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Development and initial evaluation of attentive eating intervention for weight management in primary care

Project title

Development and initial evaluation of attentive eating intervention for weight management in primary care

Project reference


Final report date

30 September 2013

Project start date

01 October 2011

Project end date

01 October 2013

Project duration

2 years

Lead investigator(s)
  • Mr Eric Robinson, School of Psychology, Birmingham University
NIHR School Collaborators
  • Professor Paul Aveyard, Nuffield Department of Primary Care Health Sciences, University of Oxford
  • Dr Suzanne Higgs, School of Psychology, Birmingham University
  • Mrs Amanda Lewis, Department of Primary Care Clinical Sciences, Birmingham University
  • Ms Deborah Lycett, Department of Primary Care Clinical Sciences, Birmingham University
  • Dr Kate Jolly, Department of Public Health, Epidemiology & Biostatistics, Birmingham University
  • Dr Amanda Daley, Department of Primary Care Clinical Sciences, Birmingham University

Project objectives

The aim of this research is to follow the MRC Framework for Development and Evaluation of Complex Interventions to determine which of several possible attentive eating strategies might be best suited to a phase II trial application. We will do this in four steps.

  1. Survey existing literature on enhancing memory of food consumed and self monitoring. This will produce a long-list of possible approaches to use to enhance attentive eating and the research team will select the most promising ideas to take forward to the next stage.
  2. The team will then work up the strategies into plausible scenarios and use the Behaviour Change Wheel and the taxonomy of behaviour change interventions to design interventions to motivate and support patients to use these attentive eating strategies.
  3. The research team will recruit staff of the University of Birmingham who are overweight and want to lose weight to try out the strategies. We will describe the strategies and then use the behavioural interventions we have developed to encourage and support our volunteers to adopt one or more of the attentive eating strategies. The aim of this part of the research is to examine the degree to which participants use these various strategies. Although we will measure weight loss, weight is not the primary outcome. Use will be assessed by debrief interviews and reflection, perhaps supplemented by realtime monitoring if feasible.

This would lead to a funding application for a post-doctoral fellowship to test these attentive eating strategies in a phase II trial in a clinical population trying to lose weight. Such trials are typically published in leading speciality journals.

Using the MRC Framework for Complex Intervention, we propose phase O and I testing of attentive eating interventions for weight management in obesity. 

Brief summary


Attentive eating means eating devoid of distraction and increasing awareness and memory for food being consumed. Encouraging individuals to eat more attentively could help reduce calorie intake, as a strong evidence base suggests that memory and awareness of food being consumed substantially influence energy intake.


The development and feasibility testing of a smartphone based attentive eating intervention is reported. Informed by models of behavioral change, a smartphone application was developed. Feasibility was tested in twelve overweight and obese volunteers, sampled from university staff. Participants used the application during a four week trial and semi-structured interviews were conducted to assess acceptability and to identify barriers to usage. We also recorded adherence by downloading application usage data from participants’ phones at the end of the trial.


Adherence data indicated that participants used the application regularly. Participants also felt the application was easy to use and lost weight during the trial. Thematic analysis indicated that participants felt that the application raised their awareness of what they were eating. Analysis also indicated barriers to using a smartphone application to change dietary behaviour.


An attentive eating based intervention using smartphone technology is feasible and testing of its effectiveness for dietary change and weight loss is warranted. 

Plain English summary

Attentive eating means attending to your food and consciously remembering it and recalling this next time you come to eat. Experiments in psychology laboratories show that attending to the food you eat or being consciously reminded of what you have previously eaten limits food intake at the current meal and at future meals. However, there is no evidence from clinical studies that this has any effect on weight loss in overweight people but the preliminary evidence suggests that it might. However, it is unlikely that simply telling people ‘think about what you are eating’ will have any useful effect. Instead we propose to follow advice from the Medical Research Council about how to produce an intervention that will have the best chance of changing people’s behaviour. We propose first to search for and assess which attentive eating interventions have shown any effect in short term experiments and also search for evidence of effects of self-monitoring of food, which are likely to be similar to those for attentive eating. Using these as a basis, we will construct a comprehensive catalogue of attentive eating strategies that might be used. We will use the information from this to develop possible new strategies. We will then use a method called the Behaviour Change Wheel to consider ways in which we can best communicate and support people to use each of these strategies. The whole group will consider the long list and decide which ones are best suited for further testing. We will invite staff at the University of Birmingham who want to lose weight to try one or more of these strategies. By regular interview and weighing, we will record how often people use these strategies and how successful they are in controlling weight. We will evaluate these data and decide which one or two strategies might be taken forward for testing in a controlled clinical trial to assist weight loss. 


Published articles

  1. Robinson E, Aveyard P, Daley A, Jolly K, Lewis A, Lycett D, Higgs S. Eating attentively: a systematic review and meta-analysis of the effect of food intake memory and awareness on eating. Am J Clin Nutr. 2013;97(4):728-42 doi:10.3945/ajcn.112.045245.
  2. Robinson E, Higgs S, Daley AJ, Jolly K, Lycett D, Lewis A, Aveyard P. Development and feasibility testing of a smart phone based attentive eating intervention. BMC Public Health. 2013;13:639 doi:10.1186/1471-2458-13-639. 

Public involvement

Although this project is research on volunteers, it is actively seeking their responses and views on interventions that might be used for future clinical testing. We therefore suggest that this is involving potential future users. Furthermore, we will seek from among our trial participants people to attend the final session when the PI will present the findings of the research to the wider group. This group will determine which interventions go forward for phase II testing and help shape the research that will follow in phase II. 

This project was funded by the National Institute for Health Research School for Primary Care Research (project number 128)

Department of Health Disclaimer

The views and opinions expressed therein are those of the authors and do not necessarily reflect those of the NIHR School for Primary Care Research, NIHR, NHS or the Department of Health.