It's not a magic bullet for obesity. But a new retainer-like device that keeps people from scarfing down food faster than the gut can signal to the brain, "I'm getting full, stop eating," has proven safe and effective in a new study.
The custom-fitted device is popped in the upper palate only while eating.
Its purpose, as described in the study by Australian researchers, is to "displace oral volume," thereby forcing people to take smaller bites and chew their food more thoroughly and slowly before swallowing.
Essentially, it's a mechanical way of getting people to do what their mothers always told them to do: Slow down.
The device, called SMART (or "sensor monitored alimentary restriction therapy," itself a mouthful) was invented by a woman with a condition called torus palatinus, where bony protrusions that can grow from barely there, to the size of a ping-pong ball cut in half forms on the roof of the mouth.
Not only was she thin, but also she was always the last person to finish eating because of her reduced oral capacity.
She created a device that would simulate her condition "so that people would take smaller bites, chew their food more thoroughly, actually taste their food and have some oral processing going on to trigger their satiety response," said Bill Longley, CEO of Atlanta-based Scientific Intake, makers of SMART. The company is seeking a strategic partner to bring its device to the Canadian market.
Most overweight people are rapid eaters, and numerous studies have linked rate of eating to overeating. Eating quickly appears to inhibit the release of gut hormones that signal satiety. "We're simply outpacing our body's ability to shut down when it feels full," Longley said.
The device works on the concept of dietary restriction. Similar to bariatric, or stomach-shrinking surgery, people feel fuller, faster and on fewer calories, he said.
"It's more in harmony with the body's defence system against overeating."
A sensor embedded in the device acts like an automatic diet "journal" by tracking how often its used.
The new study, paid for by the manufacturers of the SMART device and published in the journal Obesity, involved 20 overweight and obese participants, aged 18 to 50; 16 completed the study. All were prescribed a diet that emphasized whole grains, fresh fruit and vegetables, lean protein, foods low in saturated fat and the elimination of refined sugars. People used the devices for 10 meals per week, on average, throughout the study.
After 16 weeks, the mean weight loss was five kilograms. Waist and hip circumferences also decreased significantly, according to the researchers.
All participants described themselves as "fast eaters" at the study's outset. Four months later, "almost all reported eating more slowly and being more conscious of portion size and satiation," the researchers report.
They were less likely to engage in "emotional" or uncontrolled eating, and experienced less hunger and cravings.
No serious adverse events were reported. Several patients experienced some gagging, initially, while eating, "but this ceased when they had adequately adjusted their eating pattern," according to the researchers. The device also made people lisp; some felt so self-conscious they either ate their lunch alone at work, avoided lunchroom conversations or avoided wearing it at work altogether. Longley says the device is thicker than retainers, which are often quite thin. "A lot of people think this thing is huge, and it really isn't." Most people get used to it quickly, he said.
The new paper shows proof of concept, says Dr. David Lau, president of Obesity Canada and a professor of medicine at the University of Calgary.
"It has a modest effect — five per cent of body weight loss, which is not insignificant. But it tells us this does, in fact, work," Lau said.
The larger question is, would people stick with it?
The concept "is certainly innovative and could certainly help some people manage their weight if used at most meals," added Dr. Arya Sharma, scientific director of the Canadian Obesity Network and chair in obesity research and management at the University of Alberta in Edmonton.
"Obviously, we still lack long-term effectiveness data and are still not sure who the best patients for this device may be," he added.
At the very least, "it reinforces what we're telling people all the time," said Lau, of the University of Calgary. "If you eat slower, you eat less."
"What I usually tell my patients is to eat slowly, savour the food and chew well. That should take a good 15 to 20 minutes to eat dinner."