TY - JOUR AU - Wang, Xiao AU - Xiao, Yuxue AU - Nam, Sujin AU - Zhong, Ting AU - Tang, Dongyan AU - Li, Cheung William Ho AU - Song, Peige AU - Xia, Wei PY - 2025/3/27 TI - Use of Mukbang in Health Promotion: Scoping Review JO - J Med Internet Res SP - e56147 VL - 27 KW - mukbang KW - health promotion KW - eating behaviors KW - appetite KW - scoping review N2 - Background: Mukbang is a recent internet phenomenon in which anchors publicly record and show their eating through short video platforms. Researchers reported a tangible impact of mukbang on the psychological and physical health, appetite, and eating behavior of the public, it is critical to obtain clear and comprehensive insights concerning the use of mukbang to promote the viewers? appetite, eating behaviors, and health to identify directions for future work. Objective: This scoping review aims to comprehensively outline the current evidence regarding the impact of mukbang consumption on dietary behaviors, appetite regulation, flavor perception, and physical and psychological well-being. Specifically, we conducted an analysis of public perceptions and attitudes toward mukbang while summarizing the reciprocal influence it has on health promotion. Methods: This study was conducted as a scoping review following the Joanna Briggs Institute guideline and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. We comprehensively searched 8 electronic databases in Chinese, English, and Korean languages. We also searched gray literature sources like Google Scholar and ProQuest. We used a data extraction chart to extract information relevant to the impact of mukbang on health. The extracted data were qualitatively analyzed to form different themes related to health, categorizing and integrating the results based on the type of study (qualitative, observational, and experimental). Results: This scoping review finally included 53 studies; the annual distribution exhibited a consistent upward trend across all categories since their initial publication in 2017. Based on the results of the analysis, we have summarized 4 themes, which showed that mukbang may have positive effects on viewers? appetite, food choices, and weight control; it can also meet the psychological needs of viewers and provide digital companionship and happiness. However, excessive viewing may also be harmful to viewer?s health, which has also caused health concerns for some viewers. Conclusions: This study conducted a comprehensive search, screening, and synthesis of existing studies focusing on mukbang and health across various languages and varying levels of quality, which has presented the analytical evidence of the relationship between mukbang and dietary behaviors, appetite, flavor perception, and health. According to the results, future research could consider analyzing the beneficial and harmful factors of mukbang, thereby further optimizing the existing mukbang videos accordingly to explore the potential of using mukbang for health intervention or promotion, so as to improve or customize the content of mukbang based on this scoping review, maximize the appetite and health promotion effects of mukbang videos. Trial Registration: INPLASY INPLASY2022120109; https://inplasy.com/inplasy-2022-12-0109/ UR - https://www.jmir.org/2025/1/e56147 UR - http://dx.doi.org/10.2196/56147 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/56147 ER - TY - JOUR AU - Rooper, R. Isabel AU - Ortega, Adrian AU - Massion, A. Thomas AU - Lakhtakia, Tanvi AU - Kruger, Macarena AU - Parsons, M. Leah AU - Lipman, D. Lindsay AU - Azubuike, Chidiebere AU - Tack, Emily AU - Obleada, T. Katrina AU - Graham, K. Andrea PY - 2025/3/21 TI - Optimizing Testimonials for Behavior Change in a Digital Intervention for Binge Eating: Human-Centered Design Study JO - JMIR Form Res SP - e59691 VL - 9 KW - health behavior KW - health narratives KW - binge eating KW - user engagement KW - personalization KW - behavior change KW - digital health KW - intervention KW - human-centered design KW - behavioral health KW - preferences N2 - Background: Testimonials from credible sources are an evidence-based strategy for behavior change. Behavioral health interventions have used testimonials to promote health behaviors (eg, physical activity and healthy eating). Integrating testimonials into eating disorder (ED) interventions poses a nuanced challenge because ED testimonials can promote ED behaviors. Testimonials in ED interventions must therefore be designed carefully. Some optimal design elements of testimonials are known, but questions remain about testimonial speakers, messaging, and delivery, especially for ED interventions. Objective: We sought to learn how to design and deliver testimonials focused on positive behavior change strategies within our multisession digital binge eating intervention. Methods: We applied human-centered design methods to learn users? preferences for testimonial speakers, messaging, and delivery (modalities, over time, and as ?nudges? for selecting positive behavior change strategies they could practice). We recruited target users of our multisession intervention to complete design sessions. Adults (N=22, 64% self-identified as female; 32% as non-Hispanic Black, 41% as non-Hispanic White, and 27% as Hispanic) with recurrent binge eating and obesity completed individual interviews. Data were analyzed using methods from thematic analysis. Results: Most participants preferred designs with testimonials (vs without) for their motivation and validation of the intervention?s efficacy. A few distrusted testimonials for appearing too ?commercial? or personally irrelevant. For speakers, participants preferred sociodemographically tailored testimonials and were willing to report personal data in the intervention to facilitate tailoring. For messaging, some preferred testimonials with ?how-to? advice, whereas others preferred ?big picture? success stories. For delivery interface, participants were interested in text, video, and multimedia testimonials. For delivery over time, participants preferred testimonials from new speakers to promote engagement. When the intervention allowed users to choose between actions (eg, behavioral strategies), participants preferred testimonials to be available across all actions but said that selectively delivering a testimonial with one action could ?nudge? them to select it. Conclusions: Results indicated that intervention users were interested in testimonials. While participants preferred sociodemographically tailored testimonials, they said different characteristics mattered to them, indicating that interventions should assess users? most pertinent identities and tailor testimonials accordingly. Likewise, users? divided preferences for testimonial messaging (ie, ?big picture? vs ?how-to?) suggest that optimal messaging may differ by user. To improve the credibility of testimonials, which some participants distrusted, interventions could invite current users to submit testimonials for future integration in the intervention. Aligned with nudge theory, our findings indicate testimonials could be used as ?nudges? within interventions?a ripe area for further inquiry?though future work should test if delivering a testimonial only with the nudged choice improves its uptake. Further research is needed to validate these design ideas in practice, including evaluating their impact on behavior change toward improving ED behaviors. UR - https://formative.jmir.org/2025/1/e59691 UR - http://dx.doi.org/10.2196/59691 ID - info:doi/10.2196/59691 ER - TY - JOUR AU - Schnepper, Rebekka AU - Roemmel, Noa AU - Schaefert, Rainer AU - Lambrecht-Walzinger, Lena AU - Meinlschmidt, Gunther PY - 2025/3/20 TI - Exploring Biases of Large Language Models in the Field of Mental Health: Comparative Questionnaire Study of the Effect of Gender and Sexual Orientation in Anorexia Nervosa and Bulimia Nervosa Case Vignettes JO - JMIR Ment Health SP - e57986 VL - 12 KW - anorexia nervosa KW - artificial intelligence KW - bulimia nervosa KW - ChatGPT KW - eating disorders KW - LLM KW - responsible AI KW - transformer KW - bias KW - large language model KW - gender KW - vignette KW - quality of life KW - symptomatology KW - questionnaire KW - generative AI KW - mental health KW - AI N2 - Background: Large language models (LLMs) are increasingly used in mental health, showing promise in assessing disorders. However, concerns exist regarding their accuracy, reliability, and fairness. Societal biases and underrepresentation of certain populations may impact LLMs. Because LLMs are already used for clinical practice, including decision support, it is important to investigate potential biases to ensure a responsible use of LLMs. Anorexia nervosa (AN) and bulimia nervosa (BN) show a lifetime prevalence of 1%?2%, affecting more women than men. Among men, homosexual men face a higher risk of eating disorders (EDs) than heterosexual men. However, men are underrepresented in ED research, and studies on gender, sexual orientation, and their impact on AN and BN prevalence, symptoms, and treatment outcomes remain limited. Objectives: We aimed to estimate the presence and size of bias related to gender and sexual orientation produced by a common LLM as well as a smaller LLM specifically trained for mental health analyses, exemplified in the context of ED symptomatology and health-related quality of life (HRQoL) of patients with AN or BN. Methods: We extracted 30 case vignettes (22 AN and 8 BN) from scientific papers. We adapted each vignette to create 4 versions, describing a female versus male patient living with their female versus male partner (2 × 2 design), yielding 120 vignettes. We then fed each vignette into ChatGPT-4 and to ?MentaLLaMA? based on the Large Language Model Meta AI (LLaMA) architecture thrice with the instruction to evaluate them by providing responses to 2 psychometric instruments, the RAND-36 questionnaire assessing HRQoL and the eating disorder examination questionnaire. With the resulting LLM-generated scores, we calculated multilevel models with a random intercept for gender and sexual orientation (accounting for within-vignette variance), nested in vignettes (accounting for between-vignette variance). Results: In ChatGPT-4, the multilevel model with 360 observations indicated a significant association with gender for the RAND-36 mental composite summary (conditional means: 12.8 for male and 15.1 for female cases; 95% CI of the effect ?6.15 to ?0.35; P=.04) but neither with sexual orientation (P=.71) nor with an interaction effect (P=.37). We found no indications for main effects of gender (conditional means: 5.65 for male and 5.61 for female cases; 95% CI ?0.10 to 0.14; P=.88), sexual orientation (conditional means: 5.63 for heterosexual and 5.62 for homosexual cases; 95% CI ?0.14 to 0.09; P=.67), or for an interaction effect (P=.61, 95% CI ?0.11 to 0.19) for the eating disorder examination questionnaire overall score (conditional means 5.59?5.65 95% CIs 5.45 to 5.7). MentaLLaMA did not yield reliable results. Conclusions: LLM-generated mental HRQoL estimates for AN and BN case vignettes may be biased by gender, with male cases scoring lower despite no real-world evidence supporting this pattern. This highlights the risk of bias in generative artificial intelligence in the field of mental health. Understanding and mitigating biases related to gender and other factors, such as ethnicity, and socioeconomic status are crucial for responsible use in diagnostics and treatment recommendations. UR - https://mental.jmir.org/2025/1/e57986 UR - http://dx.doi.org/10.2196/57986 ID - info:doi/10.2196/57986 ER - TY - JOUR AU - Gulec, Hayriye AU - Muzik, Michal AU - Smahel, David AU - Dedkova, Lenka PY - 2025/3/11 TI - Longitudinal Associations Between Adolescents? mHealth App Use, Body Dissatisfaction, and Physical Self-Worth: Random Intercept Cross-Lagged Panel Study JO - JMIR Ment Health SP - e60844 VL - 12 KW - mHealth app KW - body dissatisfaction KW - physical self-worth KW - random intercept cross-lagged panel model KW - RI-CLPM KW - longitudinal study KW - adolescent N2 - Background: Longitudinal investigation of the association between mobile health (mHealth) app use and attitudes toward one?s body during adolescence is scarce. mHealth apps might shape adolescents? body image perceptions by influencing their attitudes toward their bodies. Adolescents might also use mHealth apps based on how they feel and think about their bodies. Objective: This prospective study examined the longitudinal within-person associations between mHealth app use, body dissatisfaction, and physical self-worth during adolescence. Methods: The data were gathered from a nationally representative sample of Czech adolescents aged between 11 and 16 years (N=2500; n=1250, 50% girls; mean age 13.43, SD 1.69 years) in 3 waves with 6-month intervals. Participants completed online questionnaires assessing their mHealth app use, physical self-worth, and body dissatisfaction at each wave. The mHealth app use was determined by the frequency of using sports, weight management, and nutritional intake apps. Physical self-worth was assessed using the physical self-worth subscale of the Physical Self Inventory-Short Form. Body dissatisfaction was measured with the items from the body dissatisfaction subscale of the Eating Disorder Inventory-3. The random intercept cross-lagged panel model examined longitudinal within-person associations between the variables. A multigroup design was used to compare genders. Due to the missing values, the final analyses used data from 2232 adolescents (n=1089, 48.8% girls; mean age 13.43, SD 1.69 years). Results: The results revealed a positive within-person effect of mHealth app use on the physical self-worth of girls: increased mHealth app use predicted higher physical self-worth 6 months later (?=.199, P=.04). However, this effect was not consistent from the 6th to the 12th month: a within-person increase in using apps in the 6th month did not predict changes in girls? physical self-worth in the 12th month (?=.161, P=.07). Regardless of gender, the within-person changes in the frequency of using apps did not influence adolescents? body dissatisfaction. In addition, neither body dissatisfaction nor physical self-worth predicted app use frequency at the within-person level. Conclusions: This study highlighted that within-person changes in using mHealth apps were differentially associated with adolescents? body-related attitudes. While increased use of mHealth apps did not influence body dissatisfaction across genders, it significantly predicted higher physical self-worth in adolescent girls 6 months later. A similar association was not observed among boys after 6 months. These findings indicate that using mHealth apps is unlikely to have a detrimental impact on adolescents? body dissatisfaction and physical self-worth; instead, they may have a positive influence, particularly in boosting the physical self-worth of adolescent girls. UR - https://mental.jmir.org/2025/1/e60844 UR - http://dx.doi.org/10.2196/60844 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60844 ER - TY - JOUR AU - Miranda, Christina AU - Matheson, Brittany AU - Datta, Nandini AU - Whyte, Aileen AU - Yang, Hyun-Joon AU - Schmiedmayer, Paul AU - Ravi, Vishnu AU - Aalami, Oliver AU - Lock, James PY - 2025/2/28 TI - Enhancing Distress Tolerance Skills in Adolescents With Anorexia Nervosa Through the BALANCE Mobile App: Feasibility and Acceptability Study JO - JMIR Form Res SP - e70278 VL - 9 KW - mHealth KW - mobile health KW - mobile application KW - emotion regulation KW - eating disorders KW - family-based treatment KW - distress tolerance KW - mealtimes N2 - Background: Anorexia nervosa is a severe psychiatric disorder with high morbidity and mortality, particularly among adolescents. Family-based treatment (FBT) is the leading evidence-based intervention for adolescent anorexia nervosa, involving parents in renourishment and behavior interruption. Despite its effectiveness, challenges in distress tolerance and emotion regulation during high-stress situations, such as mealtimes, contribute to suboptimal treatment outcomes, with only 35% to 50% of adolescents achieving full recovery. Enhancing distress tolerance skills during FBT may improve treatment responses and recovery rates. The BALANCE mobile app was developed to address this need, offering real-time, dialectical behavior therapy (DBT)?based distress tolerance skills to support adolescents and families during mealtimes. Objective: Our aim was to explore the feasibility and acceptability of a mobile app designed to deliver distress tolerance skills to adolescents with and adolescents without anorexia nervosa. When fully programmed and optimized, we plan to use the mobile app to improve distress tolerance during mealtimes for adolescents with anorexia nervosa undergoing FBT. Methods: BALANCE was developed collaboratively with Stanford University?s Center for Biodesign, leveraging the expertise of clinical psychologists and using biodesign student input and the Stanford Spezi ecosystem. The app underwent an iterative development process, with feedback from adolescent users. The initial feasibility and acceptability of the app were assessed through self-reported questionnaires and structured interviews with 24 adolescents aged 12 to 18 years, including 4 diagnosed with anorexia nervosa and 20 healthy controls. Adolescents with anorexia nervosa specifically used the app during mealtimes, and healthy controls used it as needed. Participants assessed the app?s usability, perceived effectiveness, and its impact on their distress tolerance. Results: The app demonstrated high usability and acceptability. Of 24 participants, 83% (n=20) reported enjoying the app, 88% (n=21) would recommend it to peers, and 100% (n=24) found it user-friendly. Adolescents with anorexia nervosa reported that BALANCE helped them manage stressful mealtimes more effectively, highlighting features such as guided meditation, breathing exercises, and gamification elements as particularly effective. Healthy controls provided additional feedback, confirming the app?s broad appeal to the target audience and potential scalability. Preliminary findings suggest that BALANCE may enhance distress tolerance in adolescents with and adolescents without anorexia nervosa. Conclusions: BALANCE shows promise as an innovative mobile health intervention for enhancing distress tolerance in adolescents with anorexia nervosa. Its user-friendly design and tailored DBT-based skills make it a feasible tool for integration into FBT. Future research should explore its integration into clinical practice and its impact on treatment outcomes. As distress tolerance skills are relevant to a range of mental health conditions, future research may also expand BALANCE?s application to broader adolescent populations. UR - https://formative.jmir.org/2025/1/e70278 UR - http://dx.doi.org/10.2196/70278 ID - info:doi/10.2196/70278 ER - TY - JOUR AU - Cheung, Gar-Mun Lauryn AU - Thomas, Carien Pamela AU - Brvar, Eva AU - Rowe, Sarah PY - 2025/1/3 TI - User Experiences of and Preferences for Self-Guided Digital Interventions for the Treatment of Mild to Moderate Eating Disorders: Systematic Review and Metasynthesis JO - JMIR Ment Health SP - e57795 VL - 12 KW - eating disorders KW - anorexia KW - bulimia KW - binge eating KW - other specified feeding or eating disorder KW - OSFED KW - intervention KW - digital intervention KW - self-help KW - systematic review N2 - Background: Digital interventions typically involve using smartphones or PCs to access online or downloadable self-help and may offer a more accessible and convenient option than face-to-face interventions for some people with mild to moderate eating disorders. They have been shown to substantially reduce eating disorder symptoms, but treatment dropout rates are higher than for face-to-face interventions. We need to understand user experiences and preferences for digital interventions to support the design and development of user-centered digital interventions that are engaging and meet users? needs. Objective: This study aims to understand user experiences and user preferences for digital interventions that aim to reduce mild to moderate eating disorder symptoms in adults. Methods: We conducted a metasynthesis of qualitative studies. We searched 6 databases for published and unpublished literature from 2013 to 2024. We searched for studies conducted in naturalistic or outpatient settings, using primarily unguided digital self-help interventions designed to reduce eating disorder symptoms in adults with mild to moderate eating disorders. We conducted a thematic synthesis using line-by-line coding of the results and findings from each study to generate themes. Results: A total of 8 studies were included after screening 3695 search results. Overall, 7 metathemes were identified. The identified metathemes included the appeal of digital interventions, role of digital interventions in treatment, value of support in treatment, communication at the right level, importance of engagement, shaping knowledge to improve eating disorder behaviors, and design of the digital intervention. Users had positive experiences with digital interventions and perceived them as helpful for self-reflection and mindfulness. Users found digital interventions to be convenient and flexible and that they fit with their lifestyle. Overall, users noticed reduced eating disorder thoughts and behaviors. However, digital interventions were not generally perceived as a sufficient treatment that could replace traditional face-to-face treatment. Users have individual needs, so an ideal intervention would offer personalized content and functions. Conclusions: Users found digital interventions for eating disorders practical and effective but stressed the need for interventions to address the full range of symptoms, severity, and individual needs. Future digital interventions should be cocreated with users and offer more personalization. Further research is needed to determine the appropriate balance of professional and peer support and whether these interventions should serve as the first step in the stepped care model. Trial Registration: PROSPERO CRD42023426932; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=426932 UR - https://mental.jmir.org/2025/1/e57795 UR - http://dx.doi.org/10.2196/57795 UR - http://www.ncbi.nlm.nih.gov/pubmed/39752210 ID - info:doi/10.2196/57795 ER - TY - JOUR AU - Palacios, E. Jorge AU - Erickson-Ridout, K. Kathryn AU - Paik Kim, Jane AU - Buttlaire, Stuart AU - Ridout, Samuel AU - Argue, Stuart AU - Tregarthen, Jenna PY - 2024/11/27 TI - Effects of a Digital Therapeutic Adjunct to Eating Disorder Treatment on Health Care Service Utilization and Clinical Outcomes: Retrospective Observational Study Using Electronic Health Records JO - JMIR Ment Health SP - e59145 VL - 11 KW - digital therapeutics KW - app-augmented therapy KW - eating disorders KW - health care utilization KW - costs KW - real-world data KW - depression KW - emergency department KW - outpatient care KW - eating KW - treatment KW - therapy KW - retrospective analysis KW - electronic health record KW - patient KW - app KW - outpatient N2 - Background: The need for scalable solutions facilitating access to eating disorder (ED) treatment services that are efficient, effective, and inclusive is a major public health priority. Remote access to synchronous and asynchronous support delivered via health apps has shown promise, but results are so far mixed, and there are limited data on whether apps can enhance health care utilization. Objective: This study aims to examine the effects of app-augmented treatment on clinical outcomes and health care utilization for patients receiving treatment for an ED in outpatient and intensive outpatient levels of care. Methods: Recovery Record was implemented in outpatient and intensive outpatient services in a California-based health maintenance organization. We examined outcomes for eligible patients with ED by comparing clinical and service utilization medical record data over a 6-month period after implementation with analogous data for the control group in the year prior. We used a logistic regression model and inverse-weighted estimates of the probability of treatment to adjust for treatment selection bias. Results: App-augmented treatment was associated with a significant decrease in emergency department visits (P<.001) and a significant increase in outpatient treatment utilization (P<.001). There was a significantly larger weight gain for patients in low-weight categories (ie, underweight, those with anorexia, or those with severe anorexia) with app-augmented treatment (treatment effect: 0.74, 0.25, and 0.35, respectively; P=.02), with a greater percentage of patients moving into a higher BMI class (P=.01). Conclusions: Integrating remote patient engagement apps into ED treatment plans can have beneficial effects on both clinical outcomes and service utilization. More research should be undertaken on long-term efficacy and cost-effectiveness to further explore the impact of digital health interventions in ED care. UR - https://mental.jmir.org/2024/1/e59145 UR - http://dx.doi.org/10.2196/59145 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/59145 ER - TY - JOUR AU - Liu, Jianyi AU - Giannone, Alyssa AU - Wang, Hailing AU - Wetherall, Lucy AU - Juarascio, Adrienne PY - 2024/11/18 TI - Understanding Patients? Preferences for a Digital Intervention to Prevent Posttreatment Deterioration for Bulimia-Spectrum Eating Disorders: User-Centered Design Study JO - JMIR Form Res SP - e60865 VL - 8 KW - bulimia nervosa KW - binge eating KW - digital intervention KW - deterioration prevention KW - eating disorder KW - bulimia KW - digital health KW - deterioration KW - maintenance KW - mHealth KW - mobile health app KW - interviews KW - qualitative KW - user-centered design KW - psychotherapy KW - CBT KW - cognitive behavioral therapy KW - needs KW - preferences KW - mobile phone N2 - Background: Deterioration rates after enhanced cognitive behavioral therapy (CBT-E) for patients with bulimia-spectrum eating disorders (BN-EDs) remain high, and decreased posttreatment skill use might be a particularly relevant contributor. Digital interventions could be an ideal option to improve skill use after treatment ends but they have yet to be investigated for BN-EDs. Objective: This study used a user-centered design approach to explore patients? interest in a digital intervention to prevent deterioration after CBT-E and their desired features. Methods: A total of 12 participants who previously received CBT-E for BN-EDs and experienced at least a partial response to treatment completed a qualitative interview asking about their interests and needs for an app designed to prevent deterioration after treatment ended. Participants were also presented with features commonly used in digital interventions for EDs and were asked to provide feedback. Results: All 12 participants expressed interest in using an app to prevent deterioration after treatment ended. In total, 11 participants thought the proposed feature of setting a goal focusing on skill use weekly would help improve self-accountability for skill use, and 6 participants supported the idea of setting goals related to specific triggers because they would know what skills to use in high-risk situations. A total of 10 participants supported the self-monitoring ED behaviors feature because it could increase their awareness levels. Participants also reported wanting to track mood (n=6) and food intake (n=5) besides the proposed tracking feature. A total of 10 participants reported wanting knowledge-based content in the app, including instructions on skill practice (n=6), general mental health strategies outside of EDs (n=4), guided mindfulness exercises (n=3), and nutrition recommendations (n=3). Eight participants reported a desire for the app to send targeted push notifications, including reminders of skill use (n=7) and inspirational quotes for encouragement (n=3). Finally, 8 participants reported wanting a human connection in the app, 6 participants wishing to interact with other users to support and learn from each other, and 4 participants wanting to connect with professionals as needed. Overall, participants thought that having an app targeting skill use could provide continued support and improve self-accountability, thus lowering the risk of decreased skill use after treatment ended. Conclusions: Insights from participants highlighted the perceived importance of continued support for continued skill use after treatment ended. This study also provided valuable design implications regarding potential features focusing on facilitating posttreatment skill use to include in digital deterioration prevention programs. Future research should examine the optimal approaches to deliver the core features identified in this study that could lead to higher continued skill use and a lower risk of deterioration in the long term. UR - https://formative.jmir.org/2024/1/e60865 UR - http://dx.doi.org/10.2196/60865 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/60865 ER - TY - JOUR AU - Oliveira, Ashleigh AU - Wolff, John AU - Alfouzan, Nouf AU - Yu, Jin AU - Yahya, Asma AU - Lammy, Kayla AU - Nakamura, T. Manabu PY - 2024/11/11 TI - A Novel Web App for Dietary Weight Management: Development, Implementation, and Usability Study JO - JMIR Form Res SP - e58363 VL - 8 KW - health application KW - weight loss KW - behavior change technique KW - BCT KW - online weight loss program KW - weight monitoring KW - meal planning KW - sustainable weight loss KW - dietary fiber KW - mHealth KW - mobile health N2 - Background: Online weight loss programs have ambiguous efficacy. There is a growing body of evidence that weight loss programs when combined with apps have better outcomes; however, many apps lack an evidence-based approach to dietary changes for weight loss and do not rely on a theoretical framework for behavior change. Objective: This study aimed to describe the development and the preliminary usability and acceptability testing of a web app that uses behavior change techniques (BCTs) to support users of a comprehensive online weight loss program. Methods: The weight loss program intervention components were nutrient and weight tracking charts that needed a remotely accessible and online format. The app was designed by nutrition researchers and developers in a collaborative effort. A review of BCTs in weight loss and web apps was performed as well as an assessment of user needs to inform the initial prototype. A preliminary app prototype, version 1.0, was provided to participants of a weight loss trial (N=30) to assess for feasibility of its use. A full app prototype, version 2.0, was feasibility and acceptability tested by trial participants (n=11) with formal feedback by Likert-scale survey and open-ended questions. In the final round of testing, a user group of scientists and developers (n=11) was selected to provide a structured 3-month review through which the group met weekly for collective feedback sessions. Results: The process resulted in a fully developed web app, MealPlot, by the Applied Research Institute, for meal planning and weight tracking that can be used by weight loss users and health professionals to track their patients. MealPlot includes a weight chart, a protein-fiber chart, and a chat feature. In addition, MealPlot has 2 distinct platforms, 1 for weight loss users and 1 for health professionals. Selected BCTs for incorporation into the app were goal setting, feedback, problem-solving, self-monitoring, and social support. Version 1.0 was used successfully to provide a functioning, online weight chart over the course of a 1-year trial. Version 2.0 provided a functional weight chart and meal planning page, but 8 out of 11 participants indicated MealPlot was difficult to use. Version 3.0 was developed based on feedback and strategies provided from user group testing. Conclusions: The web app, MealPlot, was developed to improve outcomes and functionality of an online weight loss program by providing a remote method of tracking weight, food intake, and connecting users to health professionals for consistent guidance that is not otherwise available in a traditional in-person health care setting. The final version 3.0 of the web app will be refined based on findings of a review study gathering feedback from health professionals and from actual weight loss users who are part of a clinical weight loss trial. UR - https://formative.jmir.org/2024/1/e58363 UR - http://dx.doi.org/10.2196/58363 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/58363 ER - TY - JOUR AU - Gentile, Alessandra AU - Kristian, Yan Yosua AU - Cini, Erica PY - 2024/11/4 TI - Effectiveness of Computer-Based Psychoeducational Self-Help Platforms for Eating Disorders (With or Without an Associated App): Protocol for a Systematic Review JO - JMIR Res Protoc SP - e60165 VL - 13 KW - self-help KW - online self-help KW - eating disorders KW - anorexia nervosa KW - psychoeducational intervention KW - psychoeducation KW - binge eating KW - anorexia KW - bulimia KW - access to care KW - patient education KW - patient self-help N2 - Background: Access to psychological health care is extremely difficult, especially for individuals with severely stigmatized disorders such as eating disorders (EDs). There has been an increase in children, adolescents, and adults with ED symptoms and ED, especially following the COVID-19 pandemic. Computer-based self-help platforms (± associated apps) allow people to bridge the treatment gap and receive support when in-person treatment is unavailable or not preferred. Objective: The aim of this systematic review is to evaluate the effectiveness of computer-based self-help platforms for EDs, some of which may have associated apps. Methods: The proposed systematic review will follow the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. This review will report and evaluate the literature concerning the efficacy of self-help platforms for EDs. Articles were obtained from the Ovid MEDLINE, Embase, Global Health, and APA PsycInfo. The inclusion criteria included research with original data and gray literature; research evaluating the efficacy of web-based psychoeducational self-help platforms for EDs; people with an ED diagnosis, ED symptoms, at risk of developing EDs, or from the general population without ED-related behaviors; pre? and post?computer-based ± associated apps intervention clinical outcome of ED symptoms; pre? and post?computer-based ± associated apps intervention associated mental health difficulties; and literature in English. The exclusion criteria were solely guided self-help platforms, only in-person interventions with no computer-based ± associated apps comparison group, only in-person?delivered CBT, self-help platforms for conditions other than eating disorders, systematic reviews, meta-analyses, posters, leaflets, books, reviews, and research that only reported physical outcomes. Two independent authors used the search terms to conduct the initial search. The collated articles then were screened by their titles and abstracts, and finally, full-text screenings were conducted. The Cochrane Risk of Bias 2 tool will be used to assess the risks of bias in the included studies. Data extraction will be conducted, included studies will undergo narrative synthesis, and results will be presented in tables. The systematic review will be submitted to a peer-reviewed journal. Results: The authors conducted a database search for articles published by May 31, 2024. In total, 14 studies were included in the systematic review. Data charting, synthesis, and analysis were completed in Microsoft Excel by the end of July 2024. Results will be grouped based on the intervention stages. The results are expected to be published by the end of 2024. Overall, the systematic review found that computer-based self-help platforms are effective in reducing global ED psychopathology and ED-related behaviors. Conclusions: Self-help platforms are helpful first-stage resource in a tiered health care system. Trial Registration: PROSPERO CRD42024520866; https://tinyurl.com/5ys2unsw International Registered Report Identifier (IRRID): DERR1-10.2196/60165 UR - https://www.researchprotocols.org/2024/1/e60165 UR - http://dx.doi.org/10.2196/60165 UR - http://www.ncbi.nlm.nih.gov/pubmed/39495557 ID - info:doi/10.2196/60165 ER - TY - JOUR AU - Thomas, Carien Pamela AU - Curtis, Kristina AU - Potts, W. Henry W. AU - Bark, Pippa AU - Perowne, Rachel AU - Rookes, Tasmin AU - Rowe, Sarah PY - 2024/8/1 TI - Behavior Change Techniques Within Digital Interventions for the Treatment of Eating Disorders: Systematic Review and Meta-Analysis JO - JMIR Ment Health SP - e57577 VL - 11 KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - mobile apps KW - smartphone KW - behavior change KW - behavior change technique KW - systematic review KW - eating disorders KW - disordered eating KW - binge eating KW - bulimia nervosa KW - mobile phone N2 - Background: Previous systematic reviews of digital eating disorder interventions have demonstrated effectiveness at improving symptoms of eating disorders; however, our understanding of how these interventions work and what contributes to their effectiveness is limited. Understanding the behavior change techniques (BCTs) that are most commonly included within effective interventions may provide valuable information for researchers and developers. Establishing whether these techniques have been informed by theory will identify whether they target those mechanisms of action that have been identified as core to changing eating disorder behaviors. It will also evaluate the importance of a theoretical approach to digital intervention design. Objective: This study aims to define the BCTs within digital self-management interventions or minimally guided self-help interventions for adults with eating disorders that have been evaluated within randomized controlled trials. It also assessed which of the digital interventions were grounded in theory and the range of modes of delivery included. Methods: A literature search identified randomized controlled trials of digital intervention for the treatment of adults with eating disorders with minimal therapist support. Each digital intervention was coded for BCTs using the established BCT Taxonomy v1; for the application of theory using an adapted version of the theory coding scheme (TCS); and for modes of delivery using the Mode of Delivery Ontology. A meta-analysis evaluated the evidence that any individual BCT moderated effect size or that other potential factors such as the application of theory or number of modes of delivery had an effect on eating disorder outcomes. Results: Digital interventions included an average of 14 (SD 2.6; range 9-18) BCTs. Self-monitoring of behavior was included in all effective interventions, with Problem-solving, Information about antecedents, Feedback on behavior, Self-monitoring of outcomes of behavior, and Action planning identified in >75% (13/17) of effective interventions. Social support and Information about health consequences were more evident in effective interventions at follow-up compared with postintervention measurement. The mean number of modes of delivery was 4 (SD 1.6; range 2-7) out of 12 possible modes, with most interventions (15/17, 88%) being web based. Digital interventions that had a higher score on the TCS had a greater effect size than those with a lower TCS score (subgroup differences: ?21=9.7; P=.002; I²=89.7%) within the meta-analysis. No other subgroup analyses had statistically significant results. Conclusions: There was a high level of consistency in terms of the most common BCTs within effective interventions; however, there was no evidence that any specific BCT contributed to intervention efficacy. The interventions that were more strongly informed by theory demonstrated greater improvements in eating disorder outcomes compared to waitlist or treatment-as-usual controls. These results can be used to inform the development of future digital eating disorder interventions. Trial Registration: PROSPERO CRD42023410060; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=410060 UR - https://mental.jmir.org/2024/1/e57577 UR - http://dx.doi.org/10.2196/57577 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/57577 ER - TY - JOUR AU - Faccio, Elena AU - Reggiani, Margherita AU - Rocelli, Michele AU - Cipolletta, Sabrina PY - 2024/7/2 TI - Issues Related to the Use of Visual Social Networks and Perceived Usefulness of Social Media Literacy During the Recovery Phase: Qualitative Research Among Girls With Eating Disorders JO - J Med Internet Res SP - e53334 VL - 26 KW - visual social networks KW - body image KW - eating disorders KW - risks KW - potentials KW - social networks KW - social network KW - social media KW - literacy KW - food intake KW - appetite disorders KW - appetite disorder KW - eating disorder KW - patient safety KW - patient-centered approach KW - recovery KW - body comparison KW - users KW - semistructured interviews KW - semistructured interview KW - girls KW - adolescent KW - adolescents KW - content analysis KW - online N2 - Background: The patient-centered approach is essential for quality health care and patient safety. Understanding the service user?s perspective on the factors maintaining the health problem is crucial for successful treatment, especially for patients who do not recognize their condition as clinically relevant or concerning. Despite the association between intensive use of visual social media and body dissatisfaction and eating disorders, little is known about the meanings users assign to posting or searching for edited photos and the strategies they use to protect themselves from digital risks. Objective: This study aims to examine how young women recovering from eating disorders in Northern Italy perceive the health risks and potential benefits associated with visual social networks (ie, Instagram and Snapchat). The literature has found these platforms to be detrimental to online body comparisons. It also explores the perceived usefulness, willingness, and personal interest in coconstructing social media literacy programs with girls recovering from eating disorders. Methods: A total of 30 semistructured interviews were conducted with adolescent girls aged 14-17 years at the end of their treatment for eating disorders. The following areas of research were addressed: (1) the meanings associated with the use of Instagram and Snapchat; (2) the investment in the photographic dimension and feedback; (3) the impact of visual social networks on body experiences; (4) the potential and risks perceived in their use; (5) the importance of supporting girls undergoing treatment for eating disorders in using social networks; and (6) the usefulness and willingness to co-design social network literacy programs. Content analysis was applied. Results: A total of 7 main contents emerged: active or passive role in using social networks, the impact of online interactions on body image, investment in the photographic dimension, effects on self-representation, perceived risks, self-protective strategies, and potential benefits. The findings highlight a strong awareness of the processes that trigger body comparisons in the virtual context, creating insecurity and worsening the relationship with oneself. The self-protective behaviors identified are the development of critical thinking, the avoidance of sensitive content, increased control over social networking site use, and a certain skepticism toward developing antagonistic ideologies. All these topics were considered fundamental. Conclusions: The findings provide important insights for health professionals working with youth in preparing media literacy programs. These programs aim to reduce potential risks and amplify the positive effects of online resources. They underscore the importance of addressing this issue during hospitalization to develop skills and critical thinking aimed at changing small habits that perpetuate the problem in everyday life. The inherent limitations in current service practices, which may not adequately address individual needs or impact posttreatment life, must also be considered. UR - https://www.jmir.org/2024/1/e53334 UR - http://dx.doi.org/10.2196/53334 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/53334 ER - TY - JOUR AU - Pare, M. Shannon AU - Gunn, Elizabeth AU - Morrison, M. Katherine AU - Miller, L. Alison AU - Duncan, M. Alison AU - Buchholz, C. Andrea AU - Ma, L. David W. AU - Tremblay, F. Paul AU - Vallis, Ann Lori AU - Mercer, J. Nicola AU - Haines, Jess PY - 2024/6/20 TI - Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study JO - JMIR Res Protoc SP - e48549 VL - 13 KW - stress KW - child, preschool KW - adiposity KW - household chaos KW - cortisol KW - COVID-19 KW - behavioral mechanisms KW - caregiver-child relationship quality N2 - Background: Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. Objective: The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. Methods: The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child?s height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child?s physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child?s mental health, as well as a 1-day dietary assessment for their child. Results: Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study?s sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children?s mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ?CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. Conclusions: Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. Trial Registration: ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711 International Registered Report Identifier (IRRID): DERR1-10.2196/48549 UR - https://www.researchprotocols.org/2024/1/e48549 UR - http://dx.doi.org/10.2196/48549 UR - http://www.ncbi.nlm.nih.gov/pubmed/38900565 ID - info:doi/10.2196/48549 ER - TY - JOUR AU - Bould, Helen AU - Kennedy, Mari-Rose AU - Penton-Voak, Ian AU - Thomas, May Lisa AU - Bird, Jon AU - Biddle, Lucy PY - 2024/5/14 TI - Exploring How Virtual Reality Could Be Used to Treat Eating Disorders: Qualitative Study of People With Eating Disorders and Clinicians Who Treat Them JO - JMIR XR Spatial Comput SP - e47382 VL - 1 KW - eating disorders KW - virtual reality KW - anorexia nervosa KW - bulimia nervosa KW - EDNOS KW - treatment KW - immersive KW - clinicians KW - qualitative data KW - psychoeducation KW - therapeutic KW - limitations N2 - Background: Immersive virtual reality (VR) interventions are being developed and trialed for use in the treatment of eating disorders. However, little work has explored the opinions of people with eating disorders, or the clinicians who treat them, on the possible use of VR in this context. Objective: This study aims to use qualitative methodology to explore the views of people with eating disorders, and clinicians who treat them, on the possible use of VR in the treatment of eating disorders. Methods: We conducted a series of focus groups and interviews with people with lived experience of eating disorders and clinicians on their views about VR and how it could potentially be used in the treatment of eating disorders. People with lived experience of eating disorders were recruited between October and December 2020, with focus groups held online between November 2020 and February 2021; clinicians were recruited in September 2021 and interviewed between September and October 2021. We took a thematic approach to analyzing the resulting qualitative data. Results: We conducted 3 focus groups with 10 individuals with a current or previous eating disorder, 2 focus groups with 4 participants, and 1 with 2 participants. We held individual interviews with 4 clinicians experienced in treating people with eating disorders. Clinicians were all interviewed one-to-one because of difficulties in scheduling mutually convenient groups. We describe themes around representing the body in VR, potential therapeutic uses for VR, the strengths and limitations of VR in this context, and the practicalities of delivering VR therapy. Suggested therapeutic uses were to practice challenging situations around food-related and weight/appearance-related scenarios and interactions, to retrain attention, the representation of the body, to represent the eating disorder, for psychoeducation, and to enable therapeutic conversations with oneself. There was a substantial agreement between the groups on these themes. Conclusions: People with lived experience of eating disorders and clinicians with experience in treating eating disorders generated many ideas as to how VR could be used as a part of eating disorders treatment. They were also aware of potential limitations and expressed the need for caution around how bodies are represented in a VR setting. UR - https://xr.jmir.org/2024/1/e47382 UR - http://dx.doi.org/10.2196/47382 UR - http://www.ncbi.nlm.nih.gov/pubmed/ ID - info:doi/10.2196/47382 ER - TY - JOUR AU - Chew, Jocelyn Han Shi AU - Chew, WS Nicholas AU - Loong, Ern Shaun Seh AU - Lim, Lin Su AU - Tam, Wilson Wai San AU - Chin, Han Yip AU - Chao, M. Ariana AU - Dimitriadis, K. Georgios AU - Gao, Yujia AU - So, Yan Jimmy Bok AU - Shabbir, Asim AU - Ngiam, Yuan Kee PY - 2024/5/7 TI - Effectiveness of an Artificial Intelligence-Assisted App for Improving Eating Behaviors: Mixed Methods Evaluation JO - J Med Internet Res SP - e46036 VL - 26 KW - artificial intelligence KW - chatbot KW - chatbots KW - weight KW - overweight KW - eating KW - food KW - weight loss KW - mHealth KW - mobile health KW - app KW - apps KW - applications KW - self-regulation KW - self-monitoring KW - anxiety KW - depression KW - consideration of future consequences KW - mental health KW - conversational agent KW - conversational agents KW - eating behavior KW - healthy eating KW - food consumption KW - obese KW - obesity KW - diet KW - dietary N2 - Background: A plethora of weight management apps are available, but many individuals, especially those living with overweight and obesity, still struggle to achieve adequate weight loss. An emerging area in weight management is the support for one?s self-regulation over momentary eating impulses. Objective: This study aims to examine the feasibility and effectiveness of a novel artificial intelligence?assisted weight management app in improving eating behaviors in a Southeast Asian cohort. Methods: A single-group pretest-posttest study was conducted. Participants completed the 1-week run-in period of a 12-week app-based weight management program called the Eating Trigger-Response Inhibition Program (eTRIP). This self-monitoring system was built upon 3 main components, namely, (1) chatbot-based check-ins on eating lapse triggers, (2) food-based computer vision image recognition (system built based on local food items), and (3) automated time-based nudges and meal stopwatch. At every mealtime, participants were prompted to take a picture of their food items, which were identified by a computer vision image recognition technology, thereby triggering a set of chatbot-initiated questions on eating triggers such as who the users were eating with. Paired 2-sided t tests were used to compare the differences in the psychobehavioral constructs before and after the 7-day program, including overeating habits, snacking habits, consideration of future consequences, self-regulation of eating behaviors, anxiety, depression, and physical activity. Qualitative feedback were analyzed by content analysis according to 4 steps, namely, decontextualization, recontextualization, categorization, and compilation. Results: The mean age, self-reported BMI, and waist circumference of the participants were 31.25 (SD 9.98) years, 28.86 (SD 7.02) kg/m2, and 92.60 (SD 18.24) cm, respectively. There were significant improvements in all the 7 psychobehavioral constructs, except for anxiety. After adjusting for multiple comparisons, statistically significant improvements were found for overeating habits (mean ?0.32, SD 1.16; P<.001), snacking habits (mean ?0.22, SD 1.12; P<.002), self-regulation of eating behavior (mean 0.08, SD 0.49; P=.007), depression (mean ?0.12, SD 0.74; P=.007), and physical activity (mean 1288.60, SD 3055.20 metabolic equivalent task-min/day; P<.001). Forty-one participants reported skipping at least 1 meal (ie, breakfast, lunch, or dinner), summing to 578 (67.1%) of the 862 meals skipped. Of the 230 participants, 80 (34.8%) provided textual feedback that indicated satisfactory user experience with eTRIP. Four themes emerged, namely, (1) becoming more mindful of self-monitoring, (2) personalized reminders with prompts and chatbot, (3) food logging with image recognition, and (4) engaging with a simple, easy, and appealing user interface. The attrition rate was 8.4% (21/251). Conclusions: eTRIP is a feasible and effective weight management program to be tested in a larger population for its effectiveness and sustainability as a personalized weight management program for people with overweight and obesity. Trial Registration: ClinicalTrials.gov NCT04833803; https://classic.clinicaltrials.gov/ct2/show/NCT04833803 UR - https://www.jmir.org/2024/1/e46036 UR - http://dx.doi.org/10.2196/46036 UR - http://www.ncbi.nlm.nih.gov/pubmed/38713909 ID - info:doi/10.2196/46036 ER - TY - JOUR AU - Abdullah, Rifham Shazana AU - Wan Mohd Zin, Mona Ruziana AU - Azizul, Hayati Nur AU - Sulaiman, Suffia Nur AU - Khalid, Mustafa Norhayati AU - Mohd Salim Mullahi Jahn, Jahn Roshan AU - Khalil, Nazrin Muhamad Khairul AU - Abu Seman, Norhashimah AU - Zainal Abidin, Azlin Nur AU - Ali, Azizan AU - Tan, Zhuan You AU - Omar, Azahadi AU - Seman, Zamtira AU - Yahya, Abqariyah AU - Md Noh, Fairulnizal Mohd PY - 2024/4/10 TI - The Effect of a Combined Intermittent Fasting Healthy Plate Intervention on Anthropometric Outcomes and Body Composition Among Adults With Overweight and Obesity: Nonrandomized Controlled Trial JO - JMIR Form Res SP - e51542 VL - 8 KW - intermittent fasting KW - dry fasting KW - healthy plate KW - obesity KW - overweight N2 - Background: Adult obesity and overweight pose a substantial risk to global public health and are associated with various noncommunicable diseases. Although intermittent fasting (IF) is increasingly used as a relatively new dietary strategy for weight loss, the effectiveness of 2 days per week of dry fasting remains unknown. Objective: This study aims to evaluate the effectiveness of a combined dry IF and healthy plate (IFHP) and healthy plate (HP) intervention in improving anthropometric outcomes and body composition. Methods: This nonrandomized controlled trial involved 177 adults who were overweight and obese. Among them, 91 (51.4%) were allocated to the IFHP group and 86 (48.6%) were allocated to the HP group. The overall study duration was 6 months (October 2020 to March 2021). The intervention was divided into 2 phases: supervised (3 months) and unsupervised (3 months). The data were collected at baseline, after the supervised phase (month 3), and after the unsupervised phase (month 6). Anthropometric (weight, height, waist circumference, and hip circumference) and body composition (body fat percentage, body fat mass, skeletal muscle mass, and visceral fat area) data were measured at all 3 data collection points. Sociodemographic data were obtained using a questionnaire at baseline. Results: Most participants were female (147/177, 83.1%) and Malay (141/177, 79.7%). After 3 months, there were significant reductions in weight (difference ?1.68; P<.001), BMI (difference ?0.62; P<.001), body fat percentage (difference ?0.921; P<.001), body fat mass (difference ?1.28; P<.001), and visceral fat area (difference ?4.227; P=.008) in the IFHP group, whereas no significant changes were observed in the HP group. Compared to baseline, participants in the IFHP group showed a significant decrease in weight (difference ?1.428; P=.003), BMI (difference ?0.522; P=.005), body fat percentage (difference ?1.591; P<.001), body fat mass (difference ?1.501; P<.001), visceral fat area (difference ?7.130; P<.001), waist circumference (difference ?2.304; P=.001), and hip circumference (difference ?1.908; P=.002) at month 6. During the unsupervised phase, waist (IFHP difference ?3.206; P<.001, HP difference ?2.675; P=.004) and hip (IFHP difference ?2.443; P<.001; HP difference ?2.896; P<.001) circumferences were significantly reduced in both groups (P<.01), whereas skeletal muscle mass (difference 0.208; P=.04) and visceral fat area (difference ?2.903; P=.003) were significantly improved in the IFHP group only. No significant difference in the between-group comparison was detected throughout the intervention (all P>.05). Conclusions: A combined IFHP intervention was effective in improving anthropometric outcomes and body composition in adults with overweight and obesity. International Registered Report Identifier (IRRID): RR2-10.2196/33801. UR - https://formative.jmir.org/2024/1/e51542 UR - http://dx.doi.org/10.2196/51542 UR - http://www.ncbi.nlm.nih.gov/pubmed/38598283 ID - info:doi/10.2196/51542 ER - TY - JOUR AU - Lim, Heemoon AU - Lee, Hyejung PY - 2024/4/5 TI - Eating Habits and Lifestyle Factors Related to Childhood Obesity Among Children Aged 5-6 Years: Cluster Analysis of Panel Survey Data in Korea JO - JMIR Public Health Surveill SP - e51581 VL - 10 KW - BMI KW - body mass index KW - childhood obesity KW - cluster analysis KW - healthy eating KW - healthy lifestyle KW - pediatric obesity KW - preschool child KW - prevention KW - unsupervised machine learning N2 - Background: Childhood obesity has emerged as a major health issue due to the rapid growth in the prevalence of obesity among young children worldwide. Establishing healthy eating habits and lifestyles in early childhood may help children gain appropriate weight and further improve their health outcomes later in life. Objective: This study aims to classify clusters of young children according to their eating habits and identify the features of each cluster as they relate to childhood obesity. Methods: A total of 1280 children were selected from the Panel Study on Korean Children. Data on their eating habits (eating speed, mealtime regularity, consistency of food amount, and balanced eating), sleep hours per day, outdoor activity hours per day, and BMI were obtained. We performed a cluster analysis on the children?s eating habits using k-means methods. We conducted ANOVA and chi-square analyses to identify differences in the children?s BMI, sleep hours, physical activity, and the characteristics of their parents and family by cluster. Results: At both ages (ages 5 and 6 years), we identified 4 clusters based on the children?s eating habits. Cluster 1 was characterized by a fast eating speed (fast eaters); cluster 2 by a slow eating speed (slow eaters); cluster 3 by irregular eating habits (poor eaters); and cluster 4 by a balanced diet, regular mealtimes, and consistent food amounts (healthy eaters). Slow eaters tended to have the lowest BMI (P<.001), and a low proportion had overweight and obesity at the age of 5 years (P=.03) and 1 year later (P=.005). There was a significant difference in sleep time (P=.01) and mother?s education level (P=.03) at the age of 5 years. Moreover, there was a significant difference in sleep time (P=.03) and the father?s education level (P=.02) at the age of 6 years. Conclusions: Efforts to establish healthy eating habits in early childhood may contribute to the prevention of obesity in children. Specifically, providing dietary guidance on a child?s eating speed can help prevent childhood obesity. This research suggests that lifestyle modification could be a viable target to decrease the risk of childhood obesity and promote the development of healthy children. Additionally, we propose that future studies examine long-term changes in obesity resulting from lifestyle modifications in children from families with low educational levels. UR - https://publichealth.jmir.org/2024/1/e51581 UR - http://dx.doi.org/10.2196/51581 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578687 ID - info:doi/10.2196/51581 ER - TY - JOUR AU - Anastasiadou, Dimitra AU - Herrero, Pol AU - Garcia-Royo, Paula AU - Vázquez-De Sebastián, Julia AU - Slater, Mel AU - Spanlang, Bernhard AU - Álvarez de la Campa, Elena AU - Ciudin, Andreea AU - Comas, Marta AU - Ramos-Quiroga, Antoni Josep AU - Lusilla-Palacios, Pilar PY - 2024/4/5 TI - Assessing the Clinical Efficacy of a Virtual Reality Tool for the Treatment of Obesity: Randomized Controlled Trial JO - J Med Internet Res SP - e51558 VL - 26 KW - obesity KW - virtual reality KW - psychological treatment KW - embodiment KW - motivational interviewing KW - self-conversation N2 - Background: Virtual reality (VR) interventions, based on cognitive behavioral therapy principles, have been proven effective as complementary tools in managing obesity and have been associated with promoting healthy behaviors and addressing body image concerns. However, they have not fully addressed certain underlying causes of obesity, such as a lack of motivation to change, low self-efficacy, and the impact of weight stigma interiorization, which often impede treatment adherence and long-term lifestyle habit changes. To tackle these concerns, this study introduces the VR self-counseling paradigm, which incorporates embodiment and body-swapping techniques, along with motivational strategies, to help people living with obesity effectively address some of the root causes of their condition. Objective: This study aims to assess the clinical efficacy of ConVRself (Virtual Reality self-talk), a VR platform that allows participants to engage in motivational self-conversations. Methods: A randomized controlled trial was conducted with 68 participants from the bariatric surgery waiting list from the obesity unit of the Vall d?Hebron University Hospital in Barcelona, Spain. Participants were assigned to 1 of 3 groups: a control group (CG), which only received treatment as usual from the obesity unit; experimental group 1 (EG1), which, after intensive motivational interviewing training, engaged in 4 sessions of VR-based self-conversations with ConVRself, and underwent embodiment and body-swapping techniques; and experimental group 2 (EG2), which engaged in 4 VR-based sessions led by a virtual counselor with a prerecorded discourse, and only underwent the embodiment technique. In the case of both EG1 and EG2, the VR interventions were assisted by a clinical researcher. Readiness to change habits, eating habits, and psychological variables, as well as adherence and satisfaction with ConVRself were measured at baseline, after the intervention, 1 week after the intervention, and 4 weeks after the intervention. Results: Regarding the primary outcomes, EG1 (24/68, 35%) and EG2 (22/68, 32%) showed significant improvements in confidence to lose weight compared to the CG (22/68, 32%) at all assessment points (?=?.16; P=.02). Similarly, EG1 demonstrated a significant increase after the intervention in readiness to exercise more compared to the CG (?=?.17; P=.03). Regarding the secondary outcomes, EG1 participants showed a significant reduction in uncontrolled eating (?=.71; P=.01) and emotional eating (?=.29; P=.03) compared to the CG participants, as well as in their anxiety levels compared to EG2 and CG participants (?=.65; P=.01). In addition, participants from the experimental groups reported high adherence and satisfaction with the VR platform (EG1: mean 59.82, SD 4.00; EG2: mean 58.43, SD 5.22; d=0.30, 95% CI ?0.30 to 0.89). Conclusions: This study revealed that using VR self-conversations, based on motivational interviewing principles, may have benefits in helping people with obesity to enhance their readiness to change habits and self-efficacy, as well as reduce dysfunctional eating behaviors and anxiety. Trial Registration: ClinicalTrials.gov NCT05094557; https://www.clinicaltrials.gov/study/NCT05094557 UR - https://www.jmir.org/2024/1/e51558 UR - http://dx.doi.org/10.2196/51558 UR - http://www.ncbi.nlm.nih.gov/pubmed/38578667 ID - info:doi/10.2196/51558 ER - TY - JOUR AU - Edwards, Katie AU - Croker, Helen AU - Farrow, Claire AU - Haycraft, Emma AU - Herle, Moritz AU - Llewellyn, Clare AU - Pickard, Abigail AU - Blissett, Jacqueline PY - 2024/3/19 TI - Examining Parent Mood, Feeding Context, and Feeding Goals as Predictors of Feeding Practices Used by Parents of Preschool Children With Avid Eating Behavior: Protocol for an Ecological Momentary Assessment Study JO - JMIR Res Protoc SP - e55193 VL - 13 KW - ecological momentary assessment KW - avid eating KW - children?s eating behavior KW - parental feeding practices KW - feeding behaviour KW - parent KW - children KW - eating behaviour KW - obesity KW - environmental factors KW - observational study KW - feeding KW - United Kingdom N2 - Background: An avid eating behavior profile is characterized by a greater interest in food and a tendency to overeat in response to negative emotions. Parents use specific strategies to manage feeding interactions with children with avid eating behavior. While momentary and contextual factors, such as parental mood, have been found to influence parental feeding practices, there is a lack of research examining parents? daily experiences of feeding children with avid eating behavior. Examining this is important because parental feeding practices are key levers in tailored interventions to support children?s healthy eating behavior. Objective: We aim to describe the ecological momentary assessment methods and procedures used in the APPETItE (Appetite in Preschoolers: Producing Evidence for Tailoring Interventions Effectively) project, which aims to examine how variation in parental mood, feeding goals, and the context of eating occasions affect the parental feeding practices used to manage feeding interactions with children with an avid eating behavior profile. Methods: Participants are primary caregivers from the APPETItE cohort who have a preschool-age child (aged 3-5 years) with an avid eating behavior profile. Caregivers complete a 10-day ecological momentary assessment period using signal- and event-contingent surveys to examine (1) mood and stress, (2) parental feeding goals, and (3) contextual factors as predictors of parental feeding practices. Results: Recruitment and data collection began in October 2023 and is expected to be completed by spring 2024. The data have a 3-level structure: repeated measurements (level 1) nested within days (level 2) nested within an individual (level 3). Thus, lag-dependent models will be conducted to test the main hypotheses. Conclusions: The findings from this study will provide an understanding of caregivers? daily experiences of feeding preschool children with avid eating behavior, who are at greater risk for the development of obesity. Understanding the predictors of feeding practices at the moment they occur, and across various contexts, will inform the development of tailored resources to support caregivers in managing children?s avid eating behavior. International Registered Report Identifier (IRRID): DERR1-10.2196/55193 UR - https://www.researchprotocols.org/2024/1/e55193 UR - http://dx.doi.org/10.2196/55193 UR - http://www.ncbi.nlm.nih.gov/pubmed/38502178 ID - info:doi/10.2196/55193 ER - TY - JOUR AU - O'Hara, Cathal AU - Gibney, R. Eileen PY - 2024/2/14 TI - Dietary Intake Assessment Using a Novel, Generic Meal?Based Recall and a 24-Hour Recall: Comparison Study JO - J Med Internet Res SP - e48817 VL - 26 KW - meal patterns KW - eating behaviors KW - eating occasions KW - nutrition assessment KW - dietary intake assessment KW - 24-hour recall KW - relative validity N2 - Background: Dietary intake assessment is an integral part of addressing suboptimal dietary intakes. Existing food-based methods are time-consuming and burdensome for users to report the individual foods consumed at each meal. However, ease of use is the most important feature for individuals choosing a nutrition or diet app. Intakes of whole meals can be reported in a manner that is less burdensome than reporting individual foods. No study has developed a method of dietary intake assessment where individuals report their dietary intakes as whole meals rather than individual foods. Objective: This study aims to develop a novel, meal-based method of dietary intake assessment and test its ability to estimate nutrient intakes compared with that of a web-based, 24-hour recall (24HR). Methods: Participants completed a web-based, generic meal?based recall. This involved, for each meal type (breakfast, light meal, main meal, snack, and beverage), choosing from a selection of meal images those that most represented their intakes during the previous day. Meal images were based on generic meals from a previous study that were representative of the actual meal intakes in Ireland. Participants also completed a web-based 24HR. Both methods were completed on the same day, 3 hours apart. In a crossover design, participants were randomized in terms of which method they completed first. Then, 2 weeks after the first dietary assessments, participants repeated the process in the reverse order. Estimates of mean daily nutrient intakes and the categorization of individuals according to nutrient-based guidelines (eg, low, adequate, and high) were compared between the 2 methods. P values of less than .05 were considered statistically significant. Results: In total, 161 participants completed the study. For the 23 nutrient variables compared, the median percentage difference between the 2 methods was 7.6% (IQR 2.6%-13.2%), with P values ranging from <.001 to .97, and out of 23 variables, effect sizes for the differences were small for 19 (83%) variables, moderate for 2 (9%) variables, and large for 2 (9%) variables. Correlation coefficients were statistically significant (P<.05) for 18 (78%) of the 23 variables. Statistically significant correlations ranged from 0.16 to 0.45, with median correlation of 0.32 (IQR 0.25-0.40). When participants were classified according to nutrient-based guidelines, the proportion of individuals who were classified into the same category ranged from 52.8% (85/161) to 84.5% (136/161). Conclusions: A generic meal?based method of dietary intake assessment provides estimates of nutrient intake comparable with those provided by a web-based 24HR but with varying levels of agreement among nutrients. Further studies are required to refine and improve the generic recall across a range of nutrients. Future studies will consider user experience including the potential feasibility of incorporating image recognition of whole meals into the generic recall. UR - https://www.jmir.org/2024/1/e48817 UR - http://dx.doi.org/10.2196/48817 UR - http://www.ncbi.nlm.nih.gov/pubmed/38354039 ID - info:doi/10.2196/48817 ER - TY - JOUR AU - Huffman, Goodgame Landry AU - Lawrence-Sidebottom, Darian AU - Beam, Brenna Aislinn AU - Parikh, Amit AU - Guerra, Rachael AU - Roots, Monika AU - Huberty, Jennifer PY - 2024/1/31 TI - Improvements in Adolescents? Disordered Eating Behaviors in a Collaborative Care Digital Mental Health Intervention: Retrospective Observational Study JO - JMIR Form Res SP - e54253 VL - 8 KW - behavioral care KW - mental health KW - web-based coaching KW - web-based therapy KW - eating disorders KW - eating KW - anorexia KW - coach KW - coaching KW - pediatric KW - pediatrics KW - adolescent KW - adolescents KW - teen KW - teens KW - teenager KW - teenagers KW - digital mental health intervention KW - DMHI KW - collaborative KW - digital health N2 - Background: Young people today are exhibiting increasing rates of disordered eating behaviors, as well as eating disorders (EDs), alongside other mental and behavioral problems such as anxiety and depression. However, limited access to mental health care means that EDs, disordered eating behaviors, and comorbid mental health problems are often underdiagnosed and undertreated. Digital mental health interventions (DMHIs) offer accessible and scalable alternatives to traditional treatment modalities, but their effectiveness has not been well established among adolescents with EDs and disordered eating behaviors. Objective: This study uses data from a collaborative care pediatric DMHI to determine whether participation in a DMHI is associated with a reduction in adolescents? disordered eating behaviors. Methods: Adolescent members in care with Bend Health Inc completed the SCOFF questionnaire at baseline (before the start of care) and approximately every month during care to assess disordered eating behaviors. They also completed assessments of mental health symptoms at baseline. Member characteristics, mental health symptoms, and disordered eating behaviors of adolescents with elevated SCOFF scores at baseline (before the start of care) were compared to those of adolescents with nonelevated SCOFF scores at baseline. Members participated in web-based coaching or therapy sessions throughout the duration of mental health care. Results: Compared to adolescents with nonelevated SCOFF scores (n=520), adolescents with elevated SCOFF scores (n=169) were predominantly female and exhibited higher rates of elevated anxiety and depressive symptoms. SCOFF scores decreased over time in care with the DMHI for 61.4% (n=70) of adolescents with elevated SCOFF scores, and each additional month of participation was associated with greater improvements in disordered eating behaviors (F1,233=72.82; P<.001). Conclusions: Our findings offer promising preliminary evidence that participation in mental health care with a collaborative care DMHI may be beneficial in the reduction of disordered eating symptoms in adolescents, including those who are experiencing comorbid anxiety and depressive symptoms. UR - https://formative.jmir.org/2024/1/e54253 UR - http://dx.doi.org/10.2196/54253 UR - http://www.ncbi.nlm.nih.gov/pubmed/38294855 ID - info:doi/10.2196/54253 ER - TY - JOUR AU - Myers, A. Candice AU - Beyl, A. Robbie AU - Hsia, S. Daniel AU - Harris, N. Melissa AU - Reed, J. Isabella AU - Eliser, D. Danielle AU - Bagneris, Lauren AU - Apolzan, W. John PY - 2023/12/20 TI - Effects of Episodic Food Insecurity on Psychological and Physiological Responses in African American Women With Obesity (RESPONSES): Protocol for a Longitudinal Observational Cohort Study JO - JMIR Res Protoc SP - e52193 VL - 12 KW - food security KW - body weight KW - racially minoritized group KW - low income KW - stress KW - cortisol KW - allostatic load N2 - Background: Food insecurity is a risk factor for multiple chronic diseases, including obesity. Importantly, both food insecurity and obesity are more prevalent in African American women than in other groups. Furthermore, food insecurity is considered a cyclic phenomenon, with episodes of food adequacy (ie, enough food to eat) and food shortage (ie, not enough food to eat). More research is needed to better understand why food insecurity is linked to obesity, including acknowledging the episodic nature of food insecurity as a stressor and identifying underlying mechanisms. Objective: The objective of this study is to investigate the episodic nature of food insecurity as a stressor via responses in body weight and psychological and physiological parameters longitudinally and do so in a health-disparate population?African American women. Methods: We enrolled 60 African American women (food-insecure cohort: n=30, 50%; food-secure cohort: n=30, 50%) aged 18-65 years with obesity (BMI 30-50 kg/m2) to measure (1) daily body weight remotely over 22 weeks and (2) psychological and physiological parameters via clinic assessments at the beginning and end of the 22-week study. Furthermore, we are assessing episodes of food insecurity, stress, hedonic eating, and appetite on a weekly basis. We hypothesize that food-insecure African American women with obesity will demonstrate increased body weight and changes in psychological and physiological end points, whereas food-secure African American women with obesity will not. We are also examining associations between changes in psychological and physiological parameters and changes in body weight and performing a mediation analysis on the psychological parameters assessed at the study midpoint. Psychological questionnaires are used to assess stress; executive function, decision-making, and motivation; and affect and nonhomeostatic eating. Physiological measurements are used to evaluate the levels of cortisol, dehydroepiandrosterone-sulfate (DHEA-S), C-reactive protein, thyroid hormones, blood glucose, glycated hemoglobin, and insulin, as well as allostatic load. Results: This study has completed participant recruitment (n=60). At the time of study enrollment, the mean age of the participants was almost 47 (SD 10.8) years, and they had a mean BMI of 39.6 (SD 5.31) kg/m2. All data are anticipated to be collected by the end of 2023. Conclusions: We believe that this is the first study to examine changes in body weight and psychological and physiological factors in food-insecure African American women with obesity. This study has significant public health implications because it addresses the cyclic nature of food insecurity to identify underlying mechanisms that can be targeted to mitigate the adverse relationship between food insecurity and obesity and reduce health disparities in minority populations. Trial Registration: ClinicalTrials.gov NCT05076487; https://clinicaltrials.gov/study/NCT05076487 International Registered Report Identifier (IRRID): DERR1-10.2196/52193 UR - https://www.researchprotocols.org/2023/1/e52193 UR - http://dx.doi.org/10.2196/52193 UR - http://www.ncbi.nlm.nih.gov/pubmed/38117554 ID - info:doi/10.2196/52193 ER - TY - JOUR AU - Bond, S. Dale AU - Papasavas, K. Pavlos AU - Raynor, A. Hollie AU - Grilo, M. Carlos AU - Steele, R. Vaughn PY - 2023/11/6 TI - Transcranial Magnetic Stimulation for Reducing the Relative Reinforcing Value of Food in Adult Patients With Obesity Pursuing Metabolic and Bariatric Surgery: Protocol for a Pilot, Within-Participants, Sham-Controlled Trial JO - JMIR Res Protoc SP - e50714 VL - 12 KW - obesity KW - repetitive transcranial magnetic stimulation KW - food reinforcement KW - hedonic hunger KW - electroencephalography KW - metabolic and bariatric surgery N2 - Background: Metabolic and bariatric surgery (MBS) is the most effective and durable obesity treatment. However, there is heterogeneity in weight outcomes, which is partially attributed to variability in appetite and eating regulation. Patients with a strong desire to eat in response to the reward of palatable foods are more likely to overeat and experience suboptimal outcomes. This subgroup, classified as at risk, may benefit from repetitive transcranial magnetic stimulation (rTMS), a noninvasive brain stimulation technique that shows promise for reducing cravings and consumption of addictive drugs and food; no study has evaluated how rTMS affects the reinforcing value of food and brain reward processing in the context of MBS. Objective: The goal of the Transcranial Magnetic Stimulation to Reduce the Relative Reinforcing Value of Food (RESTRAIN) study is to perform an initial rTMS test on the relative reinforcing value (RRV) of food (the reinforcing value of palatable food compared with money) among adult patients who are pursuing MBS and report high food reinforcement. Using a within-participants sham-controlled crossover design, we will compare the active and sham rTMS conditions on pre- to posttest changes in the RRV of food (primary objective) and the neural modulation of reward, measured via electroencephalography (EEG; secondary objective). We hypothesize that participants will show larger decreases in food reinforcement and increases in brain reward processing after active versus sham rTMS. Methods: Participants (n=10) will attend 2 study sessions separated by a washout period. They will be randomized to active rTMS on 1 day and sham rTMS on the other day using a counterbalanced schedule. For both sessions, participants will arrive fasted in the morning and consume a standardized breakfast before being assessed on the RRV of food and reward tasks via EEG before and after rTMS of the left dorsolateral prefrontal cortex. Results: Recruitment and data collection began in December 2022. As of October 2023, overall, 52 patients have been screened; 36 (69%) screened eligible, and 17 (47%) were enrolled. Of these 17 patients, 3 (18%) were excluded before rTMS, 5 (29%) withdrew, 4 (24%) are in the process of completing the protocol, and 5 (29%) completed the protocol. Conclusions: The RESTRAIN study is the first to test whether rTMS can target neural reward circuits to reduce behavioral (RRV) and neural (EEG) measures of food reward in patients who are pursuing MBS. If successful, the results would provide a rationale for a fully powered trial to examine whether rTMS-related changes in food reinforcement translate into healthier eating patterns and improved MBS outcomes. If the results do not support our hypotheses, we will continue this line of research to evaluate whether additional rTMS sessions and pulses as well as different stimulation locations produce clinically meaningful changes in food reinforcement. Trial Registration: ClinicalTrials.gov NCT05522803; https://clinicaltrials.gov/study/NCT05522803 International Registered Report Identifier (IRRID): DERR1-10.2196/50714 UR - https://www.researchprotocols.org/2023/1/e50714 UR - http://dx.doi.org/10.2196/50714 UR - http://www.ncbi.nlm.nih.gov/pubmed/37930756 ID - info:doi/10.2196/50714 ER - TY - JOUR AU - Sun, Shufang AU - Nardi, William AU - Murphy, Matthew AU - Scott, Ty AU - Saadeh, Frances AU - Roy, Alexandra AU - Brewer, Judson PY - 2023/9/26 TI - Mindfulness-Based Mobile Health to Address Unhealthy Eating Among Middle-Aged Sexual Minority Women With Early Life Adversity: Mixed Methods Feasibility Trial JO - J Med Internet Res SP - e46310 VL - 25 KW - mobile health KW - mindfulness KW - obesity KW - sexual minority women KW - early life adversity KW - cell phone KW - mobile phone N2 - Background: Sexual minority women (lesbian, gay, bisexual, pansexual, queer, and other nonheterosexual women) remain considerably underrepresented in health research despite being at a higher risk for diabetes and obesity as well as stigma and psychological distress than their heterosexual peers. In addition, early life adversity (ELA) is prevalent among sexual minority women, which further increases risks for obesity, psychological distress, and poor cardiovascular health. App-based mindfulness interventions are potentially promising for this group in mitigating the adverse health effects of ELA, reducing food craving and unhealthy eating, addressing the risks associated with obesity. Objective: This mixed methods feasibility trial aimed to test a mindfulness-based mobile health approach for middle-aged sexual minority women (aged 30-55 years) with ELA and overweight or obesity (BMI ?25 kg/m2) to improve health outcomes. Methods: The single-arm trial was advertised on social media and various lesbian, gay, bisexual, transgender, and queer web-based groups. At baseline, after the intervention (2 months), and at the 4-month follow-up, participants completed assessments of primary outcomes (food craving, emotional eating, and weight via a mailed scale) and secondary outcomes (depression, anxiety, mindfulness, and emotion dysregulation). A standardized weight measure was mailed to participants for weight reporting. Feasibility and acceptability were assessed after the intervention via surveys and semistructured exit interviews. Results: We screened 442 individuals, among which 30 eligible sexual minority women (mean age 40.20, SD 7.15 years) from various US regions were enrolled in the study. At baseline, 86% (26/30) and 80% (24/30) of participants had elevated depressive and anxiety symptoms, respectively. Among the 30 enrolled participants, 20 (66%) completed all intervention modules, 25 (83%) were retained at the 2-month follow-up, and 20 (66%) were retained at the 4-month follow-up. None reported adverse effects. From baseline to the 4-month follow-up, large effects were found in food craving (Cohen d=1.64) and reward-based eating (Cohen d=1.56), whereas small effects were found with weight (Cohen d=0.20; 4.21 kg on average). Significant improvements were also found in the secondary outcomes (depression, Cohen d=0.98; anxiety, Cohen d=0.50; mindfulness, Cohen d=0.49; and emotion dysregulation, Cohen d=0.44; all P<.05). Participants with higher levels of parental verbal and emotional abuse were particularly responsive to the intervention. Participants reported that the program aligned with their goals and expectations, was easy to use, and facilitated changes in eating behavior and mental health. Barriers to engagement included the need for diverse teachers, individualized support, and body positive language. Conclusions: This early phase feasibility trial provides proof-of-concept support for a mindfulness mobile health approach to improve obesity-related outcomes among sexual minority women and warrants a larger randomized controlled trial in the future. The findings also suggest the need to address trauma and psychological health when addressing weight-related outcomes among sexual minority women. UR - https://www.jmir.org/2023/1/e46310 UR - http://dx.doi.org/10.2196/46310 UR - http://www.ncbi.nlm.nih.gov/pubmed/37751273 ID - info:doi/10.2196/46310 ER - TY - JOUR AU - Hamatani, Sayo AU - Matsumoto, Kazuki AU - Andersson, Gerhard AU - Tomioka, Yukiko AU - Numata, Shusuke AU - Kamashita, Rio AU - Sekiguchi, Atsushi AU - Sato, Yasuhiro AU - Fukudo, Shin AU - Sasaki, Natsuki AU - Nakamura, Masayuki AU - Otani, Ryoko AU - Sakuta, Ryoichi AU - Hirano, Yoshiyuki AU - Kosaka, Hirotaka AU - Mizuno, Yoshifumi PY - 2023/9/19 TI - Guided Internet-Based Cognitive Behavioral Therapy for Women With Bulimia Nervosa: Protocol for a Multicenter Randomized Controlled Trial JO - JMIR Res Protoc SP - e49828 VL - 12 KW - bulimia nervosa KW - internet-based cognitive behavioral therapy KW - ICBT KW - randomized controlled trial KW - RCT KW - protocol KW - randomized KW - controlled trial KW - bulimia KW - eating KW - cognitive behavioral therapy KW - CBT KW - binge eating KW - purging KW - mobile phone N2 - Background: Individual face-to-face cognitive behavioral therapy is known to be effective for bulimia nervosa (BN). Since foods vary considerably between regions and cultures in which patients live, cultural adaptation of the treatment program is particularly important in cognitive behavioral therapy for BN. Recently, an internet-based cognitive behavioral therapy (ICBT) program was developed for Japanese women with BN, adapted to the Japanese food culture. However, no previous randomized controlled trial has examined the effectiveness of ICBT. Objective: This paper presents a research protocol for strategies to examine the effects of guided ICBT. Methods: This study is designed as a multicenter, prospective, assessor-blinded randomized controlled trial. The treatment groups will be divided into treatment as usual (TAU) alone as the control group and ICBT combined with TAU as the intervention group. The primary outcome is the total of binge eating and purging behaviors assessed before and after treatment by an independent assessor. Secondary outcomes will include measures of eating disorder severity, depression, anxiety, quality of life, treatment satisfaction, and working alliances. Treatment satisfaction and working alliances will be measured post assessment only. Other measures will be assessed at baseline, post intervention, and follow-up, and the outcomes will be analyzed on an intention-to-treat basis. Results: This study will be conducted at 7 different medical institutions in Japan from August 2022 to October 2026. Recruitment of participants began on August 19, 2022, and recruitment is scheduled to continue until July 2024. The first participants were registered on September 8, 2022. Conclusions: This is the first multicenter randomized controlled trial in Japan comparing the effectiveness of ICBT and TAU in patients with BN. Trial Registration: University Hospital Medical Information Network UMIN000048732; https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055522 International Registered Report Identifier (IRRID): DERR1-10.2196/49828 UR - https://www.researchprotocols.org/2023/1/e49828 UR - http://dx.doi.org/10.2196/49828 UR - http://www.ncbi.nlm.nih.gov/pubmed/37725414 ID - info:doi/10.2196/49828 ER - TY - JOUR AU - Woo, Sarah AU - Jung, Sunho AU - Lim, Hyunjung AU - Kim, YoonMyung AU - Park, Hee Kyung PY - 2023/8/17 TI - Exploring the Effect of the Dynamics of Behavioral Phenotypes on Health Outcomes in an mHealth Intervention for Childhood Obesity: Longitudinal Observational Study JO - J Med Internet Res SP - e45407 VL - 25 KW - behavioral dynamics KW - behavioral phenotype KW - functional data analysis KW - FDA KW - machine learning analysis KW - mobile health KW - mHealth KW - obesity intervention KW - pediatric obesity KW - mobile phone N2 - Background: Advancements in mobile health technologies and machine learning approaches have expanded the framework of behavioral phenotypes in obesity treatment to explore the dynamics of temporal changes. Objective: This study aimed to investigate the dynamics of behavioral changes during obesity intervention and identify behavioral phenotypes associated with weight change using a hybrid machine learning approach. Methods: In total, 88 children and adolescents (ages 8-16 years; 62/88, 71% male) with age- and sex-specific BMI ?85th percentile participated in the study. Behavioral phenotypes were identified using a hybrid 2-stage procedure based on the temporal dynamics of adherence to the 5 behavioral goals during the intervention. Functional principal component analysis was used to determine behavioral phenotypes by extracting principal component factors from the functional data of each participant. Elastic net regression was used to investigate the association between behavioral phenotypes and weight change. Results: Functional principal component analysis identified 2 distinctive behavioral phenotypes, which were named the high or low adherence level and late or early behavior change. The first phenotype explained 47% to 69% of each factor, whereas the second phenotype explained 11% to 17% of the total behavioral dynamics. High or low adherence level was associated with weight change for adherence to screen time (?=?.0766, 95% CI ?.1245 to ?.0312), fruit and vegetable intake (?=.1770, 95% CI .0642-.2561), exercise (?=?.0711, 95% CI ?.0892 to ?.0363), drinking water (?=?.0203, 95% CI ?.0218 to ?.0123), and sleep duration. Late or early behavioral changes were significantly associated with weight loss for changes in screen time (?=.0440, 95% CI .0186-.0550), fruit and vegetable intake (?=?.1177, 95% CI ?.1441 to ?.0680), and sleep duration (?=?.0991, 95% CI ?.1254 to ?.0597). Conclusions: Overall level of adherence, or the high or low adherence level, and a gradual improvement or deterioration in health-related behaviors, or the late or early behavior change, were differently associated with weight loss for distinctive obesity-related lifestyle behaviors. A large proportion of health-related behaviors remained stable throughout the intervention, which indicates that health care professionals should closely monitor changes made during the early stages of the intervention. Trial Registration: Clinical Research Information Science KCT0004137; https://tinyurl.com/ytxr83ay UR - https://www.jmir.org/2023/1/e45407 UR - http://dx.doi.org/10.2196/45407 UR - http://www.ncbi.nlm.nih.gov/pubmed/37590040 ID - info:doi/10.2196/45407 ER - TY - JOUR AU - Sharp, Gemma AU - Torous, John AU - West, L. Madeline PY - 2023/8/14 TI - Ethical Challenges in AI Approaches to Eating Disorders JO - J Med Internet Res SP - e50696 VL - 25 KW - eating disorders KW - body image KW - artificial intelligence KW - AI KW - chatbot KW - ethics UR - https://www.jmir.org/2023/1/e50696 UR - http://dx.doi.org/10.2196/50696 UR - http://www.ncbi.nlm.nih.gov/pubmed/37578836 ID - info:doi/10.2196/50696 ER - TY - JOUR AU - Mey, T. Jacob AU - Karpinski, A. Christine AU - Yang, Shengping AU - Madere, D. Joseph AU - Piattoly, Tavis AU - Harper, Ronnie AU - Kirwan, P. John PY - 2023/7/26 TI - Factors Influencing Nutritional Intake and Interests in Educational Content of Athletes and Sport Professionals Toward the Development of a Clinician-Supported Mobile App to Combat Relative Energy Deficiency in Sport: Formative Research and a Description of App Functions JO - JMIR Form Res SP - e45098 VL - 7 KW - dietitian KW - malnutrition KW - mHealth KW - mobile health KW - performance KW - RED-S KW - relative energy deficiency in sport KW - sports nutrition KW - technology N2 - Background: Relative energy deficiency in sport (RED-S) as a consequence of athlete malnutrition remains a prominent issue. However, it remains underrecognized, in part due to the perceived outward health of athletes. The Eat2Win app was designed to combat RED-S and athlete malnutrition by providing education, behavior modification, and direct communication with expert sports dietitians to athletes and sport professionals (professionals who work with athletes, eg, sport coaches and athletic trainers). Objective: The purpose of this formative research was to gain critical insight on motivators and barriers to optimal nutritional intake from both the athletes? and sport professionals? perspectives. Additionally, since these 2 groups represent the primary end users of an app aimed at improving athlete nutrition and reducing the risk of RED-S, a secondary objective was to gain insight on the preferences and perceptions of app-based educational content and functionality. Methods: An electronic survey was developed by an interdisciplinary team of experts. Survey questions were established based upon prevailing literature, professional dietetic field experience, and app design considerations to obtain respondent knowledge on key sports nutrition topics along with motivations and barriers to meal choices. Additionally, the survey included questions about the development of an integrative, clinician-support app aimed at addressing RED-S. These questions included preferences for educational content, modes of in-app information, and communication delivery for the target population (app end users: athletes and sport professionals). The survey was distributed through Research Electronic Data Capture (REDCap) to athletes and sport professionals using targeted email, social media, and community engagement campaigns. The electronic survey was available from May 4 to August 2, 2022. Results: Survey respondents (n=1352) included athletes and professionals who work with athletes from a variety of settings, like high school, collegiate, professional, and club sports. Respondents reported high interest in 8 core sports nutrition topics. The preferred modes of information and communication delivery were visual formats (eg, videos and infographics) and in-app alerts (eg, direct messaging and meal reminders). Only athlete respondents were asked about motivators and barriers that influence meal choices. ?Health? and ?sports performance? were the highest scoring motivators, while the highest scoring barriers were ?cost of food,? ?easy access to unhealthy food,? and ?time to cook or prepare food.? Notably, survey respondents provided positive feedback and interest using a novel function of the app: real-time meal feedback through food photography. Conclusions: The Eat2Win app is designed to combat RED-S and athlete malnutrition. Results from this study provide critical information on end-user opinions and preferences and will be used to further develop the Eat2Win app. Future research will aim to determine whether the Eat2Win app can prevent RED-S and the risk of athlete malnutrition to improve both health and performance. UR - https://formative.jmir.org/2023/1/e45098 UR - http://dx.doi.org/10.2196/45098 UR - http://www.ncbi.nlm.nih.gov/pubmed/37494083 ID - info:doi/10.2196/45098 ER - TY - JOUR AU - Presseller, K. Emily AU - Lampe, W. Elizabeth AU - Zhang, Fengqing AU - Gable, A. Philip AU - Guetterman, C. Timothy AU - Forman, M. Evan AU - Juarascio, S. Adrienne PY - 2023/7/6 TI - Using Wearable Passive Sensing to Predict Binge Eating in Response to Negative Affect Among Individuals With Transdiagnostic Binge Eating: Protocol for an Observational Study JO - JMIR Res Protoc SP - e47098 VL - 12 KW - affect KW - binge eating KW - heart rate KW - heart rate variability KW - electrodermal activity KW - ecological momentary assessment KW - wearable sensors KW - ecological momentary intervention N2 - Background: Binge eating (BE), characterized by eating a large amount of food accompanied by a sense of loss of control over eating, is a public health crisis. Negative affect is a well-established antecedent for BE. The affect regulation model of BE posits that elevated negative affect increases momentary risk for BE, as engaging in BE alleviates negative affect and reinforces the behavior. The eating disorder field?s capacity to identify moments of elevated negative affect, and thus BE risk, has exclusively relied on ecological momentary assessment (EMA). EMA involves the completion of surveys in real time on one?s smartphone to report behavioral, cognitive, and emotional symptoms throughout the day. Although EMA provides ecologically valid information, EMA surveys are often delivered only 5-6 times per day, involve self-report of affect intensity only, and are unable to assess affect-related physiological arousal. Wearable, psychophysiological sensors that measure markers of affect arousal including heart rate, heart rate variability, and electrodermal activity may augment EMA surveys to improve accurate real-time prediction of BE. These sensors can objectively and continuously measure biomarkers of nervous system arousal that coincide with affect, thus allowing them to measure affective trajectories on a continuous timescale, detect changes in negative affect before the individual is consciously aware of them, and reduce user burden to improve data completeness. However, it is unknown whether sensor features can distinguish between positive and negative affect states, given that physiological arousal may occur during both negative and positive affect states. Objective: The aims of this study are (1) to test the hypothesis that sensor features will distinguish positive and negative affect states in individuals with BE with >60% accuracy and (2) test the hypothesis that a machine learning algorithm using sensor data and EMA-reported negative affect to predict the occurrence of BE will predict BE with greater accuracy than an algorithm using EMA-reported negative affect alone. Methods: This study will recruit 30 individuals with BE who will wear Fitbit Sense 2 wristbands to passively measure heart rate and electrodermal activity and report affect and BE on EMA surveys for 4 weeks. Machine learning algorithms will be developed using sensor data to distinguish instances of high positive and high negative affect (aim 1) and to predict engagement in BE (aim 2). Results: This project will be funded from November 2022 to October 2024. Recruitment efforts will be conducted from January 2023 through March 2024. Data collection is anticipated to be completed in May 2024. Conclusions: This study is anticipated to provide new insight into the relationship between negative affect and BE by integrating wearable sensor data to measure affective arousal. The findings from this study may set the stage for future development of more effective digital ecological momentary interventions for BE. International Registered Report Identifier (IRRID): DERR1-10.2196/47098 UR - https://www.researchprotocols.org/2023/1/e47098 UR - http://dx.doi.org/10.2196/47098 UR - http://www.ncbi.nlm.nih.gov/pubmed/37410522 ID - info:doi/10.2196/47098 ER - TY - JOUR AU - Hellner, Megan AU - Steinberg, Dori AU - Baker, H. Jessica AU - Blanton, Camilla PY - 2023/1/26 TI - Digitally Delivered Dietary Interventions for Patients with Eating Disorders Undergoing Family-Based Treatment: Protocol for a Randomized Feasibility Trial JO - JMIR Res Protoc SP - e41837 VL - 12 KW - eating disorders KW - virtual treatment KW - dietary interventions KW - family-based treatment KW - anorexia KW - psychiatric disorder KW - digital health intervention KW - telehealth KW - virtual health N2 - Background: Eating disorders (EDs) affect 9% of the United States population, and anorexia nervosa (AN), specifically, has the second highest mortality rate of all psychiatric disorders. Yet, only 20% are able to access treatment. Access to care issues include long waitlists, lack of trained specialists, financial, and geographic barriers, all of which highlight the need for effective telehealth interventions. Family-based therapy (FBT) is a first-line treatment for adolescents and young adults with EDs, and weight gain early in treatment is considered a primary predictor of success with FBT. However, nutrition requirements for patients with EDs are uniquely complex. A variety of dietary interventions for guiding the renourishment process are used in practice, but empirical data on the effectiveness and acceptability of the various interventions are sparse. The significance of nutritional restoration and issues with access to first-line treatments underscore the need for further research exploring virtually delivered dietary interventions. Objective: Our objective is to compare the effectiveness and acceptability of 2 digitally delivered dietary interventions frequently used in eating disorder treatment settings: (1) calorie-based meal plans and (2) the Plate-by-Plate approach. Specifically, we will explore any potential differences in weight restoration achieved over 8 weeks of treatment as a primary measure of effectiveness, as well as additional treatment outcomes (ED symptoms, anxiety, depression, caregiver burden, and perceived effectiveness and acceptability for both caregivers and clinicians). Methods: Patients (N=100) with either AN or avoidant restrictive food intake disorders (ARFID) aged 6-24 years seeking treatment at a nationwide virtual eating disorder treatment program, were enrolled between May and August 2022. Upon admission, patients were randomly assigned to receive either the calorie-based intervention or Plate-by-Plate approach from their registered dietitian, all of whom have received training as study interventionists. While we were primarily interested in responses during the first 8 weeks of treatment, patients will be followed for up to 12 months. Descriptive statistics were used to describe patient characteristics and demographics. Weight changes and other treatment outcomes between groups will be compared using generalized linear models. Semistructured caregiver and clinician interview transcripts will undergo qualitative analysis. Results: Enrollment ran from March to August 2022, and we anticipate completion of data collection by November 2022. Analyses will be completed in January 2023. Conclusions: This study contributes to existing FBT literature by thoroughly exploring the acceptability of dietary interventions and their influence on weight restoration, an area in which research is sparse. International Registered Report Identifier (IRRID): DERR1-10.2196/41837 UR - https://www.researchprotocols.org/2023/1/e41837 UR - http://dx.doi.org/10.2196/41837 UR - http://www.ncbi.nlm.nih.gov/pubmed/36701182 ID - info:doi/10.2196/41837 ER - TY - JOUR AU - Juarascio, S. Adrienne AU - Srivastava, Paakhi AU - Presseller, K. Emily AU - Lin, Mandy AU - Patarinski, G. Anna G. AU - Manasse, M. Stephanie AU - Forman, M. Evan PY - 2022/12/14 TI - Using Continuous Glucose Monitoring to Detect and Intervene on Dietary Restriction in Individuals With Binge Eating: The SenseSupport Withdrawal Design Study JO - JMIR Form Res SP - e38479 VL - 6 IS - 12 KW - binge eating KW - loss-of-control eating KW - continuous glucose monitoring KW - mobile phone N2 - Background: Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. Objective: This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Methods: Participants (N=30) were individuals with BED or BN engaging in ?3 episodes of ?5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Results: Retention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. Conclusions: This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial Registration: ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694 UR - https://formative.jmir.org/2022/12/e38479 UR - http://dx.doi.org/10.2196/38479 UR - http://www.ncbi.nlm.nih.gov/pubmed/36515992 ID - info:doi/10.2196/38479 ER - TY - JOUR AU - Jarman, K. Hannah AU - McLean, A. Siân AU - Rodgers, Rachel AU - Fuller-Tyszkiewicz, Matthew AU - Paxton, Susan AU - O'Gorman, Beth AU - Harris, Emily AU - Shatte, Adrian AU - Bishop, Katie AU - Baumann, Tahlia AU - Mahoney, Danielle AU - Daugelat, Melissa-Claire AU - Yager, Zali PY - 2022/10/31 TI - Informing mHealth and Web-Based Eating Disorder Interventions: Combining Lived Experience Perspectives With Design Thinking Approaches JO - JMIR Form Res SP - e38387 VL - 6 IS - 10 KW - eating disorders KW - app-based intervention KW - lived experience KW - design thinking KW - interviews KW - young women KW - co-design KW - mobile health KW - mHealth N2 - Background: App-based interventions designed to prevent and treat eating disorders have considerable potential to overcome known barriers to treatment seeking. Existing apps have shown efficacy in terms of symptom reduction; however, uptake and retention issues are common. To ensure that apps meet the needs and preferences of those for whom they were designed, it is critical to understand the lived experience of potential users and involve them in the process of design, development, and delivery. However, few app-based interventions are pretested on and co-designed with end users before randomized controlled trials. Objective: To address the issue, this study used a highly novel design thinking approach to provide the context and a lived experience perspective of the end user, thus allowing for a deeper level of understanding. Methods: In total, 7 young women (mean age 25.83, SD 5.34, range 21-33 years) who self-identified as having a history of body image issues or eating disorders were recruited. Participants were interviewed about their lived experience of body image and eating disorders and reported their needs and preferences for app-based eating disorder interventions. Traditional (thematic analysis) and novel (empathy mapping; visually depicting and empathizing with the user?s personal experience) analyses were performed, providing a lived experience perspective of eating disorders and identifying the needs and preferences of this population in relation to app-based interventions for eating disorders. Key challenges and opportunities for app-based eating disorder interventions were also identified. Results: Findings highlighted the importance of understanding and identifying problematic eating disorder symptoms for the user, helpful practices for recovery that identify personal values and goals, the role of social support in facilitating hope, and aspects of usability to promote continued engagement and recovery. Conclusions: Practical guidance and recommendations are described for those developing app-based eating disorder interventions. These findings have the potential to inform practices to enhance participant uptake and retention in the context of app-based interventions for this population. UR - https://formative.jmir.org/2022/10/e38387 UR - http://dx.doi.org/10.2196/38387 UR - http://www.ncbi.nlm.nih.gov/pubmed/36315225 ID - info:doi/10.2196/38387 ER - TY - JOUR AU - Tang, W. Wymann S. AU - Ng, Y. Tricia J. AU - Wong, A. Joseph Z. AU - Ho, H. Cyrus S. PY - 2022/8/29 TI - The Role of Serious Video Games in the Treatment of Disordered Eating Behaviors: Systematic Review JO - J Med Internet Res SP - e39527 VL - 24 IS - 8 KW - serious video games KW - serious games KW - video games KW - gamification KW - digital health KW - eHealth KW - mobile health KW - mHealth KW - disordered eating KW - eating disorders N2 - Background: Eating disorders and other forms of disordered eating cause significant complications and comorbidities in patients. However, full remission with current standard treatment remains low. Challenges to treatment include underdiagnosis and high dropout rates, as well as difficulties in addressing underlying emotion dysregulation, poor impulse control, and personality traits. Serious video games (SVGs), which have the advantages of being highly engaging and accessible, may be potential tools for delivering various forms of treatment in addressing the underlying psychopathology of disordered eating. Objective: This review aims to provide an overview of the possible mechanisms by which SVGs may affect the clinical course of disordered eating, while evaluating the outcomes of studies that have assessed the role of SVGs in the treatment of disordered eating. Methods: A systematic search was performed on PubMed, PsycINFO, and Embase, using keywords related to SVGs, disordered eating, and eating disorders. A narrative synthesis was subsequently carried out. Results: In total, 2151 papers were identified, of which 11 (0.51%) were included. Of these 11 studies, 10 (91%) were randomized controlled trials, and 1 (9%) was a quasi-experimental study. The types of SVG interventions varied across the studies and targeted different mechanisms of disordered eating, ranging from addressing problem-solving and emotion regulation skills to neurocognitive training for inhibitory control. Most (10/11, 91%) of the studies showed some benefit of the SVGs in improving certain physical, behavioral, or psychological outcomes related to disordered eating. Some (4/11, 36%) of the studies also showed encouraging evidence of the retention of these benefits at follow-up. Conclusions: The studies included in this review provide collective evidence to suggest the various roles SVGs can play in plugging potential gaps in conventional therapy. Nonetheless, challenges exist in designing these games to prevent potential pitfalls, such as excessive stress arising from the SVGs themselves or potential gaming addiction. Further studies will also be required to assess the long-term benefits of SVGs as well as explore their potential preventive, and not just curative, effects on disordered eating. UR - https://www.jmir.org/2022/8/e39527 UR - http://dx.doi.org/10.2196/39527 UR - http://www.ncbi.nlm.nih.gov/pubmed/36036967 ID - info:doi/10.2196/39527 ER - TY - JOUR AU - Vega, Julio AU - Bell, T. Beth AU - Taylor, Caitlin AU - Xie, Jue AU - Ng, Heidi AU - Honary, Mahsa AU - McNaney, Roisin PY - 2022/4/25 TI - Detecting Mental Health Behaviors Using Mobile Interactions: Exploratory Study Focusing on Binge Eating JO - JMIR Ment Health SP - e32146 VL - 9 IS - 4 KW - eating disorder KW - binge eating KW - mental health KW - mobile sensing KW - context-aware computing KW - NAP KW - EMA KW - mobile phone N2 - Background: Binge eating is a subjective loss of control while eating, which leads to the consumption of large amounts of food. It can cause significant emotional distress and is often accompanied by purging behaviors (eg, meal skipping, overexercising, or vomiting). Objective: The aim of this study was to explore the potential of mobile sensing to detect indicators of binge-eating episodes, with a view toward informing the design of future context-aware mobile interventions. Methods: This study was conducted in 2 stages. The first involved the development of the DeMMI (Detecting Mental health behaviors using Mobile Interactions) app. As part of this, we conducted a consultation session to explore whether the types of sensor data we were proposing to capture were useful and appropriate, as well as to gather feedback on some specific app features relating to self-reporting. The second stage involved conducting a 6-week period of data collection with 10 participants experiencing binge eating (logging both their mood and episodes of binge eating) and 10 comparison participants (logging only mood). An optional interview was conducted after the study, which discussed their experience using the app, and 8 participants (n=3, 38% binge eating and n=5, 63% comparisons) consented. Results: The findings showed unique differences in the types of sensor data that were triangulated with the individuals? episodes (with nearby Bluetooth devices, screen and app use features, mobility features, and mood scores showing relevance). Participants had a largely positive opinion about the app, its unobtrusive role, and its ease of use. Interacting with the app increased participants? awareness of and reflection on their mood and phone usage patterns. Moreover, they expressed no privacy concerns as these were alleviated by the study information sheet. Conclusions: This study contributes a series of recommendations for future studies wishing to scale our approach and for the design of bespoke mobile interventions to support this population. UR - https://mental.jmir.org/2022/4/e32146 UR - http://dx.doi.org/10.2196/32146 UR - http://www.ncbi.nlm.nih.gov/pubmed/35086064 ID - info:doi/10.2196/32146 ER - TY - JOUR AU - Moghimi, Elnaz AU - Davis, Caroline AU - Rotondi, Michael PY - 2021/7/20 TI - The Efficacy of eHealth Interventions for the Treatment of Adults Diagnosed With Full or Subthreshold Binge Eating Disorder: Systematic Review and Meta-analysis JO - J Med Internet Res SP - e17874 VL - 23 IS - 7 KW - internet KW - cognitive behavioral therapy KW - guided self-help KW - obesity KW - weight loss KW - eating disorder KW - binge eating KW - mobile phone N2 - Background: There has been a recent rise in the use of eHealth treatments for a variety of psychological disorders, including eating disorders. Objective: This meta-analysis of randomized controlled trials is the first to evaluate the efficacy of eHealth interventions specifically for the treatment of binge eating disorder (characterized by compulsive overconsumption of food, in a relatively short period, and without compensatory behaviors such as purging or fasting). Methods: A search on the electronic databases PubMed, Web of Science, Embase, MEDLINE, and CINAHL was conducted for randomized controlled trials that compared the efficacy of eHealth treatment interventions with waitlist controls. Results: From the databases searched, 3 studies (298 participants in total) met the inclusion criteria. All interventions were forms of internet-based guided cognitive behavioral therapy. The results of the analysis demonstrated that when compared with waitlist controls, individuals enrolled in eHealth interventions experienced a reduction in objective binge episodes (standardized mean difference [SMD] ?0.77, 95% CI ?1.38 to ?0.16) and eating disorder psychopathology (SMD ?0.71, 95% CI ?1.20 to ?0.22), which included shape (SMD ?0.61, 95% CI ?1.01 to ?0.22) and weight concerns (SMD ?0.91, 95% CI ?1.33 to ?0.48). There was no significant difference in BMI between the eHealth interventions and controls (SMD ?0.01, 95% CI ?0.40 to 0.39). Conclusions: These findings provide promising results for the use of internet-based cognitive behavioral therapy for binge eating disorder treatment and support the need for future research to explore the efficacy of these eHealth interventions. UR - https://www.jmir.org/2021/7/e17874 UR - http://dx.doi.org/10.2196/17874 UR - http://www.ncbi.nlm.nih.gov/pubmed/34283028 ID - info:doi/10.2196/17874 ER - TY - JOUR AU - Feldhege, Johannes AU - Moessner, Markus AU - Wolf, Markus AU - Bauer, Stephanie PY - 2021/7/8 TI - Changes in Language Style and Topics in an Online Eating Disorder Community at the Beginning of the COVID-19 Pandemic: Observational Study JO - J Med Internet Res SP - e28346 VL - 23 IS - 7 KW - COVID-19 KW - eating disorders KW - online eating disorder community KW - language KW - mental health KW - social media KW - LIWC KW - Linguistic Inquiry and Word Count KW - Reddit KW - topic modeling N2 - Background: COVID-19 has affected individuals with lived experience of eating disorders (EDs), with many reporting higher psychological distress, higher prevalence of ED symptoms, and compensatory behaviors. The COVID-19 pandemic and the health and safety measures taken to contain its spread also disrupted routines and reduced access to familiar coping mechanisms, social support networks, and health care services. Social media and the ED communities on social media platforms have been an important source of support for individuals with EDs in the past. So far, it is unknown how discussions in online ED communities changed as offline support networks were disrupted and people spent more time at home in the first months of the COVID-19 pandemic. Objective: The aim of this study is to identify changes in language content and style in an online ED community during the initial onset of the COVID-19 pandemic. Methods: We extracted posts and their comments from the ED community on the social media website Reddit and concatenated them to comment threads. To analyze these threads, we applied top-down and bottom-up language analysis methods based on topic modeling with latent Dirichlet allocation and 13 indicators from the Linguistic Inquiry and Word Count program, respectively. Threads were split into prepandemic (before March 11, 2020) and midpandemic (after March 11, 2020) groups. Standardized mean differences were calculated to estimate change between pre- and midpandemic threads. Results: A total of 17,715 threads (n=8772, 49.5% prepandemic threads; n=8943, 50.5% midpandemic threads) were extracted from the ED community and analyzed. The final topic model contained 21 topics. CIs excluding zero were found for standardized mean differences of 15 topics and 9 Linguistic Inquiry and Word Count categories covering themes such as ED symptoms, mental health, treatment for EDs, cognitive processing, social life, and emotions. Conclusions: Although we observed a reduction in discussions about ED symptoms, an increase in mental health and treatment-related topics was observed at the same time. This points to a change in the focus of the ED community from promoting potentially harmful weight loss methods to bringing attention to mental health and treatments for EDs. These results together with heightened cognitive processing, increased social references, and reduced inhibition of negative emotions detected in discussions indicate a shift in the ED community toward a pro-recovery orientation. UR - https://www.jmir.org/2021/7/e28346 UR - http://dx.doi.org/10.2196/28346 UR - http://www.ncbi.nlm.nih.gov/pubmed/34101612 ID - info:doi/10.2196/28346 ER - TY - JOUR AU - Beilharz, Francesca AU - Sukunesan, Suku AU - Rossell, L. Susan AU - Kulkarni, Jayashri AU - Sharp, Gemma PY - 2021/6/16 TI - Development of a Positive Body Image Chatbot (KIT) With Young People and Parents/Carers: Qualitative Focus Group Study JO - J Med Internet Res SP - e27807 VL - 23 IS - 6 KW - body image KW - eating disorder KW - chatbot KW - conversational agent KW - artificial intelligence KW - mental health KW - digital health KW - design N2 - Background: Body image and eating disorders represent a significant public health concern; however, many affected individuals never access appropriate treatment. Conversational agents or chatbots reflect a unique opportunity to target those affected online by providing psychoeducation and coping skills, thus filling the gap in service provision. Objective: A world-first body image chatbot called ?KIT? was designed. The aim of this study was to assess preliminary acceptability and feasibility via the collection of qualitative feedback from young people and parents/carers regarding the content, structure, and design of the chatbot, in accordance with an agile methodology strategy. The chatbot was developed in collaboration with Australia?s national eating disorder support organization, the Butterfly Foundation. Methods: A conversation decision tree was designed that offered psychoeducational information on body image and eating disorders, as well as evidence-based coping strategies. A version of KIT was built as a research prototype to deliver these conversations. Six focus groups were conducted using online semistructured interviews to seek feedback on the KIT prototype. This included four groups of people seeking help for themselves (n=17; age 13-18 years) and two groups of parents/carers (n=8; age 46-57 years). Participants provided feedback on the cartoon chatbot character design, as well as the content, structure, and design of the chatbot webchat. Results: Thematic analyses identified the following three main themes from the six focus groups: (1) chatbot character and design, (2) content presentation, and (3) flow. Overall, the participants provided positive feedback regarding KIT, with both young people and parents/carers generally providing similar reflections. The participants approved of KIT?s character and engagement. Specific suggestions were made regarding the brevity and tone to increase KIT?s interactivity. Conclusions: Focus groups provided overall positive qualitative feedback regarding the content, structure, and design of the body image chatbot. Incorporating the feedback of lived experience from both individuals and parents/carers allowed the refinement of KIT in the development phase as per an iterative agile methodology. Further research is required to evaluate KIT?s efficacy. UR - https://www.jmir.org/2021/6/e27807 UR - http://dx.doi.org/10.2196/27807 UR - http://www.ncbi.nlm.nih.gov/pubmed/34132644 ID - info:doi/10.2196/27807 ER - TY - JOUR AU - Chung, Alicia AU - Vieira, Dorice AU - Donley, Tiffany AU - Tan, Nicholas AU - Jean-Louis, Girardin AU - Kiely Gouley, Kathleen AU - Seixas, Azizi PY - 2021/6/3 TI - Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review JO - J Med Internet Res SP - e19697 VL - 23 IS - 6 KW - social media KW - eating behaviors KW - adolescent health N2 - Background: The influence of social media among adolescent peer groups can be a powerful change agent. Objective: Our scoping review aimed to elucidate the ways in which social media use among adolescent peers influences eating behaviors. Methods: A scoping review of the literature of articles published from journal inception to 2019 was performed by searching PubMed (ie, MEDLINE), Embase, CINAHL, PsycINFO, Web of Science, and other databases. The review was conducted in three steps: (1) identification of the research question and clarification of criteria using the population, intervention, comparison, and outcome (PICO) framework; (2) selection of articles from the literature using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; and (3) charting and summarizing information from selected articles. PubMed?s Medical Subject Headings (MeSH) and Embase?s Emtree subject headings were reviewed along with specific keywords to construct a comprehensive search strategy. Subject headings and keywords were based on adolescent age groups, social media platforms, and eating behaviors. After screening 1387 peer-reviewed articles, 37 articles were assessed for eligibility. Participant age, gender, study location, social media channels utilized, user volume, and content themes related to findings were extracted from the articles. Results: Six articles met the final inclusion criteria. A final sample size of 1225 adolescents (aged 10 to 19 years) from the United States, the United Kingdom, Sweden, Norway, Denmark, Portugal, Brazil, and Australia were included in controlled and qualitative studies. Instagram and Facebook were among the most popular social media platforms that influenced healthful eating behaviors (ie, fruit and vegetable intake) as well as unhealthful eating behaviors related to fast food advertising. Online forums served as accessible channels for eating disorder relapse prevention among youth. Social media influence converged around four central themes: (1) visual appeal, (2) content dissemination, (3) socialized digital connections, and (4) adolescent marketer influencers. Conclusions: Adolescent peer influence in social media environments spans the spectrum of healthy eating (ie, pathological) to eating disorders (ie, nonpathological). Strategic network-driven approaches should be considered for engaging adolescents in the promotion of positive dietary behaviors. UR - https://www.jmir.org/2021/6/e19697 UR - http://dx.doi.org/10.2196/19697 UR - http://www.ncbi.nlm.nih.gov/pubmed/34081018 ID - info:doi/10.2196/19697 ER - TY - JOUR AU - Langlet, Sundström Billy AU - Odegi, Dorothy AU - Zandian, Modjtaba AU - Nolstam, Jenny AU - Södersten, Per AU - Bergh, Cecilia PY - 2021/4/13 TI - Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study JO - JMIR Serious Games SP - e24998 VL - 9 IS - 2 KW - feeding and eating disorders KW - anorexia nervosa KW - bulimia nervosa KW - binge eating disorder KW - immersive virtual reality KW - eating disorders KW - virtual reality N2 - Background: Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders. Objective: The aim of this study was to evaluate the feasibility and usability of an immersive virtual reality technology administered through an app for use by patients with eating disorders. Methods: Twenty-six participants, including 19 eating disorder clinic personnel and 5 information technology personnel, were recruited through emails and personal invitations. Participants handled virtual food and utensils on an app using immersive virtual reality technology comprising a headset and two hand controllers. In the app, the participants learned about the available actions through a tutorial and they were introduced to a food challenge. The challenge consisted of a meal type (meatballs, potatoes, sauce, and lingonberries) that is typically difficult for patients with anorexia nervosa to eat in real life. Participants were instructed, via visual feedback from the app, to eat at a healthy rate, which is also a challenge for patients. Participants rated the feasibility and usability of the app by responding to the mHealth Evidence Reporting and Assessment checklist, the 10-item System Usability Scale, and the 20-point heuristic evaluation questionnaire. A cognitive walkthrough was performed using video recordings of participant interactions in the virtual environment. Results: The mean age of participants was 37.9 (SD 9.7) years. Half of the participants had previous experience with virtual reality. Answers to the mHealth Evidence Reporting and Assessment checklist suggested that implementation of the app would face minor infrastructural, technological, interoperability, financial, and adoption problems. There was some disagreement on intervention delivery, specifically regarding frequency of use; however, most of the participants agreed that the app should be used at least once per week. The app received a mean score of 73.4 (range 55-90), earning an overall ?good? rating. The mean score of single items of the heuristic evaluation questionnaire was 3.6 out of 5. The lowest score (2.6) was given to the ?accuracy? item. During the cognitive walkthrough, 32% of the participants displayed difficulty in understanding what to do at the initial selection screen. However, after passing the selection screen, all participants understood how to progress through the tasks. Conclusions: Participants found the app to be usable and eating disorder personnel were positive regarding its fit with current treatment methods. Along with the food item challenges in the current app, participants considered that the app requires improvement to offer environmental and social (eg, crowded room vs eating alone) challenges. UR - https://games.jmir.org/2021/2/e24998 UR - http://dx.doi.org/10.2196/24998 UR - http://www.ncbi.nlm.nih.gov/pubmed/33847593 ID - info:doi/10.2196/24998 ER - TY - JOUR AU - Milton, Clare Alyssa AU - Hambleton, Ashlea AU - Dowling, Mitchell AU - Roberts, Elizabeth Anna AU - Davenport, Tracey AU - Hickie, Ian PY - 2021/2/16 TI - Technology-Enabled Reform in a Nontraditional Mental Health Service for Eating Disorders: Participatory Design Study JO - J Med Internet Res SP - e19532 VL - 23 IS - 2 KW - eating disorders KW - body image KW - mental health KW - technology KW - co-design KW - participatory design KW - service reform KW - consumer engagement N2 - Background: The recent Australian National Agenda for Eating Disorders highlights the role technology can play in improving accessibility and service development through web-based prevention, early access pathways, self-help, and recovery assistance. However, engagement with the eating disorders community to co-design, build, and evaluate these much-needed technology solutions through participatory design processes has been lacking and, until recently, underresourced. Objective: This study aims to customize and configure a technology solution for a nontraditional (web-based, phone, email) mental health service that provides support for eating disorders and body image issues through the use of participatory design processes. Methods: Participants were recruited chiefly through the Butterfly National Helpline 1800 ED HOPE (Butterfly?s National Helpline), an Australian-wide helpline supporting anyone concerned by an eating disorder or body image issue. Participants included individuals with lived experience of eating disorders and body image issues, their supportive others (such as family, health professionals, support workers), and staff of the Butterfly Foundation. Participants took part in participatory design workshops, running up to four hours, which were held nationally in urban and regional locations. The workshop agenda followed an established process of discovery, evaluation, and prototyping. Workshop activities included open and prompted discussion, reviewing working prototypes, creating descriptive artifacts, and developing user journeys. Workshop artifacts were used in a knowledge translation process, which identified key learnings to inform user journeys, user personas, and the customization and configuration of the InnoWell Platform for Butterfly?s National Helpline. Further, key themes were identified using thematic techniques and coded in NVivo 12 software. Results: Six participatory design workshops were held, of which 45 participants took part. Participants highlighted that there is a critical need to address some of the barriers to care, particularly in regional and rural areas. The workshops highlighted seven overarching qualitative themes: identified barriers to care within the current system; need for people to be able to access the right care anywhere, anytime; recommendations for the technological solution (ie, InnoWell Platform features and functionality); need for communication, coordination, and integration of a technological solution embedded in Butterfly?s National Helpline; need to consider engagement and tone within the technological solution; identified challenges and areas to consider when implementing a technological solution in the Helpline; and potential outcomes of the technological solution embedded in the Helpline relating to system and service reform. Ultimately, this technology solution should ensure that the right care is provided to individuals the first time. Conclusions: Our findings highlight the value of actively engaging stakeholders in participatory design processes for the customization and configuration of new technologies. End users can highlight the critical areas of need, which can be used as a catalyst for reform through the implementation of these technologies in nontraditional services. UR - http://www.jmir.org/2021/2/e19532/ UR - http://dx.doi.org/10.2196/19532 UR - http://www.ncbi.nlm.nih.gov/pubmed/33591283 ID - info:doi/10.2196/19532 ER - TY - JOUR AU - Humphreys, Gabrielle AU - Evans, Rebecca AU - Makin, Harriet AU - Cooke, Richard AU - Jones, Andrew PY - 2021/2/9 TI - Identification of Behavior Change Techniques From Successful Web-Based Interventions Targeting Alcohol Consumption, Binge Eating, and Gambling: Systematic Review JO - J Med Internet Res SP - e22694 VL - 23 IS - 2 KW - systematic review KW - web-based intervention KW - behavior and behavior mechanism KW - behavior change technique KW - alcohol consumption KW - binge eating KW - gambling N2 - Background: Web-based interventions are thought to overcome barriers to treatment, such as accessibility and geographical location, which can undermine the effectiveness of traditional face-to-face interventions. Owing to these features, researchers are increasingly testing the efficacy of web-based interventions as ways to reduce alcohol misuse, binge eating, and gambling. However, many web-based interventions have poorly defined mechanisms of action; therefore, it is often uncertain how they propose to bring about behavior change. Objective: This systematic review aims to identify effective behavior change techniques (BCTs) present in web-based interventions aimed at reducing alcohol consumption, binge eating, or gambling. Methods: This systematic review covered research conducted in the last 20 years. Inclusion criteria for interventions were web-based administration; targeting alcohol use, binge eating, and/or gambling; and reporting on baseline and postintervention measures of behavior. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines were followed. We coded intervention effectiveness, study quality, and BCTs present in the interventions. Results: Following removal of 4152 ineligible articles, 45 were included in the review: 32 (71%) targeted alcohol misuse, 6 (13%) targeted binge eating, and 7 (16%) targeted gambling. In total, 5 frequency counts were performed to identify the most commonly used BCTs: all studies, effective interventions, high-quality studies at 2 thresholds, and both high quality and effective studies. The results obtained from this were integrated to identify 7 BCTs. These 7 BCTs were problem solving, feedback on behavior, self-monitoring of behavior, self-monitoring of outcomes, instruction on how to perform a behavior, information about social and health consequences, and social comparison. A total of 4 BCTs were found in all frequency counts: feedback on behavior, self-monitoring of behavior, instruction on how to perform a behavior, and social comparison. Self-monitoring of outcomes of behavior was found in 3 of the 5 frequency counts, problem solving was found in 2 frequency counts, and information about social and health consequences was found in 1 frequency count. Conclusions: This systematic review identified 7 of the most frequently used BCTs used in web-based interventions focused on alcohol misuse, binge eating, and gambling. These results can inform the development of evidence-based eHealth interventions that have the potential to lead to effective, positive behavior changes in all 3 areas. UR - http://www.jmir.org/2021/2/e22694/ UR - http://dx.doi.org/10.2196/22694 UR - http://www.ncbi.nlm.nih.gov/pubmed/33560243 ID - info:doi/10.2196/22694 ER - TY - JOUR AU - Nutley, K. Sara AU - Falise, M. Alyssa AU - Henderson, Rebecca AU - Apostolou, Vasiliki AU - Mathews, A. Carol AU - Striley, W. Catherine PY - 2021/1/27 TI - Impact of the COVID-19 Pandemic on Disordered Eating Behavior: Qualitative Analysis of Social Media Posts JO - JMIR Ment Health SP - e26011 VL - 8 IS - 1 KW - eating disorders KW - anorexia nervosa KW - binge eating disorder KW - COVID-19 KW - coronavirus KW - Reddit KW - social media KW - disorder KW - eating KW - qualitative KW - experience KW - mental health KW - theme N2 - Background: A growing body of evidence is suggesting a significant association between the COVID-19 pandemic and population-level mental health. Study findings suggest that individuals with a lifetime history of disordered eating behavior may be negatively affected by COVID-19?related anxiety, and prevention measures may disrupt daily functioning and limit access to treatment. However, data describing the influence of the COVID-19 pandemic on disordered eating behaviors are limited, and most findings focus on individuals in treatment settings. Objective: The aim of this study is to characterize the experiences of Reddit users worldwide who post in eating disorder (ED)?related discussion forums describing the influence of the COVID-19 pandemic on their overall mental health and disordered eating behavior. Methods: Data were collected from popular subreddits acknowledging EDs as their primary discussion topic. Unique discussion posts dated from January 1 to May 31, 2020 that referenced the COVID-19 pandemic were extracted and evaluated using inductive, thematic data analysis. Results: Six primary themes were identified: change in ED symptoms, change in exercise routine, impact of quarantine on daily life, emotional well-being, help-seeking behavior, and associated risks and health outcomes. The majority of users reported that the COVID-19 pandemic and associated public health prevention measures negatively impacted their psychiatric health and contributed to increased disordered eating behaviors. Feelings of isolation, frustration, and anxiety were common. Many individuals used Reddit forums to share personal experiences, seek advice, and offer shared accountability. Conclusions: Reddit discussion forums have provided a therapeutic community for individuals to share experiences and provide support for peers with ED during a period of increased psychiatric distress. Future research is needed to assess the impact of the COVID-19 pandemic on disordered eating behavior and to evaluate the role of social media discussion forums in mental health treatment, especially during periods of limited treatment access. UR - http://mental.jmir.org/2021/1/e26011/ UR - http://dx.doi.org/10.2196/26011 UR - http://www.ncbi.nlm.nih.gov/pubmed/33465035 ID - info:doi/10.2196/26011 ER - TY - JOUR AU - Low, M. Daniel AU - Rumker, Laurie AU - Talkar, Tanya AU - Torous, John AU - Cecchi, Guillermo AU - Ghosh, S. Satrajit PY - 2020/10/12 TI - Natural Language Processing Reveals Vulnerable Mental Health Support Groups and Heightened Health Anxiety on Reddit During COVID-19: Observational Study JO - J Med Internet Res SP - e22635 VL - 22 IS - 10 KW - COVID-19 KW - mental health KW - psychiatry KW - infodemiology KW - infoveillance KW - infodemic KW - social media KW - Reddit KW - natural language processing KW - ADHD KW - eating disorders KW - anxiety KW - suicidality N2 - Background: The COVID-19 pandemic is impacting mental health, but it is not clear how people with different types of mental health problems were differentially impacted as the initial wave of cases hit. Objective: The aim of this study is to leverage natural language processing (NLP) with the goal of characterizing changes in 15 of the world?s largest mental health support groups (eg, r/schizophrenia, r/SuicideWatch, r/Depression) found on the website Reddit, along with 11 non?mental health groups (eg, r/PersonalFinance, r/conspiracy) during the initial stage of the pandemic. Methods: We created and released the Reddit Mental Health Dataset including posts from 826,961 unique users from 2018 to 2020. Using regression, we analyzed trends from 90 text-derived features such as sentiment analysis, personal pronouns, and semantic categories. Using supervised machine learning, we classified posts into their respective support groups and interpreted important features to understand how different problems manifest in language. We applied unsupervised methods such as topic modeling and unsupervised clustering to uncover concerns throughout Reddit before and during the pandemic. Results: We found that the r/HealthAnxiety forum showed spikes in posts about COVID-19 early on in January, approximately 2 months before other support groups started posting about the pandemic. There were many features that significantly increased during COVID-19 for specific groups including the categories ?economic stress,? ?isolation,? and ?home,? while others such as ?motion? significantly decreased. We found that support groups related to attention-deficit/hyperactivity disorder, eating disorders, and anxiety showed the most negative semantic change during the pandemic out of all mental health groups. Health anxiety emerged as a general theme across Reddit through independent supervised and unsupervised machine learning analyses. For instance, we provide evidence that the concerns of a diverse set of individuals are converging in this unique moment of history; we discovered that the more users posted about COVID-19, the more linguistically similar (less distant) the mental health support groups became to r/HealthAnxiety (?=?0.96, P<.001). Using unsupervised clustering, we found the suicidality and loneliness clusters more than doubled in the number of posts during the pandemic. Specifically, the support groups for borderline personality disorder and posttraumatic stress disorder became significantly associated with the suicidality cluster. Furthermore, clusters surrounding self-harm and entertainment emerged. Conclusions: By using a broad set of NLP techniques and analyzing a baseline of prepandemic posts, we uncovered patterns of how specific mental health problems manifest in language, identified at-risk users, and revealed the distribution of concerns across Reddit, which could help provide better resources to its millions of users. We then demonstrated that textual analysis is sensitive to uncover mental health complaints as they appear in real time, identifying vulnerable groups and alarming themes during COVID-19, and thus may have utility during the ongoing pandemic and other world-changing events such as elections and protests. UR - http://www.jmir.org/2020/10/e22635/ UR - http://dx.doi.org/10.2196/22635 UR - http://www.ncbi.nlm.nih.gov/pubmed/32936777 ID - info:doi/10.2196/22635 ER - TY - JOUR AU - Yim, Heng See AU - Bailey, Emma AU - Gordon, Gemma AU - Grant, Nina AU - Musiat, Peter AU - Schmidt, Ulrike PY - 2020/9/23 TI - Exploring Participants? Experiences of a Web-Based Program for Bulimia and Binge Eating Disorder: Qualitative Study JO - J Med Internet Res SP - e17880 VL - 22 IS - 9 KW - eHealth KW - self-help KW - eating disorders KW - bulimia KW - binge eating disorder KW - internet-based intervention KW - qualitative research N2 - Background: Guided cognitive behavioral self-help is a recommended first-line treatment for eating disorders (EDs) such as bulimia nervosa (BN) or binge eating disorder (BED). Online versions of such self-help programs are increasingly being studied in randomized controlled trials (RCTs), with some evidence that they can reduce ED symptoms, although intervention dropout is variable across interventions. However, in-depth research into participants? experiences and views on the acceptability of web-based interventions is limited. Objective: This is a qualitative process study of participants? experiences of everyBody Plus, a web-based cognitive behavioral intervention, integrated into a large RCT to aid the interpretation of the main trial?s results. To our knowledge, this is the first such study in digital intervention for EDs research to include real-time feedback into the qualitative analysis. This study aims to build upon the emerging literature by qualitatively exploring participants? experiences of a web-based intervention for BN and BED. Methods: Participants were those who took part in the UK arm of a larger RCT investigating the efficacy of the everyBody Plus intervention. Reflexive thematic analysis was completed on 2 sources of data from the online platform: real-time feedback quotes provided at the end of completing a module on the platform (N=104) and semistructured telephone interview transcripts (n=12). Results: Four main themes were identified. The first theme identified positive and negative user experiences, with a desire for a more customized and personalized intervention. Another theme positively reflected on how flexible and easy the intervention was to embed into daily life, compared with the silo of face-to-face therapy. The third theme identified how the intervention had a holistic impact cognitively, emotionally, interpersonally, and behaviorally. The final theme was related to how the intervention was not a one size fits all and how the perceived usefulness and relevance were often dependent on participants? demographic and clinical characteristics. Conclusions: Overall, participants reported positive experiences with the use of the everyBody Plus web-based intervention, including flexibility of use and the potential to holistically impact people?s lives. The participants also provided valuable suggestions for how similar future web-based interventions could be improved and, in the context of EDs, how programs can be designed to be more inclusive of people by encompassing different demographic and clinical characteristics. UR - http://www.jmir.org/2020/9/e17880/ UR - http://dx.doi.org/10.2196/17880 UR - http://www.ncbi.nlm.nih.gov/pubmed/32965235 ID - info:doi/10.2196/17880 ER - TY - JOUR AU - Viguria, Iranzu AU - Alvarez-Mon, Angel Miguel AU - Llavero-Valero, Maria AU - Asunsolo del Barco, Angel AU - Ortuño, Felipe AU - Alvarez-Mon, Melchor PY - 2020/7/14 TI - Eating Disorder Awareness Campaigns: Thematic and Quantitative Analysis Using Twitter JO - J Med Internet Res SP - e17626 VL - 22 IS - 7 KW - awareness campaigns KW - eating disorders KW - Twitter KW - social media N2 - Background: Health awareness initiatives are frequent but their efficacy is a matter of controversy. We have investigated the effect of the Eating Disorder Awareness Week and Wake Up Weight Watchers campaigns on Twitter. Objective: We aimed to examine whether the Eating Disorder Awareness Week and Wake Up Weight Watchers initiatives increased the volume and dissemination of Twitter conversations related to eating disorders and investigate what content generates the most interest on Twitter. Methods: Over a period of 12 consecutive days in 2018, we collected tweets containing the hashtag #wakeupweightwatchers and hashtags related to Eating Disorder Awareness Week (#eatingdisorderawarenessweek, #eatingdisorderawareness, or #EDAW), with the hashtag #eatingdisorder as a control. The content of each tweet was rated as medical, testimony, help offer, awareness, pro-ana, or anti-ana. We analyzed the number of retweets and favorites generated, as well as the potential reach and impact of the hashtags and the characteristics of contributors. Results: The number of #wakeupweightwatchers tweets was higher than that of Eating Disorder Awareness Week and #eatingdisorder tweets (3900, 2056, and 1057, respectively). The content of tweets was significantly different between the hashtags analyzed (P<.001). Medical content was lower in the awareness campaigns. Awareness and help offer content were lower in #wakeupweightwatchers tweets. Retweet and favorite ratios were highest in #wakeupweightwatchers tweets. Eating Disorder Awareness Week achieved the highest impact, and very influential contributors participated. Conclusions: Both awareness campaigns effectively promoted tweeting about eating disorders. The majority of tweets did not promote any specific preventive or help-seeking behaviors. UR - http://www.jmir.org/2020/7/e17626/ UR - http://dx.doi.org/10.2196/17626 UR - http://www.ncbi.nlm.nih.gov/pubmed/32673225 ID - info:doi/10.2196/17626 ER - TY - JOUR AU - Aupperle, Leora Robin AU - Paulus, P. Martin AU - Kuplicki, Rayus AU - Touthang, James AU - Victor, Teresa AU - Yeh, Hung-Wen AU - AU - Khalsa, S. Sahib PY - 2020/1/28 TI - Web-Based Graphic Representation of the Life Course of Mental Health: Cross-Sectional Study Across the Spectrum of Mood, Anxiety, Eating, and Substance Use Disorders JO - JMIR Ment Health SP - e16919 VL - 7 IS - 1 KW - mental health KW - life history KW - psychosocial factors KW - depression KW - anxiety KW - substance use disorders KW - eating disorders N2 - Background: Although patient history is essential for informing mental health assessment, diagnosis, and prognosis, there is a dearth of standardized instruments measuring time-dependent factors relevant to psychiatric disorders. Previous research has demonstrated the potential utility of graphical representations, termed life charts, for depicting the complexity of the course of mental illness. However, the implementation of these assessments is limited by the exclusive focus on specific mental illnesses (ie, bipolar disorder) and the lack of intuitive graphical interfaces for data collection and visualization. Objective: This study aimed to develop and test the utility of the Tulsa Life Chart (TLC) as a Web-based, structured approach for obtaining and graphically representing historical information on psychosocial and mental health events relevant across a spectrum of psychiatric disorders. Methods: The TLC interview was completed at baseline by 499 participants of the Tulsa 1000, a longitudinal study of individuals with depressive, anxiety, substance use, or eating disorders and healthy comparisons (HCs). All data were entered electronically, and a 1-page electronic and interactive graphical representation was developed using the Google Visualization Application Programming Interface. For 8 distinct life epochs (periods of approximately 5-10 years), the TLC assessed the following factors: school attendance, hobbies, jobs, social support, substance use, mental health treatment, family structure changes, negative and positive events, and epoch and event-related mood ratings. We used generalized linear mixed models (GLMMs) to evaluate trajectories of each domain over time and by sex, age, and diagnosis, using case examples and Web-based interactive graphs to visualize data. Results: GLMM analyses revealed main or interaction effects of epoch and diagnosis for all domains. Epoch by diagnosis interactions were identified for mood ratings and the number of negative-versus-positive events (all P values <.001), with all psychiatric groups reporting worse mood and greater negative-versus-positive events than HCs. These differences were most robust at different epochs, depending on diagnosis. There were also diagnosis and epoch main effects for substance use, mental health treatment received, social support, and hobbies (P<.001). User experience ratings (each on a 1-5 scale) revealed that participants found the TLC pleasant to complete (mean 3.07, SD 1.26) and useful for understanding their mental health (mean 3.07, SD 1.26), and that they were likely to recommend it to others (mean 3.42, SD 0.85). Conclusions: The TLC provides a structured, Web-based transdiagnostic assessment of psychosocial history relevant for the diagnosis and treatment of psychiatric disorders. Interactive, 1-page graphical representations of the TLC allow for the efficient communication of historical life information that would be useful for clinicians, patients, and family members. UR - http://mental.jmir.org/2020/1/e16919/ UR - http://dx.doi.org/10.2196/16919 UR - http://www.ncbi.nlm.nih.gov/pubmed/32012081 ID - info:doi/10.2196/16919 ER - TY - JOUR AU - Goodday, M. Sarah AU - Atkinson, Lauren AU - Goodwin, Guy AU - Saunders, Kate AU - South, Matthew AU - Mackay, Clare AU - Denis, Mike AU - Hinds, Chris AU - Attenburrow, Mary-Jane AU - Davies, Jim AU - Welch, James AU - Stevens, William AU - Mansfield, Karen AU - Suvilehto, Juulia AU - Geddes, John PY - 2020/1/15 TI - The True Colours Remote Symptom Monitoring System: A Decade of Evolution JO - J Med Internet Res SP - e15188 VL - 22 IS - 1 KW - symptom assessment KW - signs and symptoms KW - digital health KW - ecological momentary assessment KW - mood disorders UR - https://www.jmir.org/2020/1/e15188 UR - http://dx.doi.org/10.2196/15188 UR - http://www.ncbi.nlm.nih.gov/pubmed/31939746 ID - info:doi/10.2196/15188 ER - TY - JOUR AU - Ralph-Nearman, Christina AU - Arevian, C. Armen AU - Puhl, Maria AU - Kumar, Rajay AU - Villaroman, Diane AU - Suthana, Nanthia AU - Feusner, D. Jamie AU - Khalsa, S. Sahib PY - 2019/10/29 TI - A Novel Mobile Tool (Somatomap) to Assess Body Image Perception Pilot Tested With Fashion Models and Nonmodels: Cross-Sectional Study JO - JMIR Ment Health SP - e14115 VL - 6 IS - 10 KW - body image KW - body perception KW - body representation KW - body image disorder KW - eating disorder KW - mobile health KW - mental health KW - mobile app KW - digital health N2 - Background: Distorted perception of one?s body and appearance, in general, is a core feature of several psychiatric disorders including anorexia nervosa and body dysmorphic disorder and is operative to varying degrees in nonclinical populations. Yet, body image perception is challenging to assess, given its subjective nature and variety of manifestations. The currently available methods have several limitations including restricted ability to assess perceptions of specific body areas. To address these limitations, we created Somatomap, a mobile tool that enables individuals to visually represent their perception of body-part sizes and shapes as well as areas of body concerns and record the emotional valence of concerns. Objective: This study aimed to develop and pilot test the feasibility of a novel mobile tool for assessing 2D and 3D body image perception. Methods: We developed a mobile 2D tool consisting of a manikin figure on which participants outline areas of body concern and indicate the nature, intensity, and emotional valence of the concern. We also developed a mobile 3D tool consisting of an avatar on which participants select individual body parts and use sliders to manipulate their size and shape. The tool was pilot tested on 103 women: 65 professional fashion models, a group disproportionately exposed to their own visual appearance, and 38 nonmodels from the general population. Acceptability was assessed via a usability rating scale. To identify areas of body concern in 2D, topographical body maps were created by combining assessments across individuals. Statistical body maps of group differences in body concern were subsequently calculated using the formula for proportional z-score. To identify areas of body concern in 3D, participants? subjective estimates from the 3D avatar were compared to corresponding measurements of their actual body parts. Discrepancy scores were calculated based on the difference between the perceived and actual body parts and evaluated using multivariate analysis of covariance. Results: Statistical body maps revealed different areas of body concern between models (more frequently about thighs and buttocks) and nonmodels (more frequently about abdomen/waist). Models were more accurate at estimating their overall body size, whereas nonmodels tended to underestimate the size of individual body parts, showing greater discrepancy scores for bust, biceps, waist, hips, and calves but not shoulders and thighs. Models and nonmodels reported high ease-of-use scores (8.4/10 and 8.5/10, respectively), and the resulting 3D avatar closely resembled their actual body (72.7% and 75.2%, respectively). Conclusions: These pilot results suggest that Somatomap is feasible to use and offers new opportunities for assessment of body image perception in mobile settings. Although further testing is needed to determine the applicability of this approach to other populations, Somatomap provides unique insight into how humans perceive and represent the visual characteristics of their body. UR - http://mental.jmir.org/2019/10/e14115/ UR - http://dx.doi.org/10.2196/14115 UR - http://www.ncbi.nlm.nih.gov/pubmed/31469647 ID - info:doi/10.2196/14115 ER - TY - JOUR AU - Hamatani, Sayo AU - Numata, Noriko AU - Matsumoto, Kazuki AU - Sutoh, Chihiro AU - Ibuki, Hanae AU - Oshiro, Keiko AU - Tanaka, Mari AU - Setsu, Rikukage AU - Kawasaki, Yohei AU - Hirano, Yoshiyuki AU - Shimizu, Eiji PY - 2019/10/23 TI - Internet-Based Cognitive Behavioral Therapy via Videoconference for Patients With Bulimia Nervosa and Binge-Eating Disorder: Pilot Prospective Single-Arm Feasibility Trial JO - JMIR Form Res SP - e15738 VL - 3 IS - 4 KW - bulimia nervosa KW - binge-eating disorder KW - cognitive behavioral therapy KW - internet-based cognitive behavioral therapy KW - videoconference N2 - Background: A major problem in providing mental health services is the lack of access to treatment, especially in remote areas. Thus far, no clinical studies have demonstrated the feasibility of internet-based cognitive behavioral therapy (ICBT) with real-time therapist support via videoconference for bulimia nervosa and binge-eating disorder in Japan. Objective: The goal of the research was to evaluate the feasibility of ICBT via videoconference for patients with bulimia nervosa or binge-eating disorder. Methods: Seven Japanese subjects (mean age 31.9 [SD 7.9] years) with bulimia nervosa and binge-eating disorder received 16 weekly sessions of individualized ICBT via videoconference with real-time therapist support. Treatment included CBT tailored specifically to the presenting diagnosis. The primary outcome was a reduction in the Eating Disorder Examination Edition 16.0D (EDE 16D) for bulimia nervosa and binge-eating disorder: the combined objective binge and purging episodes, objective binge episodes, and purging episodes. The secondary outcomes were the Eating Disorders Examination Questionnaire, Bulimic Investigatory Test, Edinburgh, body mass index for eating symptoms, Motivational Ruler for motivation to change, EuroQol-5 Dimension for quality of life, 9-item Patient Health Questionnaire for depression, 7-item Generalized Anxiety Disorder scale for anxiety, and Working Alliance Inventory?Short Form (WAI-SF). All outcomes were assessed at week 1 (baseline) and weeks 8 (midintervention) and 16 (postintervention) during therapy. Patients were asked about adverse events at each session. For the primary analysis, treatment-related changes were assessed by comparing participant scores and 95% confidence intervals using the paired t test. Results: Although the mean combined objective binge and purging episodes improved from 47.60 to 13.60 (71% reduction) and showed a medium effect size (Cohen d=?0.76), there was no significant reduction in the combined episodes (EDE 16D ?41; 95% CI ?2.089 to 0.576; P=.17). There were no significant treatment-related changes in secondary outcomes. The WAI-SF scores remained consistently high (64.8 to 66.0) during treatment. Conclusions: ICBT via videoconference is feasible in Japanese patients with bulimia nervosa and binge-eating disorder. Trial Registration: UMIN Clinical Trials Registry UMIN000029426; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000033419 UR - http://formative.jmir.org/2019/4/e15738/ UR - http://dx.doi.org/10.2196/15738 UR - http://www.ncbi.nlm.nih.gov/pubmed/31647472 ID - info:doi/10.2196/15738 ER - TY - JOUR AU - Anastasiadou, Dimitra AU - Folkvord, Frans AU - Serrano-Troncoso, Eduardo AU - Lupiañez-Villanueva, Francisco PY - 2019/5/31 TI - Mobile Health Adoption in Mental Health: User Experience of a Mobile Health App for Patients With an Eating Disorder JO - JMIR Mhealth Uhealth SP - e12920 VL - 7 IS - 6 KW - eating disorders KW - mental health KW - mHealth KW - mobile applications KW - focus groups N2 - Background: Despite the worldwide growth in mobile health (mHealth) tools and the possible benefits for both patients and health care providers, the overall adoption levels of mHealth tools by health professionals remain relatively low. Objective: This study aimed (1) to investigate attitudes of health care providers and mHealth experts toward mHealth tools in the health context in general, and this study aimed (2) to test the acceptability and feasibility of a specific mHealth tool for patients with an eating disorder (ED), called TCApp, among patients and ED specialists. Methods: To this purpose, we conducted an explorative qualitative study with 4 in-depth group discussions with several groups of stakeholders: our first focus group was conducted with 11 experts on mHealth from the Catalan Association of Health Entities; the second focus group included 10 health care professionals from the Spanish College of Doctors of Barcelona; the third focus group involved 9 patients with an ED who had used the TCApp over a 12-week period, and the fourth and last focus group involved 8 ED specialists who had monitored such ED patients on the Web. Results: The focus groups showed that health care providers and mHealth experts reported barriers for mHealth adoption more often than facilitators, indicating that mHealth techniques are difficult to obtain and use. Most barriers were attributed to external factors relating to the human or organizational environment (ie, lack of time because of workload, lack of direct interest on a legislative or political level) rather than being attributed to internal factors relating to individual obstacles. The results of the mHealth intervention study indicate that the TCApp was considered as easy to use and useful, although patients and the ED specialists monitoring them on the Web reported different adoption problems, such as the inability to personalize the app, a lack of motivational and interactive components, or difficulties in adhering to the study protocol. Conclusions: In general, this paper indicates that both health professionals and patients foresee difficulties that need to be addressed before comprehensive adoption and usage of mHealth techniques can be effectively implemented. Such findings are in line with previous studies, suggesting that although they acknowledge their possible benefits and cost-effectiveness, health care providers are quite resistant and conservative about integrating mHealth technologies in their daily practice. UR - https://mhealth.jmir.org/2019/6/e12920/ UR - http://dx.doi.org/10.2196/12920 UR - http://www.ncbi.nlm.nih.gov/pubmed/31199329 ID - info:doi/10.2196/12920 ER - TY - JOUR AU - Stapleton, L. Jerod AU - Manne, L. Sharon AU - Day, K. Ashley AU - Levonyan-Radloff, Kristine AU - Pagoto, L. Sherry PY - 2018/02/20 TI - Healthy Body Image Intervention Delivered to Young Women via Facebook Groups: Formative Study of Engagement and Acceptability JO - JMIR Res Protoc SP - e54 VL - 7 IS - 2 KW - body image KW - dissonance-based intervention KW - indoor tanning bed KW - social media KW - Facebook KW - behavioral intervention KW - prevention N2 - Background: There is increasing interest in using social media sites such as Facebook to deliver health interventions so as to expose people to content while they are engaging in their usual social media habit. This formative intervention development study is novel in describing a preliminary test of using the secret group feature of Facebook to deliver a behavioral intervention targeting users of indoor tanning beds to reduce their risk of skin cancer. Intervention content was designed to challenge body image-related constructs associated with indoor tanning through the use of dissonance-inducing content. Objective: To evaluate engagement with and acceptability of using a secret Facebook group to deliver a healthy body image intervention to young women engaged in indoor tanning. Methods: Seventeen young women completed a baseline survey and joined a secret Facebook group with intervention content delivered via daily posts for 4 weeks. Engagement data was extracted and acceptability was measured via a follow-up survey. Results: The study had a high retention rate (94%, [16/17]). On average, posts were viewed by 91% of participants, liked by 35%, and commented on by 26%. The average comment rate was highest (65%) for posts that elicited comments by directly posing questions or discussion topics to the group. Average intervention acceptability ratings were highly positive and participants reported feeling connected to the group and its topic. Average rates of past 1-month indoor tanning reported following the intervention were lower than the baseline rate (P=.08, Cohen d=0.47). Conclusions: This study is novel in demonstrating participant engagement with and acceptability of using Facebook secret groups to deliver a dissonance-inducing intervention approach that utilizes group-based discussions related to body image. The study is also unique within the field of skin cancer prevention by demonstrating the potential value of delivering an indoor tanning intervention within an interactive social media format. The findings suggest that Facebook metrics of intervention post engagement (ie, likes and comments) may vary based on post types and that designing specifically labeled discussion posts may be helpful for soliciting engagement as well as challenging beliefs. UR - http://www.researchprotocols.org/2018/2/e54/ UR - http://dx.doi.org/10.2196/resprot.9429 UR - http://www.ncbi.nlm.nih.gov/pubmed/29463495 ID - info:doi/10.2196/resprot.9429 ER - TY - JOUR AU - Carter, Allison AU - Forrest, I. Jamie AU - Kaida, Angela PY - 2017/02/09 TI - Association Between Internet Use and Body Dissatisfaction Among Young Females: Cross-Sectional Analysis of the Canadian Community Health Survey JO - J Med Internet Res SP - e39 VL - 19 IS - 2 KW - body satisfaction KW - Internet use KW - girls KW - young women KW - Canada N2 - Background: Recent research suggests Internet exposure, including Facebook use, is positively correlated with body dissatisfaction, especially among girls and young women. Canada has one of the highest Internet access rates in the world, yet no previous study has examined this relationship using nationally representative data. Objective: Our objective was to evaluate the relationship between Internet use and body dissatisfaction among a national, population-based sample of Canadian females 12-29 years of age. Methods: We used cross-sectional data from the Canadian Community Health Survey 2011-2012. Body dissatisfaction was measured using a 5-point Likert scale and defined as ?very dissatisfied/dissatisfied? with one?s body. The explanatory variable was time spent using the Internet per week in the past 3 months, ranging from none/<1 hour to >20 hours. We used multinomial logistic regression to investigate whether greater Internet use was associated with increasing odds of being very dissatisfied/dissatisfied, neutral, or satisfied with one?s body, using very satisfied as the referent. Probability survey sampling weights were applied to all analyses. Results: Of 2983 included participants, sampled to represent 940,786 young Canadian females, most were 20-29 years old (61.98%) and living in households with an annual income Can $80,000 or more (44.61%). The prevalence of body dissatisfaction was 14.70%, and 25- to 29-year-olds were more likely than 12- to 14-year-olds to be very dissatisfied or dissatisfied with their body (20.76% vs 6.34%). Few (5.01%) reported none/<1 hour of Internet use, over half (56.93%) reported 1-10 hours, and one-fifth (19.52%) reported spending >20 hours online per week. Adjusting for age and income, the odds of being very dissatisfied/dissatisfied, relative to very satisfied, were greater in the highest versus lowest Internet use group (adjusted odds ratio [AOR] 3.03, 95% CI 1.19-7.70). The AORs for this level of body dissatisfaction increased across increasing levels of Internet use, ranging from 0.88 (95% CI 0.35-2.21) to 3.03 (95% CI 1.19-7.70). Additionally, those who spent 11-14 hours online were more likely to be neutral (AOR 3.66, 95% CI 1.17-11.45) and those who spent 15-20 hours online were more likely to be neutral (AOR 4.36, 95% CI 1.18-16.13) or satisfied (AOR 2.82, 95% CI 1.14-7.01) with their bodies, relative to very satisfied, compared with those spending no time or <1 hour online. Conclusions: A substantial proportion of Canadian females 12-29 years of age spent large amounts of time (>20 hours) on the Internet each week, and body dissatisfaction was significantly more likely among this group. Those who spent 11-20 hours online were also more likely to be less satisfied with their bodies. Efforts are needed to support girls and young women to achieve and maintain a positive body image in today?s digital age. UR - http://www.jmir.org/2017/2/e39/ UR - http://dx.doi.org/10.2196/jmir.5636 UR - http://www.ncbi.nlm.nih.gov/pubmed/28183688 ID - info:doi/10.2196/jmir.5636 ER - TY - JOUR AU - Nitsch, Martina AU - Dimopoulos, N. Christina AU - Flaschberger, Edith AU - Saffran, Kristina AU - Kruger, F. Jenna AU - Garlock, Lindsay AU - Wilfley, E. Denise AU - Taylor, B. Craig AU - Jones, Megan PY - 2016/01/11 TI - A Guided Online and Mobile Self-Help Program for Individuals With EatingDisorders: An Iterative Engagement and Usability Study JO - J Med Internet Res SP - e7 VL - 18 IS - 1 KW - usability study KW - engagement KW - adherence KW - dropout KW - digital health intervention KW - online program KW - self-help KW - eating disorder KW - mobile application N2 - Background: Numerous digital health interventions have been developed for mental health promotion and intervention, including eating disorders. Efficacy of many interventions has been evaluated, yet knowledge about reasons for dropout and poor adherence is scarce. Most digital health intervention studies lack appropriate research design and methods to investigate individual engagement issues. User engagement and program usability are inextricably linked, making usability studies vital in understanding and improving engagement. Objective: The aim of this study was to explore engagement and corresponding usability issues of the Healthy Body Image Program?a guided online intervention for individuals with body image concerns or eating disorders. The secondary aim was to demonstrate the value of usability research in order to investigate engagement. Methods: We conducted an iterative usability study based on a mixed-methods approach, combining cognitive and semistructured interviews as well as questionnaires, prior to program launch. Two separate rounds of usability studies were completed, testing a total of 9 potential users. Thematic analysis and descriptive statistics were used to analyze the think-aloud tasks, interviews, and questionnaires. Results: Participants were satisfied with the overall usability of the program. The average usability score was 77.5/100 for the first test round and improved to 83.1/100 after applying modifications for the second iteration. The analysis of the qualitative data revealed five central themes: layout, navigation, content, support, and engagement conditions. The first three themes highlight usability aspects of the program, while the latter two highlight engagement issues. An easy-to-use format, clear wording, the nature of guidance, and opportunity for interactivity were important issues related to usability. The coach support, time investment, and severity of users? symptoms, the program?s features and effectiveness, trust, anonymity, and affordability were relevant to engagement. Conclusions: This study identified salient usability and engagement features associated with participant motivation to use the Healthy Body Image Program and ultimately helped improve the program prior to its implementation. This research demonstrates that improvements in usability and engagement can be achieved by testing and adjusting intervention design and content prior to program launch. The results are consistent with related research and reinforce the need for further research to identify usage patterns and effective means for reducing dropout. Digital health research should include usability studies prior to efficacy trials to help create more user-friendly programs that have a higher likelihood of ?real-world? adoption. UR - http://www.jmir.org/2016/1/e7/ UR - http://dx.doi.org/10.2196/jmir.4972 UR - http://www.ncbi.nlm.nih.gov/pubmed/26753539 ID - info:doi/10.2196/jmir.4972 ER - TY - JOUR AU - Jones, Megan AU - Taylor Lynch, Katherine AU - Kass, E. Andrea AU - Burrows, Amanda AU - Williams, Joanne AU - Wilfley, E. Denise AU - Taylor, Barr C. PY - 2014/02/27 TI - Healthy Weight Regulation and Eating Disorder Prevention in High School Students: A Universal and Targeted Web-Based Intervention JO - J Med Internet Res SP - e57 VL - 16 IS - 2 KW - healthy weight regulation KW - universal and targeted delivery KW - school-based intervention KW - prevention KW - adolescents N2 - Background: Given the rising rates of obesity in children and adolescents, developing evidence-based weight loss or weight maintenance interventions that can be widely disseminated, well implemented, and are highly scalable is a public health necessity. Such interventions should ensure that adolescents establish healthy weight regulation practices while also reducing eating disorder risk. Objective: This study describes an online program, StayingFit, which has two tracks for universal and targeted delivery and was designed to enhance healthy living skills, encourage healthy weight regulation, and improve weight/shape concerns among high school adolescents. Methods: Ninth grade students in two high schools in the San Francisco Bay area and in St Louis were invited to participate. Students who were overweight (body mass index [BMI] >85th percentile) were offered the weight management track of StayingFit; students who were normal weight were offered the healthy habits track. The 12-session program included a monitored discussion group and interactive self-monitoring logs. Measures completed pre- and post-intervention included self-report height and weight, used to calculate BMI percentile for age and sex and standardized BMI (zBMI), Youth Risk Behavior Survey (YRBS) nutrition data, the Weight Concerns Scale, and the Center for Epidemiological Studies Depression Scale. Results: A total of 336 students provided informed consent and were included in the analyses. The racial breakdown of the sample was as follows: 46.7% (157/336) multiracial/other, 31.0% (104/336) Caucasian, 16.7% (56/336) African American, and 5.7% (19/336) did not specify; 43.5% (146/336) of students identified as Hispanic/Latino. BMI percentile and zBMI significantly decreased among students in the weight management track. BMI percentile and zBMI did not significantly change among students in the healthy habits track, demonstrating that these students maintained their weight. Weight/shape concerns significantly decreased among participants in both tracks who had elevated weight/shape concerns at baseline. Fruit and vegetable consumption increased for both tracks. Physical activity increased among participants in the weight management track, while soda consumption and television time decreased. Conclusions: Results suggest that an Internet-based, universally delivered, targeted intervention may support healthy weight regulation, improve weight/shape concerns among participants with eating disorders risk, and increase physical activity in high school students. Tailored content and interactive features to encourage behavior change may lead to sustainable improvements in adolescent health. UR - http://www.jmir.org/2014/2/e57/ UR - http://dx.doi.org/10.2196/jmir.2995 UR - http://www.ncbi.nlm.nih.gov/pubmed/24583683 ID - info:doi/10.2196/jmir.2995 ER - TY - JOUR AU - McClay, Carrie-Anne AU - Waters, Louise AU - McHale, Ciaran AU - Schmidt, Ulrike AU - Williams, Christopher PY - 2013/03/15 TI - Online Cognitive Behavioral Therapy for Bulimic Type Disorders, Delivered in the Community by a Nonclinician: Qualitative Study JO - J Med Internet Res SP - e46 VL - 15 IS - 3 KW - bulimia nervosa KW - self-help KW - cCBT KW - qualitative research KW - cognitive behavioral therapy N2 - Background: Cognitive behavioral therapy is recommended in the National Institute for Clinical Excellence guidelines for the treatment of bulimia nervosa. In order to make this treatment option more accessible to patients, interactive online CBT programs have been developed that can be used in the user?s own home, in privacy, and at their convenience. Studies investigating online CBT for bulimic type eating disorders have provided promising results and indicate that, with regular support from a clinician or trained support worker, online CBT can be effective in reducing bulimic symptoms. Two main factors distinguish this study from previous research in this area. First, the current study recruited a wide range of adults with bulimic type symptoms from the community. Second, the participants in the current study had used cCBT with support from a nonclinical support worker rather than a specialist eating disorder clinician. Objective: To investigate participants? experiences of using an online self-help cognitive behavioral therapy (CBT) package (Overcoming Bulimia Online) for bulimia nervosa (BN) and eating disorders not otherwise specified (EDNOS). Methods: Eight participants with a mean age of 33.9 years took part in semi-structured interviews. Interviews were transcribed and analyzed using a 6-step thematic analysis process. Results: Saturation was achieved, and 7 themes were identified in the dataset. These were: (1) conceptualizing eating disorders, (2) help-seeking behavior, (3) aspects of the intervention, (4) motivation to use the online package, (5) privacy and secrecy with regard to their eating problems, (6) recovery and the future, and (7) participant engagement describing individuals? thoughts on taking part in the online research study. Conclusions: Participants suggested that online CBT self-help represented a generally desirable and acceptable treatment option for those with bulimic type eating problems, despite some difficulties with motivation and implementation of some elements of the package. Trial Registration: International Standard Randomized Controlled Trial Number of the original RCT that this study is based on: ISRCTN41034162; http://www.controlled-trials.com/ISRCTN41034162 (Archived by WebCite at http://www.webcitation.org/6Ey9sBWTV) UR - http://www.jmir.org/2013/3/e46/ UR - http://dx.doi.org/10.2196/jmir.2083 UR - http://www.ncbi.nlm.nih.gov/pubmed/23502689 ID - info:doi/10.2196/jmir.2083 ER - TY - JOUR AU - ter Huurne, D. Elke AU - Postel, G. Marloes AU - de Haan, A. Hein AU - Drossaert, H.C Constance AU - DeJong, A.J Cor PY - 2013/02/04 TI - Web-Based Treatment Program Using Intensive Therapeutic Contact for Patients With Eating Disorders: Before-After Study JO - J Med Internet Res SP - e12 VL - 15 IS - 2 KW - Eating disorders KW - eHealth KW - Internet KW - Web-based treatment KW - Intensive therapeutic contact KW - Program evaluation KW - Treatment effectiveness. N2 - Background: Although eating disorders are common in the Netherlands, only a few patients are treated by mental health care professionals. To reach and treat more patients with eating disorders, Tactus Addiction Treatment developed a web-based treatment program with asynchronous and intensive personalized communication between the patient and the therapist. Objective: This pilot study evaluated the web-based treatment program using intensive therapeutic contact in a population of 165 patients with an eating disorder. Methods: In a pre-post design with 6-week and 6-month follow-ups, eating disorder psychopathology, body dissatisfaction, Body Mass Index, physical and mental health, and quality of life were measured. The participant?s satisfaction with the web-based treatment program was also studied. Attrition data were collected, and participants were classified as noncompleters if they did not complete all 10 assignments of the web-based treatment program. Differences in baseline characteristics between completers and noncompleters were studied, as well as reasons for noncompletion. Furthermore, differences in treatment effectiveness, treatment adherence, and baseline characteristics between participants of the three major eating disorder diagnostic groups EDNOS (n=115), BN purging (n=24), and BN nonpurging (n=24) were measured. Results: Of the 165 participants who started the web-based treatment program, 89 participants (54%) completed all of the program assignments (completers) and 76 participants (46%) ended the program prematurely (noncompleters). Severe body dissatisfaction and physical and mental health problems seemed to have a negative impact on the completion of the web-based treatment program. Among the participants who completed the treatment program, significant improvements were found in eating disorder psychopathology (F=54.6, df = 68, P<.001, d=1.14). Body dissatisfaction, quality of life, and physical and mental health also significantly improved, and almost all of these positive effects were sustained up to 6 months after the participants had completed the web-based treatment program. Body Mass Index improved only within the group of participants suffering from obesity. The improvement in eating disorder psychopathology occurred in all three eating disorder diagnostic groups, and the percentage of completers did not differ significantly between these groups. Participants? satisfaction with the treatment program, as well as with their therapist, was high, and participants indicated that they would recommend the program to other patients with eating disorders. Conclusions: The results of this study suggest that the web-based treatment program has the potential to improve eating disorder psychopathology in patients with different types of eating disorders. UR - http://www.jmir.org/2013/2/e12/ UR - http://dx.doi.org/10.2196/jmir.2211 UR - http://www.ncbi.nlm.nih.gov/pubmed/23380291 ID - info:doi/10.2196/jmir.2211 ER - TY - JOUR AU - Yom-Tov, Elad AU - Fernandez-Luque, Luis AU - Weber, Ingmar AU - Crain, P. Steven PY - 2012/11/07 TI - Pro-Anorexia and Pro-Recovery Photo Sharing: A Tale of Two Warring Tribes JO - J Med Internet Res SP - e151 VL - 14 IS - 6 KW - Medical Informatics KW - Internet KW - Photo KW - Eating Disorder KW - Anorexia Nervosa KW - Social Network N2 - Background: There is widespread use of the Internet to promote anorexia as a lifestyle choice. Pro-anorexia content can be harmful for people affected or at risk of having anorexia. That movement is actively engaged in sharing photos on social networks such as Flickr. Objective: To study the characteristics of the online communities engaged in disseminating content that encourages eating disorders (known as ?pro-anorexia?) and to investigate if the posting of such content is discouraged by the posting of recovery-oriented content. Methods: The extraction of pro-anorexia and pro-recovery photographs from the photo sharing site Flickr pertaining to 242,710 photos from 491 users and analyzing four separate social networks therein. Results: Pro-anorexia and pro-recovery communities interact to a much higher degree among themselves than what is expected from the distribution of contacts (only 59-72% of contacts but 74-83% of comments are made to members inside the community). Pro-recovery users employ similar words to those used by pro-anorexia users to describe their photographs, possibly in order to ensure that their content appears when pro-anorexia users search for images. Pro-anorexia users who are exposed to comments from the opposite camp are less likely to cease posting pro-anorexia photographs than those who do not receive such comments (46% versus 61%), and if they cease, they do so approximately three months later. Our observations show two highly active communities, where most interaction is within each community. However, the pro-recovery community takes steps to ensure that their content is visible to the pro-anorexia community, both by using textual descriptions of their photographs that are similar to those used by the pro-anorexia group and by commenting to pro-anorexia content. The latter activity is, however, counterproductive, as it entrenches pro-anorexia users in their stance. Conclusions: Our results highlight the nature of pro-anorexia and pro-recovery photo sharing and accentuate the need for clinicians to be aware of such content and its effect on their patients. Our findings suggest that some currently used interventions are not useful in helping pro-anorexia users recover. Thus, future work should focus on new intervention methods, possibly tailored to individual characteristics. UR - http://www.jmir.org/2012/6/e151/ UR - http://dx.doi.org/10.2196/jmir.2239 UR - http://www.ncbi.nlm.nih.gov/pubmed/23134671 ID - info:doi/10.2196/jmir.2239 ER -