Pediatric obesityRecent estimates show that nearly 32% of children in the United States are overweight, which is dramatically higher than the prevalence reported in the 1980s (ref. 1). Childhood obesity is associated with psychological, neurologic, pulmonary, gastrointestinal, circulatory, and endocrine conditions (2,3). Most pediatric obesity interventions are marked by modest changes in weight or adiposity and substantial relapse (4). More comprehensive assessments documenting specific behavior change are needed, eliminating methodology compromised by self-report and retrospective recall (5). Moreover, given exclusion criteria in many pediatric obesity trials, children with mood disorders (depression) and medical comorbidities (sleep problems) do not receive the interventions. Domains such as mood and sleep may be essential dimensions of assessment as mediators or moderators of weight-loss treatment. Therefore, we sought not only to examine the feasibility of adding methodologically sound technology to an empirically validated weightmanagement intervention, but also to examine interregulatory processes across behaviors (i.e., eating, physical activity (PA), mood, and sleep) in an objective manner.Ecological Momentary Assessment (EMA) is an innovative form of data collection that provides objective data on patterns of behaviors within a participant's natural environment. EMA helps to circumvent sources of bias inherent in other retrospective self-report measures (6). In adults, multiple applications of EMA methodology have provided insight into food intake and maintenance of weight-related disorders (7), and initial research has demonstrated its utility in pediatric samples with psychopathology (8). Thus, EMA methodology may assist weight-loss efforts by clarifying the antecedents of participants' eating behavior (6), by improving accuracy of selfmonitoring (9) and by specifying the temporal relationships of the target behaviors (10). The aims of this pilot study were to (i) examine the feasibility of utilizing EMA in overweight children participating in an empirically validated cognitivebehavioral weight-management intervention, and (ii) examine the relationship between EMA and weight (primary) and behavioral outcomes (secondarily; mood and sleep). To our knowledge, no studies have examined the utility of complementary EMA methodologies (phone calls and actigraphy) to measure interregulatory health processes in obese adolescents participating in a weight-loss trial. In this brief report, we discuss pilot data primarily regarding aim 1 (EMA utilization).
MethodsThis study was conducted alongside the Weight Management Center at Children's Hospital of Pittsburgh and approved by the University's Institutional Review Board. Informed assent and consent were obtained from 20 English-speaking participants (11-19 years old, 80% white, 15% African American, mean BMI = 39). Exclusion criteria consisted This study examined the feasibility of using Ecological Momentary Assessment (EMA) to examine important domains relevant...
