So, here's a different approach. A new study looks at the use of a computerized device in helping to modify eating behavior in typically developing obese adolescents. Treatment of childhood obesity by retraining eating behaviour: randomized controlled trial examines the use of a Mandometer, which provides real time feedback during meals. Originally developed for people eating disorders such as anorexia, this is the first report of the device being used to assist in weight loss. The mandometer is a portable weighing scale connected to a small computer, which continually measures the food removed from the plate. (a video showing the mandometer is available here) A graph is generated that represents food consumed over time, as a meal is eaten. For anorexia, the computerized system provides feedback to help the user eat an appropriately large meal in a reasonable amount of time. The mandometer in this report on obese individuals is set to help participants slow down their speed of eating and reduce total food intake, since obese teenagers often eat rapidly compared to normal weight controls. Here, obese teenagers were taught over time to gradually adopt a more normal pattern of eating, trying to make their graph match the "normal fullness" training graph. Those kids using the mandometer were compared to other obese teens, who were given a standard lifestyle modification therapy. The results were encouraging. After 12 months, the teens who used the mandometer had significantly decreased body mass index compared to those who had standard lifestyle intervention, and this difference was maintained at 18 months indicating that there might be a long term change in eating behavior. Several additional measures also looked considerably better asmeal size decreased, body fat was down and cholesterol was lower in those who used the computer training system. Weight loss was comparable to other studies that have used drug interventions such as orlistat or sibutramine. It is important to note that not every individual who used the mandometer did well, it's easy to imagine that a person using this approach would have to be motivated to comply with the training.
So, is this something to consider in PWS? Brain imaging studies in this population have shown that they have a significantly delayed response in detecting that they have consumed calories (Shipira, 2005), a finding that will not surprise anyone who loves a person with PWS. Coupled with rapid food consumption, which is also common, this can lead to a lot of food being eaten per meal. The drive to eat can be (and very often is) tremendous in those with PWS, and it is unreasonable to expect that such an intervention alone would fix these issues. However, it is also true that many individuals with PWS are willing to work very hard to keep their weight under control. With the real-time positive feedback that this approach provides (and lots of visual graphs and numbers, which can also be fun), this might be a good tool in helping those motivated individuals with PWS learn to eat more slowly and, perhaps, feel a bit more full with a little less food.