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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Obesity is a fast growing societal threat, causing chronic conditions, physical and psychological health problems, as well as absenteeism and large healthcare costs. Despite numerous attempts to promote physical activity and healthy diet, existing interventions do not focus on often occurring emotional causes of obesity. There is a need for self-management support of this vulnerable target group: emotional eaters. This paper presents the results of the design case study focusing on a holistic development of a personalised virtual mHealth coach that provides self-management training ‘Denk je zèlf!’ (Dutch for ‘Develop a wise mind and counsel yourself’). Target group are young adults with emotional eating disorder and obesity. The contextual inquiry study was conducted to get insights into the needs and experiences of the target users, including interviews and questionnaires with emotional eaters, obesity treatment patients and healthcare practitioners. Personas and user stories were derived from these results and translated into a new ‘Denk je zèlf!’ virtual coach, based on Dialectical Behaviour Therapy and experience sampling measures to capture user experience and emotional state. This paper makes two main contributions: (a) combining holistic design with behaviour therapy in one virtual mHealth coaching application for emotional eaters; (b) applying Personas to guide the design. Preliminary results suggest that an online self-management training might be useful for the target group. Future research will be aimed at iterative evaluation and further development of the dialectical dialogues for the virtual coach and content for the education and instruction modules.
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There is a growing number of eHealth interventionsaiming at enhancing lifestyle to address obesity. However, theexisting interventions do not take the emotional aspects ofobesity into account. Forty percent of the overweightpopulation is an emotional eater. Emotional eaters gain weightbecause of poor emotion regulation, not just due to bad eatinghabits. We aim at developing a personalized virtual coach‘Denk je zèlf!’ providing support for self-regulation ofemotions for young obese emotional eaters. This paperpresents an eCoaching model and a research study protocolaiming at the validation of persuasive coaching strategies basedon behavior change techniques. Ultimately, we aim atdesigning a personalized eCoaching framework, allowing us tooptimally translate successful behavior change mechanismsand techniques, such as dialectical strategies, into personalizedpersuasive coaching strategies.
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There is a growing number of eHealth interventionsaiming at enhancing lifestyle to address obesity. However, theexisting interventions do not take the emotional aspects ofobesity into account. Forty percent of the overweight populationis an emotional eater. Emotional eaters gain weight because ofpoor emotion regulation, not just due to bad eating habits. Weaim at developing a personalised virtual coach ‘Denk je zèlf!’providing support for self-regulation of emotions for obeseemotional eaters. This paper presents a research study protocolon validating persuasive coaching strategies in emotionregulation, based on Dialectical Behaviour Therapy, ultimatelytargeting behaviour change. Our goal is to design a personalisedeCoaching framework, allowing us to optimally translatesuccessful behaviour change mechanisms and techniques, suchas dialectical strategies, into personalised persuasive coachingstrategies.
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Obesity is a fast-growing societal threat, causingchronic conditions, physical and psychological health problems,as well as sickness absence and heavy healthcare costs. Despitenumerous attempts to promote physical activity and healthydiet, existing interventions do not focus on the commonemotional causes of obesity. There is a need for self-managementsupport of this vulnerable target group: emotional eaters. Thispaper presents the results of the design case study focusing on aholistic design and evaluation of a personalised virtual mHealthcoach that provides self-management training ‘Denk je zèlf!’(Dutch for ‘Develop a wise mind and counsel yourself’). Thetarget group are young adults with an emotional eating disorderand who are obese. The contextual inquiry study was conductedto gain insights into the needs and experiences of the targetusers, including interviews and questionnaires with emotionaleaters, patients undergoing obesity treatment, and healthcarepractitioners. Personas and the use-case scenario were derivedfrom these results and translated into the new ‘Denk je zèlf!’virtual coach, based on Dialectical Behaviour Therapy andexperience sampling measures to capture user experience andemotional state. The main contributions of this paper are: (a)combining holistic eHealth design, behavior chain analysis, anddialectic behaviour therapy in one personalised virtual mHealthcoaching application for emotional eaters; (b) applying emotionenrichedPersonas to guide the design; (c) the results of theinitial user evaluation. Preliminary results suggest that the‘Denk je zèlf!’ virtual coach is useful for helping the targetgroup. Future research will be aimed at further iterative (re)-design and evaluation, as well as development of the dialecticaldialogues for the virtual coach and content for the education andinstruction modules.
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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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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 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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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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