Examining the utility of a bite-count-based measure of eating activity in free-living human beings.

The obesity epidemic has triggered a need for novel methods for measuring eating activity in free-living settings. Here, we introduce a bite-count method that has the potential to be used in long-term investigations of eating activity. The purpose of our observational study was to describe the relationship between bite count and energy intake and determine whether there are sex and body mass index group differences in kilocalories per bite in free-living human beings. From October 2011 to February 2012, 77 participants used a wrist-worn device for 2 weeks to measure bite count during 2,975 eating activities. An automated self-administered 24-hour recall was completed daily to provide kilocalorie estimates for each eating activity. Pearson's correlation indicated a moderate, positive correlation between bite count and kilocalories (r=0.44; P<0.001) across all 2,975 eating activities. The average per-individual correlation was 0.53. A 2 (sex)×3 (body mass index group: normal, overweight, obese) analysis of variance indicated that men consumed 6 kcal more per bite than women on average. However, there were no body mass index group differences in kilocalories per bite. This was the longest study of a body-worn sensor for monitoring eating activity of free-living human beings to date, which highlights the strong potential for this method to be used in future, long-term investigations.