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Treatment of childhood obesity by retraining eating behaviour: randomised controlled trial

BMJ 2010; 340 doi: (Published 06 January 2010) Cite this as: BMJ 2010;340:b5388
  1. Anna L Ford, research nurse1,
  2. Cecilia Bergh, CEO of Mando Group AB2,
  3. Per Södersten, professor2,
  4. Matthew A Sabin, RCH Foundation clinical research fellow14,
  5. Sandra Hollinghurst, senior lecturer3,
  6. Linda P Hunt, senior lecturer1,
  7. Julian P H Shield, professor 15
  1. 1Department of Clinical Sciences, South Bristol, University of Bristol
  2. 2Karolinska Institute, Section of Applied Neuroendocrinology, Mandometer Clinic, Novum, S-141 57 Huddinge, Sweden
  3. 3Department of Community Based Medicine, University of Bristol
  4. 4Murdoch Childrens Research Institute at the Royal Children’s Hospital, Melbourne, Australia
  5. 5Bristol Royal Hospital for Children, University Hospitals Bristol NHS Foundation Trust
  1. Correspondence to: J P H Shield, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8AE j.p.h.shield{at}
  • Accepted 30 September 2009


Objective To determine whether modifying eating behaviour with use of a feedback device facilitates weight loss in obese adolescents.

Design Randomised controlled trial with 12 month intervention.

Setting Hospital based obesity clinic.

Participants 106 newly referred obese young people aged 9-17.

Interventions A computerised device, Mandometer, providing real time feedback to participants during meals to slow down speed of eating and reduce total intake; standard lifestyle modification therapy.

Main outcome measures Change in body mass index (BMI) standard deviation score (SDS) over 12 months with assessment 18 months after the start of the intervention. Secondary outcomes were body fat SDS, metabolic status, quality of life evaluation, change in portion size, and eating speed.

Results Using the last available data on all participants (n=106), those in the Mandometer group had significantly lower mean BMI SDS at 12 months compared with standard care (baseline adjusted mean difference 0.24, 95% confidence interval 0.11 to 0.36). Similar results were obtained when analyses included only the 91 who attended per protocol (baseline adjusted mean difference 0.27, 0.14 to 0.41; P<0.001), with the difference maintained at 18 months (0.27, 0.11 to 0.43; P=0.001) (n=87). The mean meal size in the Mandometer group fell by 45 g (7 to 84 g). Mean body fat SDS adjusted for baseline levels was significantly lower at 12 months (0.24, 0.10 to 0.39; P=0.001). Those in the Mandometer group also had greater improvement in concentration of high density lipoprotein cholesterol (P=0.043).

Conclusions Retraining eating behaviour with a feedback device is a useful adjunct to standard lifestyle modification in treating obesity among adolescents.

Trial registration NCT00407420.


  • We thank the participants and their families for taking part in this study; David Hopkins, Shelly Easter, and Riyaz Jamal for their clinical contributions; and Stafford Lightman and Michael Leon for constructive discussions.

  • Contributors: JPHS, MAS, CB, PS, and LPH designed the study. ALF conducted the Mandometer intervention with advice from CB. LPH, ALF, SH, and JPHS managed the database and performed all of the trial statistical analysis presented here, independent from the Mandometer Clinic, Sweden. CB and PS developed the Mandometer in the Karolinska Institute, Sweden and during the pilot study of childhood obesity. All contributors reviewed and edited the manuscript. JPHS is guarantor.

  • Funding: This study was funded by the BUPA Foundation. The Mandometer devices were loaned to the research team at no cost.

  • Competing interests: CB and PS each have 28.35% stock in Mando Group AB. Mandometer AB, a fully owned subsidiary of Mando Group AB, holds the intellectual property rights to Mandometer. JPHS (on two occasions) and MS (one occasion) were funded by Mando Group AB for attending investigator meetings in Stockholm. AF stayed at the Mandometer Clinic for 11 weeks to be trained in the use of Mandometer and was funded by Mando Group AB.

  • Ethical approval: This study was approved by United Bristol Hospitals Trust research ethics committee (ref 04/Q2006/9) and written informed consent was given by all participating families.

  • Data sharing: No additional data available.

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