Self-report versus clinical interview: Discordance among measures of binge eating in a weight-loss seeking sample.

PURPOSE: Obese, behavioral weight-loss (BWL) seeking individuals may be prone to over-reporting binge-eating (BE). However, many studies rely on self-reported measures of BE in this population, which may be inaccurate. As such, this is the first-ever study to examine the concordance rates among one self-reported and one clinician- administered measure of BE in a BWL-seeking sample with overweight/obesity. METHODS: At baseline of a BWL trial, participants (N = 94) completed two measures of BE: The Eating Disorders Examination Questionnaire (EDE-Q) and the interview-based Eating Disorder Examination (EDE, Overeating section). RESULTS: Cohen's kappa detected poor agreement between measures (κ < 0). A paired samples t-test detected large, significant differences in OBE frequency across the EDE-Q and EDE, p < 0.001. The self-reported EDE-Q detected a significantly greater frequency of OBEs compared to the EDE (MEDE-Q = 0.73, SD = 1.29 vs. MEDE = 0.06, SD = 0.34). The EDE-Q detected that approximately 50% of participants have experienced OBEs, while the EDE detected that only 5% of participants have experienced OBEs. The frequency of OBEs detected by the EDE-Q was statistically greater than the frequency of OBEs detected by the EDE, p < 0.001. DISCUSSION: Results suggest poor agreement between one self-reported measure and the "gold-standard," clinician-administered measure of BE in a BWL-seeking sample with overweight/obesity. The EDE-Q exhibited high sensitivity but low-to-moderate specificity of OBEs, with the number of false positives (41) outweighing that of true positives (4). Studies measuring BE in this population should consider relying solely on assessor-administered measures, as this sample may require clinical guidance or clarification on the definition and features of BE. LEVEL OF EVIDENCE: Level V, cross-sectional, descriptive study.

Are individuals with loss-of-control eating more prone to dietary lapse in behavioural weight loss treatment? An ecological momentary assessment study.

OBJECTIVE: Individuals with overweight/obesity and loss-of-control eating (LOC) may experience poorer outcomes from behavioural weight loss due to reactivity to internal (e.g., affective and physical) states that impact treatment adherence (e.g., dietary lapses). This study examined (a) whether the presence of LOC increased risk for dietary lapses and (b) the moderating role of LOC on the relation between internal states and dietary lapses. METHOD: Individuals (n = 189) with overweight and obesity completed ecological momentary assessment early in behavioural weight loss. RESULTS: LOC was positively associated with dietary lapse. LOC did not moderate the relation between momentary changes in internal states and dietary lapses. However, the effect of average levels of internal states on lapses was attenuated for those with LOC. DISCUSSION: Results suggest that those with LOC are at higher risk of dietary lapse, whereas elevated average levels of internal states may contribute to early inadherence for those without LOC.

Refining an algorithm-powered just-in-time adaptive weight control intervention: A randomized controlled trial evaluating model performance and behavioral outcomes.

Suboptimal weight losses are partially attributable to lapses from a prescribed diet. We developed an app (OnTrack) that uses ecological momentary assessment to measure dietary lapses and relevant lapse triggers and provides personalized intervention using machine learning. Initially, tension between user burden and complete data was resolved by presenting a subset of lapse trigger questions per ecological momentary assessment survey. However, this produced substantial missing data, which could reduce algorithm performance. We examined the effect of more questions per ecological momentary assessment survey on algorithm performance, app utilization, and behavioral outcomes. Participants with overweight/obesity (n = 121) used a 10-week mobile weight loss program and were randomized to OnTrack-short (i.e. 8 questions/survey) or OnTrack-long (i.e. 17 questions/survey). Additional questions reduced ecological momentary assessment adherence; however, increased data completeness improved algorithm performance. There were no differences in perceived effectiveness, app utilization, or behavioral outcomes. Minimal differences in utilization and perceived effectiveness likely contributed to similar behavioral outcomes across various conditions.

OnTrack: development and feasibility of a smartphone app designed to predict and prevent dietary lapses.

Given that the overarching goal of weight loss programs is to remain adherent to a dietary prescription, specific moments of nonadherence known as "dietary lapses" can threaten weight control via the excess energy intake they represent and by provoking future lapses. Just-in-time adaptive interventions could be particularly useful in preventing dietary lapses because they use real-time data to generate interventions that are tailored and delivered at a moment computed to be of high risk for a lapse. To this end, we developed a smartphone application (app) called OnTrack that utilizes machine learning to predict dietary lapses and deliver a targeted intervention designed to prevent the lapse from occurring. This study evaluated the feasibility, acceptability, and preliminary effectiveness of OnTrack among weight loss program participants. An open trial was conducted to investigate subjective satisfaction, objective usage, algorithm performance, and changes in lapse frequency and weight loss among individuals (N = 43; 86% female; body mass index = 35.6 kg/m2) attempting to follow a structured online weight management plan for 8 weeks. Participants were adherent with app prompts to submit data, engaged with interventions, and reported high levels of satisfaction. Over the course of the study, participants averaged a 3.13% weight loss and experienced a reduction in unplanned lapses. OnTrack, the first Just-in-time adaptive intervention for dietary lapses was shown to be feasible and acceptable, and OnTrack users experienced weight loss and lapse reduction over the study period. These data provide the basis for further development and evaluation.

Ecological momentary assessment of self-attitudes in response to dietary lapses.

OBJECTIVE: To examine whether self-attitudes and self-efficacy after dietary lapses relate to lapse frequency or predict risk for lapsing again on the same day. METHOD: Adults with overweight/obesity (n = 91) completed ecological momentary assessment for 14 days at the start of a lifestyle modification program. At each survey, participants reported whether they had experienced a dietary lapse, and, if so, reported their self-attitudes (i.e., self-criticism, self-forgiveness, self-regard) and self-efficacy. The relationships between participants' typical (i.e., average level for each participant across lapses) self-attitudes/self-efficacy after lapsing and lapse frequency were examined using correlations. Generalized estimating equations examined whether participants' typical (average across lapses; between-person effect) self-attitudes/self-efficacy or momentary (i.e., level of each variable at a particular lapse relative to one's typical level; within-person effect) self-attitudes/self-efficacy predicted same-day lapse occurrence. RESULTS: Lower typical self-efficacy and more negative typical self-regard related to greater lapse frequency. Additionally, lower momentary self-criticism predicted greater likelihood of same-day lapse occurrence. There also was a quadratic relationship between typical self-regard and risk of same-day lapse occurrence, such that individuals with either more negative or more positive typical self-regard were more likely to lapse on the same day. CONCLUSION: Findings provide preliminary support for the relevance of self-attitudes and self-efficacy to lapses during early lifestyle modification. While greater typical self-efficacy and more positive typical self-regard are associated with fewer lapses, lower momentary self-criticism and very positive or negative typical self-regard may confer risk for same-day lapses. (PsycINFO Database Record