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Using smartphones to understand eating disorders


Eating disorder researchers at Sanford Health are developing software built on a simple premise: It’s more accurate to record something in the moment rather than trying to recall it days, weeks or months later.

The concept is called momentary data collection, said Scott Engel, Ph.D., a behavioral health researcher at Sanford Health in Fargo, North Dakota. He’s working on the technology with colleagues Stephen Wonderlich, Ph.D., and Ross Crosby, Ph.D.

“Unfortunately, a lot of the work that has been done historically in our field has been reliant on similar procedures where you ask people to think back to something — some behavior, some emotional state, some thought that they may have had. We know that practice is flawed because there are a bunch of memory-related biases that cause problems with remembering correctly,” Engel said.

If the recollection is wrong, the research that relies on it will be as well, which makes it more difficult to help millions of people with eating disorders.

An epidemic of obesity

“Obesity is at epidemic proportions in the United States,” Engel said. “Unfortunately, super-obesity, people who are extremely obese, is more common now than ever, by far, and it’s also particularly more common in youth and adolescents.”

In 2018, 42.4% of Americans were considered obese and 9.2% were severely obese, according to the Centers for Disease Control and Prevention.

The personal cost includes higher rates of heart disease, stroke, type 2 diabetes and some types of cancer. The CDC estimates the annual financial cost at $147 billion and said yearly medical costs for people with obesity are an average of $1,429 higher than those of normal weight.

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Engel and other researchers look at the root causes of a variety of eating disorders, like anorexia nervosa and bulimia nervosa, as well as obesity and the increasing problem of binge eating. They consider psychological, social and biological factors that predispose some people to those conditions.

“It’s sort of this mishmash of all these predictive variables that put people at risk for these problems,” Engel said.

Study started with a Palm Pilot

To identify those variables, researchers ask meaningful questions of study participants to better understand what may be behind a condition, so they can determine how best to treat it.

Ideally, they want to minimize the amount of time between when something happens and when the person records what they were doing at the time, Engel said.

For example, a study participant has a fight with their significant other and responds by binge eating. If they’re able to record it immediately, instead of having to wait to tell the researcher about the event later, the details are more accurate.

“So instead of asking about yesterday or a month ago or whenever, you’re asking about something that’s really close in real-time. You don’t have them try to think back very far. People can typically more accurately provide you with good, usable information in doing that,” Engel said.

Engel, Wonderlich and Crosby’s first venture into a more real-time recording system entailed giving their research participants a Palm Pilot, a hand-held computer that was developed in the 1990s.

“We’d send them home for a week or two and they’d come back, and we’d upload their data and it worked pretty well. But there were a bunch of limitations with that,” Engel said.

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If the person lost or broke the device, all that data was also destroyed. If the research subject was unable to go to the office, there was no way to collect the information,  leaving the researchers unable to get the recordings ahead of an appointment.

Enter the iPhone

Smartphones changed that.

The researchers built on the Palm Pilot concept and came up with patient reporting software for any smartphone that allows people to record what they were feeling or doing when they had an eating disorder episode. It’s called ReTAINE, which stands for Real-Time Assessment In the Natural Environment.

“The ReTAINE system is different in a bunch of ways,” Engel said. “For one, it operates on smartphones, a smart device actually. So it can operate on any Wi-Fi-enabled or data-capable device. And once a person inputs the data, those data go to our server and we’ve got them captured almost instantaneously.”

Besides the real-time capturing and delivering of that information, the system allows researchers to see changes over time.

“You can think of it as comparing a snapshot, a picture, versus a short video,” Engel said. “The snapshot would be traditional, cross-sectional data where you ask people information and they give you this little snippet of info as opposed to collecting data through these momentary methods, which would be much more like a video.

“You get a very intense bunch of data, and you can then look at that and get a feel for dynamic flow and changes in some of these variables, rather than assuming that the one single measure you got was correct and accurately depicts that variable for that person.”

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Status of technology

The researchers have transitioned from the original version of ReTAINE to a significantly upgraded version, called ReTAINE 2.0. They are also currently working on ReTAINE 3.0, which will allow them to measure momentary variables in the area of cognitive psychology.

They have published some of their work using the ReTAINE system in the Journal of Abnormal Psychology, European Eating Disorders Review, Annals of Behavioral Medicine, Clinical Psychological Science, International Journal of Eating Disorders, Appetite and the Journal of Psychiatric Research.

Sanford Health values the ideas and problem-solving ability of its physicians, researchers, clinical workers and support staff. Any employee with an idea for a device, therapy, software, tool or other method that helps patients is encouraged to contact the innovations team and join the dozens of people at Sanford Health who are already inventing.

Learn more

Posted In Behavioral Health, Digestive Health, Fargo, Innovations, Research

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