Newswise — Reston, VA, July 13, 2021 – The Medical Care Standards Committee of the Academy for Eating Disorders (AED) – a multidisciplinary group of physicians, psychiatrists, psychologists, nurse practitioners, dieticians, advocates, and researchers - has issued a position statement regarding the Dental Slim Diet Control Device:
Recently, the British Dental Journal released findings on a new tool designed for weight loss, the Dental Slim Diet Control device.[1] This apparatus uses closed-field magnets to restrict mouth opening. The seven participants in the study were provided a commercially available extremely low-calorie (800 kcals/d) liquid diet during device use to promote weight loss. The Medical Care Standards Committee of the Academy for Eating Disorders has grave concerns about the use of this device.
Very low-calorie liquid diets are not an innovation; an 800 kcal/day starvation diet typically leads to rapid weight loss, even without this device. Rapid weight loss can lead to life threatening medical complications of severe malnutrition in every organ system, including but not limited to bradycardia, hypotension, macronutrient and micronutrient deficiencies, liver disease, and refeeding syndrome. The authors failed to assess for any medical complications including laboratory and vital sign abnormalities.
Patients in this study indeed had rapid weight loss: the equivalent of 14 pounds, in 2 weeks, and then partial weight regain just two weeks after the device was removed. This is unsurprising, as dieting is commonly associated with repeated weight cycles of weight loss and regain, which typically result in worsened health outcomes and adverse cardiometabolic risk.[2] This is in part because human brains respond to the perception of inadequate caloric intake by shifting myriad physiological processes to slow metabolism, as a result of which most caloric restriction results in short term weight loss but is nearly always followed by weight increase back to baseline and often higher.[3]
No psychological evaluation support was included in this study at any juncture, creating risk that use of this device may create or perpetuate restrictive or compensatory eating disorders behaviors, as well as other psychological concerns. The authors themselves stated that “participants indicated that they occasionally had discomfort and felt that life in general was less satisfying.” Studies have shown that weight loss attempts may lead to the development of eating disorders, depression, body dissatisfaction, and maladaptive weight control behaviors.
The study design and analyses are also a concern. The two-week follow-up does not allow assessment of safety or efficacy over any longer-term period, even though the authors recommend using and reusing the device episodically over the long-term to have multiple cycles of weight loss. It is certainly possible that this device may cause long-term weight gain due to complications of such prescribed weight cycling.
Lastly, the AED wishes to comment upon the shame and stigma implied in this study. The potential for abuse, misuse, and psychological damage from this dental device is of grave ethical concern. We call upon the entire health care community to question the use of not only this device, but of all weight loss methods that perpetuate weight stigma and may lead to patient harm.
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[1] Brunton, P., Ratnayake, J., Bodansky, H. et al. An intraoral device for weight loss: initial clinical findings. Br Dent J (2021). https://doi.org/10.1038/s41415-021-3081-1
[2] Madigan CD, Pavey T, Daley AJ, Jolly K, Brown WJ. Is weight cycling associated with adverse health outcomes? A cohort study. Prev Med. 2018 March; 108: 47–52. doi:10.1016/j.ypmed.2017.12.010.
[3] Fothergill E, Guo J, Howard L, Kerns JC, Knuth ND, Brychta R, Chen KY, Skarulis MC, Walter M, Walter PJ, Hall KD. Persistent metabolic adaptation 6 years after "The Biggest Loser" competition. Obesity (Silver Spring). 2016 Aug;24(8):1612-9. doi: 10.1002/oby.21538. Epub 2016 May 2. PubMed PMID: 27136388; PubMed Central PMCID: PMC4989512.
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The Academy for Eating Disorders (AED) is an international professional association committed to the leadership in eating disorders research, education, treatment, and prevention. The goal of the AED is to provide global access to knowledge, research, and best treatment practice for eating disorders. For additional information, please contact Elissa Myers at +1 (703) 626-9087 and visit the AED website at www.aedweb.org.
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