Randomized controlled trial comparing smartphone assisted versus traditional guided self‐help for adults with binge eating

Abstract

Objective Guided self-help treatments based on cognitive-behavior therapy (CBT-GSH) are efficacious for binge eating. With limited availability of CBT-GSH in the community, mobile technology offers a means to increase use of these interventions. The purpose of this study was to test the initial efficacy of Noom Monitor, a smartphone application designed to facilitate CBT-GSH (CBT-GSH+Noom), on study retention, adherence, and eating disorder symptoms compared to traditional CBT-GSH. Method Sixty-six men and women with DSM-5 binge eating disorder (BED) or bulimia nervosa (BN) were randomized to receive 8 sessions of CBT-GSH + Noom (n = 33) or CBT-GSH (n = 33) over 12 weeks. Primary symptom outcomes were Eating Disorder Examination objective bulimic episodes (OBEs), subjective bulimic episodes (SBEs), and compensatory behaviors. Assessments were collected at 0, 4, 8, 12, 24, and 36 weeks. Behavioral outcomes were modeled using zero-inflated negative-binomial latent growth curve models with intent-to-treat. Results There was a significant effect of treatment on change in OBEs (β =−0.84, 95%CI = −1.49, −0.19) favoring CBT-GSH + Noom. Remission rates were not statistically different between treatments for OBEs (βlogit =−0.73, 95%CI = −1.86, 3.27; CBT-GSH + Noom = 17/27, 63.0% vs. CBT-GSH 11/27, 40.7%, NNT = 4.5), but CBT-GSH + Noom participants reported greater meal and snack adherence and regular meal adherence mediated treatment effects on OBEs. The treatments did not differ at the 6-month follow-up. Discussion Smartphone applications for the treatment binge eating appear to have advantages for adherence, a critical component of treatment dissemination.

A systematic review of mHealth interventions for the support of eating disorders

“…Most of the studies included a mixed diagnostic sample of AN, BN, binge eating disorder (BED), or eating disorder not otherwise specified (Bauer, Okon, Meermann, & Kordy, ; Cardi, Clarke, & Treasure, ; Cardi, Esposito, Clarke, Schifano, & Treasure, ; Darcy, Adler, Miner, & Lock, ; Hildebrandt et al, ; Robinson et al, ; Shingleton et al, ). Two studies included an exclusively BED or loss of control eating disorder sample (Juarascio et al, ; Mazzeo et al, ), two studies used AN sample (Cardi et al, ; Cardi, Lounes, Kan, & Treasure, ; Treasure, MacAre, Mentxaka, & Harrison, ), and one study BN sample (Shapiro et al, ).…”

“…Remarkably, most of the studies were developed within a CBT context (Bauer et al, ; Darcy et al, ; Hildebrandt et al, ; Juarascio et al, ; Mazzeo et al, ; Nitsch et al, ; Robinson et al, ; Shapiro et al, ; Shingleton et al, ; Tregarthen et al, ) and used self‐monitoring strategies, psycho‐education, motivational components, feedback from the therapist or bilateral exchange of information, and social support strategies. The rest of the studies were vodcast interventions (Cardi et al, ; Cardi et al, ; Cardi, Clarke, & Treasure, ; Cardi, Lounes, et al, ; Treasure et al, ).…”

Bayesian analysis of randomized controlled trials

“…An important implication of our likelihood function is that unlike previous zero‐inflated Poisson and zero‐inflated negative binomial models (Grotzinger, Hildebrandt, & Yu, ; Hildebrandt et al, ) for binge‐eating data, we have a single generative process. We do not have a different generative process for 0’s from abstinence, full remission and the non‐zero count data.…”

“…Hildebrandt et al () conducted an experiment to test whether the Noom Monitor, a smartphone application, could augment the effect of in‐person therapeutic treatment on binge‐eating behavior. The treatment, known as guided self‐help treatments based on cognitive‐behavior therapy (CBT–GSH), had been shown in previous research to reduce binge‐eating behavior by 10–50%.…”

“…The primary outcome was Objective Bulimic Episodes (OBE). For more information about the experiment, choice of dependent (outcome) variable, historical context and past research in this area, see Hildebrandt et al (). There is a discussion of BN and Binge‐Eating as well as an explanation of the choice of outcome variable OBE.…”