Table 2

Behaviour changes due to hunger training

Theme descriptionRepresentative quotes
Portion size reduction
 Most participants reduced the amount of food they ate at a given meal“This could show me in a physical way that you're not actually starving yourself eating this small amount. I learnt really quickly that actually if I get a six-inch subway sandwich, I'm just as full and satisfied for just as long a time period as I am if I have (the amount) that I'd normally get.”- #42, female, scanner
 Some specifically reduced their portions of unhealthy foods, or foods that spiked their glucose“Instead of buying a decent size cake of chocolate I bought the little bars and that was because I had in my mind the spike that would then come and associated the spike with what then is happening in your body.” - #25, female, scanner
“I'd actually stop and think before I ate. So in the past I would have my cup of tea and just automatically reach for the biscuit tin. And maybe have two or three, instead of stopping at one. It's like ‘I only need that one, I'm fine now’. So definitely changed, my behaviours there. Even just being aware of when I was eating, of having that sensation of fullness, instead of just carrying on eating.” - #57, female, fingerpricker
 Others reduced their intake in order to be able to eat when desired“I've noticed that if I'm having less at lunch(…)then I'm able to eat my dinner at dinner time vs having a huge lunch and then my blood sugar is still so high that I couldn't have dinner.” – #38, female, scanner.
 A few participants noticed their evening meal influenced morning glucose levels, often modifying their evening meal to eat breakfast at a convenient time“We had a friend round and I had a dessert. I had to wait 20 min or longer in the morning. But I don't have 20 min in the morning. So, I was like, ‘okay, let's not do that’.” - #79, female, fingerpricker.
Food choice
 Participants from both groups found particular foods delayed their next subsequent meals due to being over their glucose cut-offs, and those wearing the scanner reported seeing a spike in glucose levels after consuming certain foods (or “spikey” foods). People also noticed which foods kept them satisfied for longer, which they viewed as positive.“It made me acutely aware of what foods lasted me longer before the start growl (stomach growl) level was achieved.” - #50, male, scanner.
 Reduced intake of “sugary foods” and “sweet stuff”, bread, chips, biscuits, chocolate, cakes, takeaways and fast food, sugar-sweetened beverages (SSBs), and alcohol.“It was more around the drinking because I take a lot of convincing that things (are) right loaded with sugar and if I can't see it, I'm probably not going to believe a word you say. So, it was good to see it(…)After (I drank) I pricked my finger and saw it did shoot up, I would think a bit and have a look at what I was drinking and what was in it.” – #40, female, fingerpricker.
 Increased intake of vegetables, salads, homemade meals, nuts, eggs, water, and coffee. “Especially on a day off if I go up into the hills. I tend to bring things like muesli bars and just keep snacking all day, whereas now I'm not doing that. I'm waiting ' til I'm hungry and have a proper sit down. I'm drinking a lot more water, as well. - #20, male, fingerpricker
 Increased planning of meals“Actually I probably have thought about planning my day out meal wise a little bit more ‘cause I’d just grab whatever and just eat till I was full or you know, it used to be I’d come home from work and grab a snack and have dinner some time after that and yeah, I don’t snack anymore.” - #9, female, fingerpricker
Timing and frequency of meals
 Most reduced their number of eating occasions by eliminating snacking. The majority of this group changed their habit of grazing to eating a fixed number of meals a day, because they realised that they were not hungry, did not want to delay their next meal, and/or to avoid fingerpricking. Most chose to have a sugar-free beverage instead of food; a few combined their snack food with their main meal.I would amalgamate (a snack) into a meal. So, this last weekend we were away so you know, we'd have a handful of chips, one or two crackers, some bits and pieces(…), and then you go, okay well I've had it. Now the old me, prior to this (study), would be having it a bit later on when the blood sugar would still be high and two, I'd probably be having the entire pack – #64, male, fingerpricker.
 For most, monitoring their glucose confirmed their normal morning food pattern. However, some had glucose levels that were too high to eat breakfast at their usual time. For these participants, elevated morning glucose was frustrating. Some ate later, and others ignored their glucose and ate anyway.“Because based on my monitoring, I'm pretty good, and I don't need to have breakfast, which was a relief, because I'm not a fan of breakfast to begin with.” - #62, female, scanner
  • Themes listed in order of frequency.