. Eric Muth. Your patience, understanding and sincere desire to truly coach and mentor me throughout this project has proven that it is, in fact, possible to teach an old dog, new tricks (it just takes more time and can be really frustrating for the teacher). Next, I would also like to thank my Committee members Dr. Adam Hoover and Dr. Patrick Rosopa for dedicating their time and efforts to this project, I really appreciate it. I also want to thank my lab mates Phil Jasper, Amelia Kinsela and James Salley for their feedback and support throughout the project. I need to thank the Creative Inquiry undergraduates, especially Stephanie Newton who assisted with scheduling and data collection for this project. Finally, I would like to thank my wife Susan for always being there with a kind word, strong shoulder or firm kick in the backside. Her untiring love and dedication not only made this project possible, but keeps me grounded. I would like to thank the Clemson University Human Factors Institute for the $1000 grant that funded my subject payments for this study. I would also like to thank the Science, Mathematics & Research for Transformation Scholarship program for the financial support for the past year while completing this thesis. iii TABLE OF CONTENTS Page TITLE PAGE .................................................................................................................... i ABSTRACT ..................................................................................................................... ii ACKNOWLEDGEMENTS ........................................................................................... iii LIST OF TABLES ......................................................................................................... vi LIST OF FIGURES ....................................................................................................... vii CHAPTER I. INTRODUCTION ......................................................................................... 1 Purpose ..................................................................................................... 1 Motivation for the Current Work: The Obesity Pandemic .................... 1 Understanding and Measuring Energy Balances ..................................... 2 The Bite Counter: A dietary self-monitoring tool for weight loss treatment and research. ................................................... 3 Weight Loss Approaches ......................................................................... 5 Self-Monitoring........................................................................................ 7 Present Study ......................................................................................... 14 II. METHODS .................................................................................................. 16 Participants ............................................................................................. 16 Design .................................................................................................... 18 Materials ................................................................................................ 19 Procedure ............................................................................................... 23 III. RESULTS .................................................................................................... 29 Study Attrition ....................................................................................... 29 Outlier Analysis ..................................................................................... 31 Testing the Hypotheses .......................................................................... 32 Research Questions ................................................................................ 35 iv Table of Contents (Continued) IV. DISCUSSION .............................................................................................. 40 Hypotheses and Research Questions ..................................................... 40 Human Factors Approach ...................................................................... 46 Study Limitations and Future Work ...................................................... 51 Conclusion ............................................................................................. 59 APPENDICES ............................................................................................................... 60 A: How to Effectively Use a Bite Counter ....................................................... 61 B: Bite Counter Instructions ............................................................................. 63 C: Survey Monkey Demographics Questionnaire ............................................ 65 D: Research Study Protocol .............................................................................. 70 E: Usability Questionnaire ............................................................................... 82 REFERENCES .............................................................................................................. 85 v LIST OF TABLES Table Page 2.1 Demographic characteristics of the 48 study participants. .......................... 18 3.1 Table of means for condition and time ........................................................ 33 vi LIST OF FIGURES Figure Page 1.1 The commercially available Bite Counter ..................................................... 4 1.2 PC software for visualizing eating activity (EA) data. A month long calendar of EAs recorded by the Bite Counter is shown on the left. Each line represents an EA and the length of the line represents the bite count. A user can click on the calendar to see more detailed information for the week, showing time of day, duration and bites for each EA as well as total bites for the day. ............................................... 5 1.3 Wrist roll motion during the taking of a bite of food occurs regardless of the type of food or utensil. .................................................. 9 1.4 Clemson University study setup to determine the accuracy of the Bite Counter ................................................................................. 10 1.5 Human calorie estimation error (HCE error) with and without calorie information (CI) present versus bite count based calorie estimation error (BCE error) for the same groups...................................................................................... 12 2.1 Flow diagram of participant recruitment and retention ............................... 17 2.2 Eating activity analysis logic flow and goal titration outline ...................... 27 3.1 Graph showing cumulative weight loss weekly by
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