Michelle Moriarty Journal Article Summary Title: Slower eating speed lowers energy intake in normal-weight but not

overweight/obese subjects Authors: Shah M, Copeland J, Dart L et al. Journal: Journal of the Academy of Nutrition and Dietetics Volume: 114 number 3 Pages: 393-402 Year: 2014

Introduction:
Review of Literature: The purpose of this study was to determine whether the effect of eating speed on energy intake is the same in normal-weight and overweight/obese subjects. Hunger levels as well as the level of fullness after consuming a slowly eating meal was measured compared with eating the same meal at a faster rate. Rationale: In previous studies, it has been shown that a faster eating rate impairs the bodys ability to sense fullness cues. Also studies have found that eating speed is positively related to body weight. Many of these studies, however, were conducted with subjects with mostly normal BMI (28.5-24.9) and from largely Asian populations. Hypotheses or Objectives: The objective of this study was to determine the effect of eating speed on energy intake in normal-weight and overweight/obese subjects. Factors such as energy density, perceived hunger and fullness following the meal and physical activity were all assessed.

Study Design and Methods:

General Approach: hypothesis testing Level of Measurement: individual measurement Specific Design: randomized crossover design Population at Risk: The subjects were recruited from Texas Christian University and the surrounding community. Normal-weight and overweight/obese men and women were randomly selected. The age range was 19 to 65 years old. To be classified as overweight a subject had to meet 2 of the 3 criteria: Waist circumference >88 cm for women, >102 cm for men BMI 25 for both men and women Percent body fat > 25% for men and >32% for women Sampling Method and Sample Size: 35 normal weight subjects were selected (aged 33.3 +/- 12.5 years; 14 women and 21 men). 35 overweight/obese subjects were selected (44.1 +/- 13.0 years; 22 women and 13 men). 90% of subjects were of the non-Hispanic origin and 30% were minorities. Selection and Exclusion Criteria for Study Group: Exclusion criteria included: Morbid obesity (BMI 40) Dieting Taking medications that affect appetite Participating in >150 minutes per week of vigorous physical activity Smoking Drinking heavily (men: >14 drinks/week, women: > 7 drinks/week)

 Self-reported disordered eating Depression Type 1 or 2 diabetes Adrenal disease Untreated thyroid disease Selection bias was present due to the fact that the majority of subjects were Caucasion, while there were other ethnicities represented, the numbers were few. Dependent Variable: The dependent variable was the test meal eaten ad libitum. The test meal was vegetable pasta that consisted of ditalini pasta, tomatoes, olive oil, green onions, garlic, parsley, basil, sugar, salt, pepper and parmesan cheese. Women were served 900 grams (1300 kcal) and men were served 1200 grams (1734 kcal). All subjects were given 12 fl oz of water with each meal and allowed more if they wished. Independent Variable: The independent variables include eating speed, energy intake, rate of energy intake, energy density, BMI, waist circumference, skin fold thickness, body density, percent body fat, physical activity, food intake prior to testing, assessment of hunger, fullness, desire to eat, thirst and palatability. Speed of eating was measured using a stop watch and the amount of food and water consumed was measured using a digital scale to the nearest 0.5 gm. For the faster eating speed, subjects were instructed to consume their meal as quickly as they could without feeling uncomfortable. They were told to eat as if they had a time constraint, to take large bites, chew quickly and refrain from pausing or putting the utensil down. For the slower pace, the subjects were instructed to eat as if they had not time constraint, take small bites, chew thoroughly and pause and put the utensil down. Specific conditions were not given regarding the precise size of each bite, the bite rate or the number of chews per bite. Energy intake was calculated from the weight in grams of the meal consumed and the energy content of the meal per 100 grams. The rate of energy intake was measured by dividing the energy intake by the respective eating duration in minutes. Energy density was calculated by dividing energy intake by the respective total grams of food and water consumed. Waist circumference was measured using Sammons Preston Gulick cloth tape measure. Skin fold thickness was measured at the abdominal, triceps, chest, midaxillary, subscapular, suprailiac and thigh sites using the Lafayette Skinfold II Calipers. Body density was calculated from the sum of 7 skin fold measures. Body fat percentage was calculated from body density. Physical activity was measured using a modified 7-day Physical Activity Recall. All food and drink intake was recorded by subjects on the day before the study days and the mornings of the study days. The food records were analyzed by the Food Processor SQL software program.

Perceived hunger, fullness, desire to eat and thirst were assessed using a validation 100 mm visual analog scale (VAS). The measurements were taken immediately before the meal was served and periodically after the meal began in both conditions. Measurements were taken at 5, 10, 15, 20, 25, 30, 45 and 60 minutes. The palatability of the meal was assessed using VAS at 1 minute after the meal began and at meal completion. Potential Confounding or Effect-Modifying Variable: Controlled by Study Design: Test meal served in same size white bowls Subjects given the same utensil during each eating condition Subjects were seating in their own area away from other subjects when eating Subjects were not allowed to communicate with one another Subjects reported to metabolic kitchen The 2 study days were separated by a washout period of at least 4 days. Physical activity and food intake before the study was controlled by having subjects keep the same intake and activity on the day before and the morning of the study. Subjects were to keep a food record. Controlled by Analysis: Age Gender Race BMI Self-reported eating rate Waist circumference Percent body fat Information Bias Controlled by Study Design: The subjects were randomly assigned an eating condition and were kept separate from each other. The authors stated some subjects were aware of what the eating conditions were from previous participants before the study was explained to them by investigators.

Results:
Missing Data: All subjects that were selected for the study completed the study. Major Findings: Energy intake and physical activity on the before and the morning of the study days did were not different by eating condition. The average palatability of the meal was high and there was no difference between the slow and fast eating conditions in the normal weight subjects (80.8 +/- 14 mm vs 80.6 +/- 13.9 mm, respectively; P=0.92) or overweight/obese subjects (83.1 +/- 14.6 mm vs 82.8 +/- 14.6 mm, respectively; P=0.86).

Food and energy intake were lower during the slow condition compared to the fast in both weight groups, however the differences were only statistically significant in the normal weight subjects (P=0.04) and not the overweight/obese subjects (P=0.18). During the slow eating condition, both groups had lower energy density and rate of energy intake and higher water intake and meal duration. Compared with the fast eating condition, the slow condition resulted in a reduction in energy intake by 10% (88 kcal) in the normal weight subjects and 8% (58 kcal) in the overweight/obese subjects. The difference in the overweight/obese group was smaller and not statistically significant. In both groups, hunger ratings were lower at 60 minutes from the beginning of the meal during the slow eating condition. The normal weight subjects reported feeling more full at 60 minutes during the slow condition. Consuming a meal at slower vs faster rate results in a significant reduction in food and energy intake in normal weight but not overweight/obese subjects.

Control for Confounding: The variables from the list above were controlled by the investigators by holding the study in a metabolic test kitchen. Statistical Analysis: A mixed-model repeated measures analysis was used to examine the effect of eating condition, weight status, and eating condition by weight status interaction on meal duration, weight of food consumed, energy intake, water intake, combined weight of food and water, energy density, rate of energy intake and palatability of the meal. The differences in these were measure by least square means. The sample size of 35 normal weight and 35 overweight/obese subjects has 95% power to detect an expected difference of 70 kcal between the two eating conditions within each group while assuming <.05 and a standard deviation for the difference for repeated measure analysis of 110 kcal.

Discussion and Conclusions:

Internal Validity: The subjects were randomly selected with the majority was of Caucasian race and with 30% minorities which makes this study more generalized than others of the same purpose.. There was equal number of subject for the two weight groups which allows for better comparison. External Validity: The results could be generalized for a greater cross section of people since a greater number of races/ethnicities were represented. Strengths and Limitations: Limitations of the study include: Small sample size Meals were consumed in a metabolic kitchen as opposed to a natural setting The slow and fast eating conditions were engineered by the investigators; the subjects were instructed on how to slow or speed their eating. Strengths include: Randomized, crossover study Compared the same number of overweight/obese subjects to normal weight subjects Approximately the same number of men and women were included in the study

The subjects were separated from one another during the study Physical activity levels and food intake before the study were controlled

Consistency with Other Studies: The authors discuss other studies that measure the effect of intake on eating speed by modifying bite size, bite rate, number of chew per bite and/or food texture. The results of these studies vary with some finding a correlation between slower eating and less intake and other finding no change intake despite speed of eating. Theoretical Importance of Reality: The results of this study can be used for the public; this issue has been brought up before and the general public would be interested to see that this study shows some correlation between a slower eating speed and less food intake. However, this study only found a decrease in intake in normal weight people not in the overweight/obese group. Since the obesity rate in the United States is growing, this information may not apply to most Americans at this time. Practical Importance of Results: The results of this study show that individuals could attempt to slow down that rate that they eat to observe if it has an effect on their intake. Further Study: The authors state that it would be important to examine whether slower eating speed over the long term would lead to weight loss.