Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep

Abstract

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...

The promise of wearable sensors and ecological momentary assessment measures for dynamical systems modeling in adolescents: a feasibility and acceptability study

“…Adolescents are willing to complete a rigorous protocol to obtain this information. Compliance rates to the physiological monitoring system, accelerometer, and survey questions are similar to those reported in the literature [6] and should be sufficient to recover relationships in the data. In general, the participants were excited about the use of the equipment and reported they would be willing to comply with a similar protocol if requested to do so by their doctor.…”

“…Ecological momentary assessment in particular has been recommended to increase the efficacy of interventions by clarifying antecedents of physical activity, by improving the accuracy of self-monitoring, and by specifying the temporal relationships of target behaviors [6]. Tools that simultaneously measure interrelated processes can significantly alter clinician's ability to inform treatment and provide feedback on engagement in health behaviors.…”

“…1 for a screenshot of the PETE app. Affective constructs-Eight affective constructs associated with physical activity [6] were identified using theory and a review of the empirical literature. Two broad constructs of positive and negative affect were measured by the 10-item International Positive and Negative Affect Schedule Short Form (I-PANAS-SF) [13].…”

“…Previous attempts to capitalize on wearable sensors and ecological momentary assessment have examined physical activity patterns and both the social and physical context of activity [4,5], affective states [6], and sleep [7]. While the articles to date have provided some evidence for the feasibility of collecting behavioral parameters from adolescents over a short period of time [8], the methodology commonly lacks physiological measurement and is limited to examining variables for a short duration (i.e., 4 days) [4].…”

Use of Ecological Momentary Assessment to Guide Curricular Change in Graduate Medical Education

“…14,15,22 It has not been used to inform behavior and learning in graduate medical education. In our literature review, we found 1 study that used EMA in a family medicine residency program to assess the cognitive impact of electronic knowledge resources.…”