Long-Term Efficacy of a Mobile Mental Wellness Program: Prospective Single-Arm Study.

BACKGROUND: Rising rates of psychological distress (symptoms of depression, anxiety, and stress) among adults in the United States necessitate effective mental wellness interventions. Despite the prevalence of smartphone app-based programs, research on their efficacy is limited, with only 14% showing clinically validated evidence. Our study evaluates Noom Mood, a commercially available smartphone-based app that uses cognitive behavioral therapy and mindfulness-based programming. In this study, we address gaps in the existing literature by examining postintervention outcomes and the broader impact on mental wellness. OBJECTIVE: Noom Mood is a smartphone-based mental wellness program designed to be used by the general population. This prospective study evaluates the efficacy and postintervention outcomes of Noom Mood. We aim to address the rising psychological distress among adults in the United States. METHODS: A 1-arm study design was used, with participants having access to the Noom Mood program for 16 weeks (N=273). Surveys were conducted at baseline, week 4, week 8, week 12, week 16, and week 32 (16 weeks' postprogram follow-up). This study assessed a range of mental health outcomes, including anxiety symptoms, depressive symptoms, perceived stress, well-being, quality of life, coping, emotion regulation, sleep, and workplace productivity (absenteeism or presenteeism). RESULTS: The mean age of participants was 40.5 (SD 11.7) years. Statistically significant improvements in anxiety symptoms, depressive symptoms, and perceived stress were observed by week 4 and maintained through the 16-week intervention and the 32-week follow-up. The largest changes were observed in the first 4 weeks (29% lower, 25% lower, and 15% lower for anxiety symptoms, depressive symptoms, and perceived stress, respectively), and only small improvements were observed afterward. Reductions in clinically relevant anxiety (7-item generalized anxiety disorder scale) and depression (8-item Patient Health Questionnaire depression scale) criteria were also maintained from program initiation through the 16-week intervention and the 32-week follow-up. Work productivity also showed statistically significant results, with participants gaining 2.57 productive work days from baseline at 16 weeks, and remaining relatively stable (2.23 productive work days gained) at follow-up (32 weeks). Additionally, effects across all coping, sleep disturbance (23% lower at 32 weeks), and emotion dysregulation variables exhibited positive and significant trends at all time points (15% higher, 23% lower, and 25% higher respectively at 32 weeks). CONCLUSIONS: This study contributes insights into the promising positive impact of Noom Mood on mental health and well-being outcomes, extending beyond the intervention phase. Though more rigorous studies are necessary to understand the mechanism of action at play, this exploratory study addresses critical gaps in the literature, highlighting the potential of smartphone-based mental wellness programs to lessen barriers to mental health support and improve diverse dimensions of well-being. Future research should explore the scalability, feasibility, and long-term adherence of such interventions across diverse populations.

Eating disorder treatment among women forty and older: increases in prevalence over time and comparisons to young adult patients.

OBJECTIVES: There is limited information on the prevalence of middle-aged women seeking specialized treatment for an eating disorder and whether middle-aged patients are significantly different from young-adult patients. This two-part study sought to identify changes in the past two decades in the prevalence of middle-aged (MA; 40+ years) and young-adult (YA; 18-39 years) women seeking treatment for an eating disorder (ED) and to identify differences and similarities between both groups. METHODS: For study 1, all unique female inpatient admissions from 1989 to 2006 were reviewed (n=1,040). For study 2, women admitted to any treatment level from January-May 2007 were compared, based on age at intake admission, on psychological questionnaires and factors relevant to an eating disorder. RESULTS: In study 1, the overall percent of MA women who presented for inpatient ED treatment increased significantly from an average of 4.7% (1989-2001) to an average of 11.6% (2002-2006). In study 2, at intake, MA women were more likely than YA to be married, be older at ED onset and report a longer duration of illness. Self-esteem, depression, anxiety, ED psychopathology, and BMI were not significantly different between groups. CONCLUSIONS: Findings indicate an increase in the prevalence of inpatient admissions among middle-aged women, but few differences between middle-aged and younger-aged women at treatment admission. However, the longer duration of illness among MA warrants in-depth investigation of factors related to resistance to seeking treatment and to existing treatments failing patients, and consideration of tailoring treatment to course of illness.

Bariatric surgery: a primer for eating disorder professionals.

Obesity is a public health epidemic with medical, psychological and economic consequences. It continues to increase globally in prevalence and severity. Despite numerous behaviourally, medically or pharmacologically guided treatments, an effective non-surgical long-term treatment approach has not been identified. Bariatric surgery has surfaced as a viable option for a subset of individuals with medically complicated obesity who have failed non-surgical approaches. Pre-operative evaluation followed by post-operative, longitudinal follow-up by a multidisciplinary team specializing in surgery, medicine, psychiatry/psychology, exercise science and nutrition constitutes recognized and necessary standard of care for these complex patients. More information is needed regarding factors that interfere with successful outcomes and mechanisms of optimal follow-up for bariatric surgery patients to prevent and detect post-operative medical, psychological and social difficulties. We will review these issues with a focus on issues relevant to eating disorders professionals.

Monetary costs associated with bulimia.

OBJECTIVE: The direct monetary costs for food and laxatives, diet pills, and diuretics used by individuals with bulimia nervosa (BN) have not been studied. METHOD: Ten participants with a presenting clinical diagnosis of BN completed a 7-day food record at the outset of treatment in order to provide estimates of weekly and yearly monetary costs for food and associated symptoms. RESULTS: Participants reported means of 3.6 purge episodes, 2.5 objective binge episodes, and 2.4 subjective binge eating episodes per week. Mean total food costs were $106.98/week (SD = $53.88) or $5,581.79/year (SD = $2,811.58). Costs associated with binge eating and purging were 32.7% of all food costs (average: $1,599.45/year). CONCLUSION: Financial costs of bulimia symptoms are significant, and appear to constitute a substantial minority of all food spending by individuals with BN.

Arts-based therapies in the treatment of eating disorders.

Arts-based therapies are increasingly being employed, in conjunction with empirically valid traditional therapies, in the residential treatment of eating disorders. A systematic database search of arts-based therapies in the treatment of eating disorders was conducted. In addition, program staff at 22 residential eating disorder treatment programs were contacted to provide information regarding arts-based therapy utilization rates. Of the 19 programs that participated in this study, all incorporate arts-based therapies on at least a weekly basis in the treatment of eating disorders. However, while published narrative reflections on arts-based therapies and eating disorders imply a generally positive outcome, no known, empirically valid studies exist on this experiential form of therapy within the area of eating disorders.

Residential treatment for eating disorders.

OBJECTIVE: The current study describes residential treatment for eating disorders in the United States. METHOD: A national study involving 22 residential eating disorder treatment programs was conducted using a survey to determine treatment program descriptions and trends. Data from 19 respondents, representing 86% of all residential treatment programs in the United States, were examined. RESULTS: Residential treatment options for individuals with anorexia nervosa and bulimia nervosa are becoming increasingly more common. A wide variety of techniques and methods are employed in the treatment of individuals with eating disorders in residential treatment programs. The average length of stay in treatment was 83 days, with an average cost per day of 956 US dollars. CONCLUSION: The residential treatment of individuals with eating disorders is a growing, variable, and largely unregulated enterprise. Future research is needed to focus on quantifying treatment program effectiveness in the residential treatment of individuals with eating disorders.