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Mobile Apps for Eating Disorders in Development

Carolina Ruiz and Bengisu Tulu

Carolina Ruiz,left, and Bengisu Tulu review the SlipBuddy app. (Worcester Polytechnic Institute)

13 December 2017. Two mobile device apps are being developed focusing on behavioral factors related to eating that can lead to unhealthy outcomes. The apps are the work of obesity researchers at Worcester Polytechnic Institute in Massachusetts and University of Connecticut in Storrs in one case, while a research team at University of Kansas in Lawrence is creating an app to help people with eating disorders.

Overweight and obesity are worldwide problems, with World Health Organization estimating in 2016 that 1.9 billion people are overweight, with 650 million of those considered obese. And while obesity is preventable, the number of people with the condition tripled since 1975, according to WHO. At this time, says the organization, more people live in countries where obesity and overweight kills more people than underweight.

The Worcester Tech/UConn team designed a smartphone app called SlipBuddy, so named to provide people with a “buddy” if they slip-up in their weight-loss plans. The team led by Worcester Tech business professor Bengisu Tulu and computer science professor Carolina Ruiz, are aware of the nearly 29,000 apps on the market dealing with weight issues, but they say SlipBuddy goes further than most others by tracking both stress and eating. The app, say its developers, helps users identify the factors that trigger overeating and substitute new stimuli to encourage healthy behaviors.

In a paper describing SlipBuddy, given in November 2017 at a meeting of American Medical Informatics Association, Tulu, Ruiz, and psychologist Sherry Pagoto, now at UConn, tell how the app asks users to check in 3 times a day to report stress levels, amount of sleep, fatigue, and any overeating that may occur. The app collects and stores the data — without personal identifiers — on a Worcester Tech server, where machine-learning algorithms look for behavior patterns specific to individual users, such as late-night eating or sleepless nights that could trigger overeating.

The analysis returns scenarios with a high risk of stress that can lead to overeating for those individuals, and instead suggests other activities, such as taking a walk or turning off the television, instead of overeating to reduce their stress. “Most weight-loss apps are all about tracking something,” says Tulu in a Worcester Tech statement, “tracking your calories, tracking your blood glucose, tracking your steps. This goes beyond that. We’re using machine learning to make this about intervention.”

In a pilot test of SlipBuddy, 16 participants all overweight and older than 18, used SlipBuddy for a month. The individuals were not trying to lose weight, but most of the group — 9 of the 16 — lost an average of 5 pounds. Of the remaining participants, 4 people gained an average of 2 pounds, and 3 others stayed at the same weight. SlipBuddy is built for Android devices and is expected to be released in 2019.

The Kansas app is being designed in the lab of psychologist Kelsie Forbush to help treat eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating. The work of Forbush and colleagues is funded by $50,000 grant from National Eating Disorders Association that estimates 20 million women and 10 million men will develop an eating disorder at some point in their lives.

Forbush says new treatment methods, such as mobile apps, are needed to help people with eating disorders. “Sadly, for 40 to 60 percent of patients with an eating disorder,” says Forbush in a university statement, “the very best available treatments simply don’t work.” To better meet the needs of these individuals, the Kansas researchers are trying a new direction in mental health called patient-focused treatment outcomes.

This type of treatment, says Forbush, calls for more monitoring by and feedback to therapists to enhance their work with patients. But most clinicians are either not trained or do not have the time for weekly client-focused outcome assessments. To overcome these obstacles, the Kansas team is developing an app for therapists to more easily and quickly track a patient’s response to treatment.

The app will guide clinicians through two self-reporting assessment guides: the Eating Pathology Symptoms Inventory and Inventory of Depression and Anxiety Symptoms. With computer-adaptive technology, the client’s previous answers determine the next questions to be asked, which reduces the time needed to administer these measures. Clients will answer the questions using a smartphone or tablet.

Analytical routines in the app will provide therapists with warnings if they need to intensify or adjust their treatments, to prevent unfavorable outcomes. “Our app is designed so that clinicians won’t have to worry about interpretation,” adds Forbush, “they’ll get feedback on their patients’ outcome without having to analyze the results themselves.”

The researchers plan to test the app with clinicians at several eating-disorder treatment clinics in the Kansas City area. “If we can improve client outcomes,” notes Forbush, “this will have a major impact on public health by reducing the number of clients who die as a result of complications from an eating disorder.”

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