Background: Around 13% of the world’s population suffers from obesity. More than 40% of people with obesity display emotional eating behaviour (eating in response to negative emotions or distress). It is an alternate to moreeffective coping strategies for negative emotions. Our study explored the opportunities for helping adults with emotional overeating using a virtual coach, aiming to identify preferences for tailored coaching strategies applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical one – the latter being a synthesis of the first two strategies. Methods: A qualitative study used vignettes reflecting the two most relevant situations for people with emotional eating: 1. experiencing negative emotions, with ensuing food cravings; and 2. after losing control to emotional eating, with ensuing feelings of low self-esteem. Applied design: 2 situations × 3 coaching strategies. Participants: 71 adult women (Mage 44.4/years, range 19–70, SD = 12.86) with high scores on the DEBQ-emotional eating scale (Memo 3.65, range 1.69–4.92, SD = .69) with mean BMI 30.1 (range 18–46, SD = 6.53). They were recruited via dieticians’ practices, were randomly assigned to the conditions and asked how they would face and react to thepresented coaching strategies. Data were transcribed and a thematic analysis was conducted. Results: Qualitative results showed that participants valued both the validating coaching strategy and the focus-onchange strategy, but indicated that a combination of validation and focus-on-change provides both mental supportand practical advice. Data showed that participants differed in their level of awareness of the role that emotions play in their overeating and the need for emotion-regulation skills. Conclusion: The design of the virtual coach should be based on dialectical coaching strategies as preferred by participants with emotional eating behaviour. It should be tailored to the different stages of awareness of their emotions and individual emotion-regulation skills.
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Background Emotional eating is a complex problem fostering obesity and resulting from maladaptive emotionregulation. Traditional behavioural weight loss interventions have shown insignificant effect. They can be improvedby targeting the specific needs of individuals with emotional eating.Objective The current study explored a tailored online approach with the aim to positively influence affect (positiveand negative) and emotion regulation by applying one of three exercises: body scan, opposite action, and positivereappraisal.Design An embedded mixed‑method design (questionnaire data (t0, t1, t2) and perceived usefulness of exercisesin t2) was used to evaluate the effects of a two‑week online quasi‑experimental pilot study.Subjects/setting In total, 80 participants with self‑reported emotional eating difficulties (DEBQ‑E; Memo = 3.48,SD = .64, range 1.62–4.92) finished baseline measurements; 15 completed the intervention. The study sample was pre‑dominantly female (95%), from 18 till 66 (Mage = 38,0 ± SD = 14.25).Results Participants reported that the exercises helped them to pay attention to their physical sensations, and to see positive aspects in negative matters. The exercises were considered difficult by the participants, with too littleexplanation, and dull, due to minor variation. The observed changes revealed small, and moreover, not significant improvements of the three exercises on positive and negative affect and overall emotion dysregulation. Although the quantitative results did not reach significance, the qualitative data highlighted which aspects of the tailored exer‑cises may have contributed to mood and emotion regulation outcomes. A notable observation in the present studyis the substantial dropout rate, with the number of participants decreasing from 80 at baseline (T0) to 15 at the post‑intervention stage (T2).Conclusions Future studies should identify tailored online exercises in emotion regulation skills in more detailand explore the contexts in which they are most effective in a personalized virtual coach virtual coach to be devel‑oped for individuals with emotional eating. Given the high dropout rate, more emphasis should be given to a properpresentation of the exercises, as well as more explanation of their usefulness and how to perform them.
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"A proportion of those with eating disorders have also experienced traumatic events and ongoing symptoms of PTSD such as re-experiencing of the trauma and nightmares. We implemented an innovative trauma intervention called Imagery Rescripting (ImRs) to explore whether for those undergoing inpatient treatment for an eating disorder (in an underweight phase), it would be possible to treat the various trauma-related symptoms as well as the eating problems. Since this has not been investigated before, we asked the participants in this study to recount their experiences. Twelve participants who were underweight, reported a past history of trauma and were in an inpatient eating disordertreatment program participated in ImRs therapy intervention. One of these participant did not engage in the ImRs therapy because she discontinued the inpatient ED treatment. Analysis of interviews with these participants found that -although they were reluctant before the start of the treatment- the ImRs treatment during their inpatient admission had given them hope again. They added that it was important to have support from group members, sociotherapists and therapists. They shared a number of ways that the ImRs treatment could be adapted to people with eating disorders. Their experiences indicated that given these factors it was possible to treat PTSD during an underweight phase. This is important: until now, treatment for eating disorders has not specifically been trauma-focused and these tips have scope to improve the ImRs intervention and eating disorder treatment more broadly in the future."
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Objectives: Emotional eating is recognized as a potential contributor to weight gain. Emotional eaters often hide their problems because of feelings of shame about their behavior, making it challenging to provide them with the necessary support. The introduction of a virtual coach might offer a potential solution in assisting them. To find out whether emotional eaters are receptive to online personalized coaching, we presented emotional eaters with two essential proto-typical problem situations for emotional eaters: “experiencing cravings” and “after giving in to cravings,” and asked them whether they preferred one of the three coaching strategies presented: Validating, Focus-on-Change and Dialectical.Methods: An experimental vignette study (2 × 3 design) was carried out. The vignettes featured two distinct personas, each representing one of the two common problem scenarios experienced by emotional eaters, along with three distinct coaching strategies for each scenario. To identify potential predictors for recognition of problem situations, questionnaires on emotional eating (DEBQ), personality traits (Big-5), well-being (PANAS), and BMI were administrated.Results: A total of 62% of the respondents identified themselves with “after giving in to cravings” and 47% with “experiencing cravings.” BMI, emotional eating and emotional stability appeared to be predictors in recognizing both the problem situations. In “experiencing cravings,” the participating women preferred Dialectical and the Validation coaching strategies. In the “after giving in to cravings” condition, they revealed a preference for the Dialectical and the Focus-on-Change coaching strategies.Conclusion: Using vignettes allowed a less threatening way of bringing up sensitive topics for emotional eaters. The personas representing the problem situations were reasonably well recognized. To further enhance this recognition, it is important for the design and content of the personas to be even more closely related to the typical problem scenarios of emotional eaters, rather than focusing on physical characteristics or social backgrounds. This way, users may be less distracted by these factors. With the knowledge gained about the predictors that may influence recognition of the problem situations, design for coaching can be more customized. The participants represented individuals with high emotional eating levels, enhancing external validity.
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Obesity is a complex problem worldwide. This chronic condition has many different causes. One of them is emotional eating. In about 40% of overweight people, emotional eating plays a major role. Emotional eating is the tendency to (over)eat in response to negative emotions such as stress or irritability. The target group is at a distance from care - due to shame they do not dare to seek help. Within the mental health services there are long waiting lists.The goal of this dissertation is to gain knowledge to support emotional eaters in coping with emotional eating behavior in a self-help setting that is appropriate to the time and context. To achieve this, we need to better understand the needs of emotional eaters in terms of virtual coaching and self-management. We formulated the following research question, "How can virtual coaching facilitate emotional eaters to cope with self-management of their emotional eating behavior?"Knowledge was gathered about their wishes regarding virtual support. Based on this, personas were developed, labeled with emotions, that give shape to the two prototypical problem situations of the emotional eater: 1) experiencing cravings, and 2) giving in to those cravings through binge or overeating.Participants recognized themselves in the problem situations presented, and that there is a need for virtual coaching and for greater understanding of one's own emotions and emotion regulation skills.Research was conducted on the possibilities surrounding the customized delivery of exercises in emotion regulation, which revealed that people mentioned the potential of the exercises, but that their presentation needed improvement.Virtual coaching is potentially successful for this group; participants showed themselves to be accessible and visible; there was openness and outspokenness by the participants about situations presented, etc.; there was goodwill towards digital coaching and doing exercises; the participants also showed themselves to be competent in doing exercises independently.The chance of success with regard to the development of a virtual coach has increased because the target group is open to virtual coaching where future users can work independently with their problems.
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Specific approaches are needed to reach and support people with a lower socioeconomic position (SEP) to achieve healthier eating behaviours. There is a growing body of evidence suggesting that digital health tools exhibit potential to address these needs because of its specific features that enable application of various behaviour change techniques (BCTs). The aim of this scoping review is to identify the BCTs that are used in diet-related digital interventions targeted at people with a low SEP, and which of these BCTs coincide with improved eating behaviour. The systematic search was performed in 3 databases, using terms related to e/m-health, diet quality and socioeconomic position. A total of 17 full text papers were included. The average number of BCTs per intervention was 6.9 (ranged 3–15). BCTs from the cluster ‘Goals and planning’ were applied most often (25x), followed by the clusters ‘Shaping knowledge’ (18x) and ‘Natural consequences’ (18x). Other frequently applied BCT clusters were ‘Feedback and monitoring’ (15x) and ‘Comparison of behaviour’ (13x). Whereas some BCTs were frequently applied, such as goal setting, others were rarely used, such as social support. Most studies (n = 13) observed a positive effect of the intervention on eating behaviour (e.g. having breakfast) in the low SEP group, but this was not clearly associated with the number or type of applied BCTs. In conclusion, more intervention studies focused on people with a low SEP are needed to draw firm conclusions as to which BCTs are effective in improving their diet quality. Also, further research should investigate combinations of BCTs, the intervention design and context, and the use of multicomponent approaches. We encourage intervention developers and researchers to describe interventions more thoroughly, following the systematics of a behaviour change taxonomy, and to select BCTs knowingly.
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Background:More than 40% of the obese population suffer from emotional eating behaviour. They give in to overeating, because they lack effective coping strategies for negative emotions. Our studies explored the opportunities for helping emotional eaters with a virtual coach. Therefore the objective of this study was to identify preferences for coaching strategies for emotional eaters applicable in a personal virtual coach environment. Three different coaching strategies were tested: a validating, a focus-on-change, and a dialectical.Methods:Instruments: Vignettes, reflecting two most relevant situations for emotional eaters: 1. having food cravings experiencing negative emotions. 2. having given into overeating experiencing feelings of low self-esteem; DEBQ.Applied Design: 2 situations x 3 coaching strategies. Participants: 71 female emotional eaters (age mean 44, range 19-70) with high scores on the DEBQ (mean 3,6) with eventual overweight (mean BMI 30,2, range 18-45); recruited via dietist practices), were randomly assigned to the conditions and were asked how they would encounter and react to the presented coaching strategies. Data is obtained by thematic analyses.Findings:Qualitative results showed that emotional eaters clearly preferred dialectical coaching in both conditions. Although this preference is expressed for craving and overeating situations, the other coaching strategies were differently evaluated for both conditions. Our study showed emotional eaters have not only differences in preferences for coaching strategies, they are in different stages of knowledge about emotion regulation.Discussion:Design of the virtual coach should be based on integration of the validation and focus-on-change into dialectical coaching strategies as preferred by emotional eaters and has to tailor to the different stages of self-knowledge about emotion regulation.
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40% of overweight people are emotional eatersEating in response to negative emotional statesHaving problems coping with emotional regulationWeight reduction on short term butWeight gain in the long run (YOYO effect)Diets are not the answer!
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Obesity has become a major societal problem worldwide [1][2]. The main reason for severe overweight is excessive intake of energy, in relation to the individual needs of a human body. Obesity is associated with poor eating habits and/or a sedentary lifestyle. A significant part of the obese population (40%) belongs to a vulnerable target group of emotional eaters, who overeat due to negative emotions [3]. There is a need for self-management support and personalized coaching to enhance emotional eaters in recognising and self-regulating their emotions.Over the last years, coaching systems have been developed for behavior change support, healthy lifestyle, and physical activity support [4]-[9]. Existing virtual coach applications lack systematic evaluation of coaching strategies and usually function as (tele-)monitoring systems. They are limited to giving general feedback to the user on achieved goals and/or accomplished (online) assignments.Dialectical Behavior Therapy (DBT) focuses on getting more control over one’s ownemotions by reinforcing skills in mindfulness, emotion regulation, and stress tolerance [10]. Emotion regulation is about recognizing and acknowledging emotions and accepting the fact that they come and go. The behavior change strategies within DBT are based on validation and dialectics [11]. Dialectics changes the users’ attitude and behavior by creating incongruence between an attitude and behavior since stimuli or the given information contradict with each other.The ultimate goal of the virtual coach is to raise awareness of emotional eaters on their own emotions, and to enhance a positive change of attitude towards accepting the negative emotions they experience. This should result in a decrease of overeating and giving in to binges. We believe that the integration of the dialectical behavior change strategies and persuasive features from the Persuasive System Design Model by Kukkonen and Harjumaa [12] will enhance the personalization of the virtual coach for this vulnerable group. We aim at developing a personalized virtual coach ‘Denk je zèlf!’ (Dutch for ‘Develop a wise mind and counsel yourself’) providing support for self-regulation of emotions for young obese emotional eaters. This poster presents an eCoaching model and a research study protocol aiming at the validation of persuasive coaching strategies based on behavior change techniques using dialectical strategies. Based on the context (e.g., location), emotional state of the user, and natural language processing, the virtual coach application enables tailoring of the real-time feedback to the individual user. Virtual coach application communicates with the user over a chat timeline and provides personal feedback.The research protocol decribes the two weeks field study on validating persuasive coaching strategies for emotional eaters. Participants (N=30), recruited via a Dutch franchise organization of dietitian nutritionists, specialized in treating emotional eating behaviors, will voluntarily participate in this research study. Participants will be presented with short dialogues (existing questions and answers) and will be asked to select the preferred coaching strategy (validating or a dialectical), according to their (current) emotions. To trigger a certain emotion (e.g., the affect that fits best with the chosen coaching strategy), a set of pictures will be shown to the user that evoke respectively sadness, anger, fear, and disgust [13].Participants will be asked to fill out the demographics data ((nick) name, age, gender, weight, length, place of residence) and three questionnaires: • Dutch Eating Behavior Questionnaire (DEBQ) [14],• Five Factor Personality Inventory (FFPI) [15], • Quality of Life Index Questionnaire [16].This research study aims at answering the following research questions: “Which coaching strategies do users with a specific type of emotional eating behavior benefit most from while consulting their personalized virtual coach?; “Which coaching strategies are optimal for which emotions?” and “Which coaching approach do users prefer in which context, e.g. time of the day, before/after a craving?”
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This study was motivated by a desire to help working-age individuals gain a better understanding of their daily nutritional intakes with a new self-reported dietary assessment method because an unhealthy eating behavior increases the risks of developing chronic diseases. In this study, we present the design and evaluation of NutriColoring, a food diary that leverages doodling on sketches to report and reflect on everyday diet in the working context. Through a 2-week field study involving 18 participants, the usefulness of NutriColoring in facilitating dietary assessment was tested by making comparisons with the typical bullet diary method. Our quantitative results showed that NutriColoring provided users with improved dietary assessment experience and intrinsic motivations, with significantly low task frustration and high enjoyment. Because of the freedom and playfulness in reporting intakes at work, the interview findings showed a high acceptance of employing NutriColoring at work. This article is concluded with a set of implications for the design and development of a Doodling toolkit to support healthy eating behaviors among office workers.
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