Our medical director weighs in

Dr. Mitchell Roslin discusses why SMARTbite works and is safe to use.

" Every month, new studies come out linking rapid eating with overeating. For many, hurried lifestyles are one more environmental condition contributing to excess weight. Slowing food intake at the mouth has been successfully validated as safe and effective for weight loss.

Our scientific research has been published in Obesity Research, a leading peer-reviewed medical journal, and shows an average reduction in food intake of 23% over the course of a day with high eating satisfaction. SMARTbite changes how you eat, not what you eat, and has proven to be very effective. In our pivotal multisite clinical trial, compliant users of SMARTbite have averaged 38.1% Excess Weight Loss (EWL) in just four months.

SMARTbite is safe, effective and affordable. We know that dietary restriction where food enters the body is much safer than dietary restriction with surgery."

Dr. Mitchell Roslin
M.D. F.A.C.S. , Chief Medical Officer of SMARTbite and Chief of Bariatric Surgery at Lenox Hill Hospital in New York City.

[Dr. Roslin's work with obesity is nationally recognized. He has been featured in articles in the New York Times, as well as appearing on both national and local news and information programs. He has been listed in New York Magazine's Best Doctors since 2000, as well as on the Castle and Connolly Guide and Harvard's list of top specialists.]


A healthy living strategy from Health Canada.

Health Canada has set a goal to encourage 20% more Canadians to move to a "normal" body weight based on a Body Mass Index (BMI) of 18.5 to 24.9 as measured by the National Population Health Survey (NPHS), CCHS, and SC/CIHI Health Indicators. SMARTbite was designed to help Canadians achieve these goals.

Scientific Research on SMARTbite

Years of scientific research links rapid eating with overweight individuals and obesity, and shows that slowing eating decreases food intake.

Expert medical associations and government healthcare organizations consistently recommend slower eating for weight loss.

In addition, studies using SMARTbite have demonstrated:

  1. the effectiveness of SMARTbite in reducing intake at meals.
  2. the relationship between using SMARTbite and weight loss.


Using SMARTbite Reduces Food Intake at Meals - A study to determine
whether using SMARTbite would reduce how much food people consumed.

Researchers at the Pennington Biomedical Research Center studied whether using the SMARTbite would change how much people ate.

The group of people who wore the SMARTbite at meals ate 23% less (533 fewer calories).

There was no decrease in fullness after meals or increase in hunger between meals.

From: Walden HM, Martin CK, Ortego LE, Ryan DH, Williamson DA. A new dental approach for reducing food intake. Obesity Research. 2004;12:1773-80.


Abstract of SMARTbite Pivotal CLINICAL Trial -38.1% Excess Weight Loss (EWL)
(submitted for publication 2009)

Randomized controlled trial of a non-invasive oral restrictive device in overweight and obese adults

M. S. Roslin, MD FACS1, R. H. Brauner, MS2, and J.A. Dixon, MBBS,.PhD FRACGP3

1Lenox Hill Hospital , New York, NY, 2Touro College of Osteopathic Medicine, New York, NY, 3Monash University and Baker IDI Heart and Diabetes Institute. Melbourne, VIC, Australia

Abstract

Aim: Effective non-surgical weight loss options remain limited. This study investigated a custom-made oral device designed to reduce food intake.

Methods: A randomized controlled study of Scientific Intake’s Sensor Monitored Alimentary Restriction Therapy (SMART™) Device was conducted on 173 overweight or obese (BMI 26-36 kg/m2) adult subjects at 5 centers. The device is placed by the user below the hard palate to mimic torus palatinus, decreasing the capacity of the oral cavity to slow eating, reduce bolus size, promote thorough chewing, increase savoring and induce satiety to reduce caloric intake. Subject-made impressions were used to manufacture devices which were provided to the treatment group to use when eating for 16 weeks. Device-embedded microsensors provided data to graph usage. Fortnightly, all subjects were assessed and received video nutritional and exercise advice. Minimum usage requirements were added during the study and non-compliant subjects excluded.

Results: There were 108 evaluable subjects. The treatment group (n=41) had a significantly greater chance (48.8% vs. 4.5%) of losing >5% of their initial body weight than the control group (n=67) and the two groups experienced 38.1% and 2.5% excess weight loss, respectively (p<0.0001). There was a highly significant negative correlation between use of the device and percent weight change – those who used the device most lost more weight. There were no serious adverse events. Design improvements were identified.

Conclusions: The effectiveness and minimal risk of this unique non-invasive device in reducing dietary intake suggest that it can be a very valuable treatment for overweight and obesity.

Correspondence: Associate Professor John B. Dixon MBBS PhD FRACGP, Human Neurotransmitters Laboratory, Baker IDI Heart and Diabetes Institute, 75 Commercial Road, Melbourne VIC Australia 3004

References

1. Haslam DW, James PT. Obesity. Lancet. 2005;336(9492):1197-1209.

2. Rosenbaum M, Leibel RL, Hirsch J. Obesity. N Engl J Med. 1997;337:396-407.

3. Olshansky SJ, Passaro DJ, Hershow RC Layden J, Carnes BA, Brody J, Hayflick L, Butler RN, Allison DB, Ludwig DC. A potential decline in life expectancy in the United States in the 21st century. New Engl J Med. 2005;352:1138–45.

4. Padwal RS, Majumdar SR. Drug treatments for obesity: orlistat, sibutramine, and rimonabant. Lancet. 2007;369(9555):71-7.

5. Arterburn DE, Crane PK, Veenstra DL. The efficacy and safety of sibutramine for weight loss: a systematic review. Arch Intern Med. 2004;164:994-1003.

6. Campbell ML, Mathys ML. Pharmacologic options for the treatment of obesity. Am J Health Syst Pharm. 2001;58:1301-8.

7. Bult MJF, van Dalen T, Muller AF. Surgical treatment of obesity. Eur J Endocrinol. 2008;158:135-145.

8. Hill SW, McCutcheon NB. Contributions of obesity, gender, hunger, food preference, and body size to bite size, bite speed, and rate of eating. Appetite. 1984;5:73-83.

9. Laessle RG, Lehrke S, Dückers S. Laboratory eating behavior in obesity. Appetite. 2007;49:399-404. Epub 2007 Feb 27.

10. Sasaki S, Katagiri A, Tsuji T, Shimoda T, Amano K. Self-reported rate of eating correlates with body mass index in 18-y old Japanese women. Int J Obes Relat Metab Disord. 2003;27:1405-10.

11. Shin A, Lim SY, Sung J, Shin HR, Kim J. Dietary intake, eating habits, and metabolic syndrome in Korean men. J Am Diet Assoc. 2009;109:633-40.

12. Kral JG, Buckley MC, Kissileff HR, Schaffner F. Metabolic correlates of eating behavior in severe obesity. Int J Obes Relat Metab Diord. 2001;25:258-64.

13. Martin C. Does slower eating rate reduce food intake? Results of an empirical test. Presented at the North American Association for the Study of Obesity 2004 Annual Scientific Meeting, Nov. 14-18, 2004. Las Vegas, NV.

14. Andrade A, Minaker T, Melanson K. Eating rate and satiation in healthy women. Presented at the North American Association for the Study of Obesity 2006 Annual Scientific Meeting, Oct 20-24, 2006. Boston, MA

15. Martin CK, Anton SD, Walden H, Arnett C, Greenway FL, Williamson DA. Slower eating rate reduces the food intake of men, but not women: implications for behavioral weight control. Behav Res Ther. 2007;45:2349-59. Epub 2007 Apr 5.

16. Ebbeling CB, Garcia-Lago E, Leidig MM, Seger-Shippee LG, Feldman HA, Ludwig DS. Altering portion sizes and eating rate to attenuate gorging during a fast food meal: effects on energy intake. Pediatrics. 2007;119:869-75

17. Yeomans MR, Gray RW, Mitchell CJ, True S. Independent effects of palatability and within-meal pauses on intake and appetite ratings in human volunteers. Appetite. 1997;29:61-76.

18. Walden HM, Martin CK, Ortego LE, Ryan DH, Williamson DA. A new dental approach for reducing food intake. Obes Res. 2004;12:1773-80.

19. SF-36® Health Survey © 1988, 2002 by JE Ware, Jr., MOT Health Assessment Lab, Quality Metric Incorporated- All rights reserved.

Acknowledgements

The authors thank Ellen Duke for her assistance in the preparation of this article.

Expert Health Organizations Recommend Slower Eating For Weight Loss

The College of Family Physicians of Canada:

"Eat slowly so your body has time to know when it's full."

From: Tips on Achieving a Healthy Weight, in "Weight Control - Losing weight and Keeping It Off."
http://www.cfpc.ca/English/cfpc/programs/patient%20education/weight%20control/default.asp

American Medical Association:

"Eating slowly gives your body time to recognize your stomach is full."

From: The AMA Healthier Life Steps (A Physician-Patient Alliance for Longer, Healthier Life): Action Plan for Healthy Eating
http://www.ama-assn.org/ama1/pub/upload/mm/433/hl_eating.pdf

American Dietetic Association:

"It takes about 20 minutes for your brain to get the message that your body is getting food. When your brain gets this message, you stop feeling hungry. So, fast eaters-slow down and give your brain a chance to get the word."

From: Eating Right for a Healthy Weight: Food, Nutrition and Health Tips from the American Dietetic Association
http://www.eatright.org/Public/content.aspx?id=206

Centers for Disease Control and Prevention:

"Common eating habits that can lead to weight gain are: Eating too fast...Eating while standing up (may lead to eating mindlessly or too quickly)..."

From: Healthy Weight - It's Not a Diet, It's a Lifestyle! Improving Your Eating Habits: Reflect, Replace, Reinforce: A Process For Improving Your Eating Habits.
http://www.cdc.gov/healthyweight/losing_weight/eating_habits.html

The National Institutes of Health: National Heart, Lung, and Blood Institute (NHLBI):

"Dietary behavior changes can make it easier to eat less without feeling deprived. An important change is to slow the rate of eating to allow satiety signals to begin to develop before the end of the meal."

"Get the (Fullness) Message. Changing the way you eat can help you to eat less and not feel deprived.

Eating slowly will help you to feel satisfied when you've eaten the right amount of food for you. It takes 15 or more minutes for your brain to get the message you've been fed. Slowing the rate of eating can allow you to feel full sooner and, therefore, help you eat less."

From: 1) The Practical Guide: Identification, Evaluation, and Treatment of Overweight and Obesity in Adults, and 2) Guide to Behavior Change. National Institutes of Health: NHLBI - National Heart, Lung, and Blood Institute.
http://www.nhlbi.nih.gov/guidelines/obesity/prctgd_b.pdf
http://www.nhlbi.nih.gov/health/public/heart/obesity/lose_wt/behavior.htm

The Obesity Society:

"Avoid eating while watching TV. TV viewers may eat too much, too fast, and are influenced by the foods and drinks that are advertised."

In: Childhood Overweight. Tips for Parents & Caregivers to Help Establish Healthy Eating Patterns with Kids.
http://www.obesity.org/information/childhood_overweight.asp

Veterans Administration National Center for Health Promotion and Disease Prevention:

"Eating too fast is almost always a problem for overweight people. Feeling full takes time, and so should eating."

From: "Slow Down... You Eat Too Fast" Handout on move.va.gov. (MOVE! Is a national weight management program is a national weight management program designed by the Office of Patient Care Services, to help veterans lose weight, keep it off and improve their health.
http://www.move.va.gov/download/NewHandouts/BehavioralHealth/B26_SlowDownYouEatTooFast.pdf

American Association of Clinical Endocrinologists, The Obesity Society, and the American Society for Metabolic & Bariatric Surgery:

"Mindful, slow eating is essential."

From: Medical Guidelines for Clinical Practice For The Perioperative Nutritional Metabolic and Nonsurgical Support of the Bariatric Surgery Patient ©2008. American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery Medical Guidelines For Clinical Practice For The Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient © 2008



EAT FAST? WEIGH MORE!

Overweight People Eat Faster and Take Larger Bites

Studying how people eat their meals, researchers found that obese people eat faster (especially when they start eating), take much larger bites, and as a result eat more food.

Laboratory eating behavior in obesity
Authors: Laessle RG, Lehrke S, Dückers S. Appetite.
2007 Sep;49(2):399-404. Epub 2007 Feb 27.


Overweight People Chew and Swallow Food Faster

These researchers found that the obese subjects in the study chewed and swallowed mouthfuls of food much faster than the nonobese subjects, and also ate their the meals faster.

Oral satiety in the obese and nonobese.
Authors: Wagner M, Hewitt MI.
Journal of the American Dietetic Association 1975 Oct;67(4):344-6


Fast Eating is a Cause of Obesity

This study of over three thousand people found that those who reported being fast eaters were much more likely to be overweight.

Eating Fast Leads to Obesity: Findings Based on Self-administered Questionnaires Among Middle-Aged Japanese Men and Women.
Otsuka R, Tamakoshi K, Yatsuya H, Murata C, Sekiya A, Wada K, Zhang H, Matsushita K, Sugiura K, Takefuji S, OuYang P, Nagasawa N, Kondo T, Sasaki S, Toyoshima H.
Journal of Epidemiology. 2006 May:16:3:117-124.


Larger Bites Are a Major Contributor to Fast Eating and Obesity

This study of college students found that the speed of eating increased with obesity and body size, and that larger bites accounted for the increased rate of eating.

Contributions of obesity, gender, hunger, food preference, and body size to bite size, bite speed, and rate of eating.
Hill SW, McCutcheon NB.
Appetite. 1984 Jun;5(2):73-83


18-Year-Olds Who Eat Faster Are More Obese

Researchers looked at eating rates in relation to obesity (by measuring body mass index*). They found that 18-year-old women who reported that they ate faster had a significantly higher body mass index (they were more overweight) than others.

*Body Mass Index (BMI) is a simple index of weight-for-height that is commonly used to classify underweight, overweight and obesity in adults. It is defined as the weight in kilograms divided by the square of the height in meters (kg/m2). For example, an adult who weighs 70kg and whose height is 1.75m will have a BMI of 22.9. (A BMI calculator is provided at www.smartweightloss.com.)

Self-reported rate of eating correlates with body mass index in 18-y old Japanese women.
Authors: Sasaki S, Katagiri A, Tsuji T, Shimoda T, Amano K.
International Journal of Obesity and Related Metabolic Disorders. 2003 Nov; 27(11): 1405-10.


Children Who Eat Fast Are More Overweight

Researchers studied the relationship between how fast children eat and their weight by videotaping 254 twins eating meals at home. The study showed that there is a clear relationship between faster eating and overweight and that fast eating can be inherited from parents.

Eating rate is a heritable phenotype related to weight in children.
Authors: Llewellyn CH, van Jaarsveld CH, Boniface D, Carnell S, Wardle J.
American Journal of Clinical Nutrition. 2008 Dec;88(6):1560-6.



FAST EATING IS BAD FOR YOUR HEALTH

Children Who Eat Fast Are More Overweight

In independent studies involving thousands of people, researchers reported that eating faster is a habit that is much more frequent in people who are overweight and also experiencing more related health problems, particularly the metabolic syndrome*

*Obesity, high blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, high fasting blood glucose level (associated with type 2 diabetes).

Eating fast leads to insulin resistance: Findings in middle-aged Japanese men and women
Otsuka R, Tamakoshi K, Yatsuya H, Wada K, Matsushita K, OuYang P, Hotta Y, Takefuji S, Mitsuhashi H, Sugiura K, Sasaki S, Kral JG, Toyoshima H..
Preventive Medicine 2008 Feb;46(2):154-9. Epub 2007 Aug 3.
Dietary intake, eating habits, and metabolic syndrome in Korean men. Shin A, Lim SY, Sung J, Shin HR, Kim J.
Journal of the American Dietetic Association 2009 Apr;109(4):633-40.


Eating Fast Makes Obesity More Dangerous to Your Health

In a study of severely obese people, researchers found that several health problems* showed up much more in people who ate fast than those who ate slower. How fast someone ate was worse than how much excess weight they had. The researchers concluded that eating rate could be a cause of the metabolic syndrome.**

*fatty liver, elevated serum lipids, central fat distribution) ***Obesity, high blood pressure, low high-density lipoprotein cholesterol level, high triglyceride level, high fasting blood glucose level (associated with type 2 diabetes).

Metabolic correlates of eating behavior in severe obesity.
Authors: Kral JG, Buckley MC, Kissileff HR, Schaffner F
International Journal of Obesity and Related Metabolic Disorders. 2001 Feb;25(2):258-64.


Men with Type 2 Diabetes Who Eat Fast are More Obese

Weight loss is recommended for people who have type 2 diabetes or hyperlipidemia. In this study, it was found that men with these conditions who ate faster were more obese than men who ate at a normal or slower rate. Eating fast may make weight loss more difficult.

Rate of Eating and Body Weight in Patients with Type 2 Diabetes or Hyperlipidaemia
Authors: Takayama S, Adamine Y, Okabe T, Koya T, Haraguchi M, Miyata Y, Sakai T, Sakura H, Sasaki T.
The Journal of International Medical Research 2002: 2002: 30:442-444.



SLOWER EATING HELPS WEIGHT LOSS

Eating Slower = Eating Less, Enjoying it More!

This important study compares fast and slow eating: Normal-weight women ate lunch as quickly as possible one day and on another day ate slowly and chewed more. They could eat as much as they wanted both times. The women ate significantly more calories in 9 minutes (eating fast) than they did in 29 minutes (eating slowly), 646 calories vs 579 calories, a reduction of 67 calories - over 10%. They were less satisfied and more hungry after the fast meal than after the slow meal, even though they had eaten more food at the fast meal.

Eating slowly led to decreases in energy intake within meals in healthy women.
Authors: Andrade AM, Greene GW, Melanson KJ.
Journal of the American Dietetic Association 2008 Jul;108(7):1186-91.


Slower Eating Reduces Food Intake

This study measured how much food was eaten by people who ate at their usual rate and slower than normal. Significantly less food was eaten when people ate slower than normal.

Does Slower Eating Rate Reduce Food Intake? Results of an Empirical Test.
Authors: Martin C, Anton S, Walden H, Arnett C, Williamson D.
Obesity Research. 2004 Oct. 12:Abstract Supplement: North American Association for the Study of Obesity 2004 Annual Scientific Meeting, Nov. 14-18, 2004.


When Fast-Eaters Slow Down? They Eat Less, Feel More Satisfied!

In a study of how changing how fast you eat affects how much you eat, women who normally ate faster ate less and felt less hungry at the end of the meal when they ate slower.

Decelerated and linear eaters: effect of eating rate on food intake and satiety.
Authors: Ioakimidis I, Bergh C, Brodin U, Södersten P.
Physiological Behavior. 2009 Feb 16;96(2):270-5. Epub 2008 Oct 18.


Slower Eating Is a Healthier Habit

In studying why Americans are more obese and have more related health problems than the French, researchers reported that the French eat slower, that "although the French may eat less than Americans, they spend more time eating."

The Ecology of Eating: Smaller Portion Sizes in France Than in the United States Help Explain the French Paradox.*
Authors: Rozin P, Kabnick K, Pete E, Fischler C, Shields C.
Psychological Science 2003 Sep 14:5:450-454.

*The French Paradox: The mortality rate from heart disease is substantially lower among the French even though the French have more fat in their diet than Americans.


Diet Drugs Also Slow Eating - With Side Effects

Researchers conducted a detailed* study of how the diet drug sibutramine (sold as Meridia, Reductil) works. They concluded that it helps decrease how much people eat because it slows eating.

*double blind, placebo-controlled, crossover randomized trial

The effects of sibutramine on the microstructure of eating behaviour and energy expenditure in obese women
Authors: Halford J, Boyland E, Cooper S, Dovey T, Huda M, Dourish C, Dawson G, Wilding J.
Journal of Psychopharmacology. 2008 Nov 21. [Epub ahead of print]



SMALLER BITES AND CHEWING MORE HELPS WEIGHT LOSS

Take Smaller Bites and Savor Food to Lose Weight

A recent study confirmed yet again that bite size matters - a lot. In a carefully controlled study, subjects taking larger bites ate much more than when they ate with smaller bites. They also ate more when they swallowed their food quickly rather than savoring their food.

In fact, when subjects took large bites, they ate 30% more than when they ate with small bites. When subjects took large bites and also swallowed their food quicker, they ate over 50% more!

Eating with smaller bites and savoring food more greatly reduces the amount of food eaten at meals.

Effect of Bite Size and Oral Processing Time of a Semisolid Food on Satiation.
Authors: Zijlstra N, de Wijk R, Mars M, Stafleu A, de Graaf C.
American Journal of Clinical Nutrition 2009:90:269-75.


Chewing Food More Helps Us Feel Satisfied

In reviewing how a very low calorie diet can be satisfying, this researcher noted that chewing activates signals to the brain that make us feel more satisfied and eat less.

A very-low-calorie conventional Japanese diet: its implications for prevention of obesity.
Author: Sakata T.
Obesity Research 1995 Sep;3 Suppl 2:233s-239s


More Chewing Decreases Hunger and Snacking

Researchers found that increased chewing (using gum in this case), reduces hunger and the desire for sweets, and reduces snacking between meals.

Short-term effects of chewing gum on snack intake and appetite.
Authors: Hetherington MM, Boyland E.
Appetite 2007 May;48(3):397-401. Epub 2006 Nov 21.


Replacing Beverages With Foods That Need Chewing Reduces Between-Meals Hunger

This was a comparison of how long having an apple, apple-sauce, or apple juice kept people satisfied before they wanted to eat again. All had the same amount of calories. Researchers found that the apple juice was the worst, the apple the best, and the apple-sauce in-between. This was true whether they were eaten with a meal or as a snack between meals.

Effects of food form and timing of ingestion on appetite and energy intake in lean young adults and in young adults with obesity.
Authors: Mattes RD, Campbell WW.
Journal of the American Dietetic Association. 2009 Mar;109(3):430-7.