Wearable fitness trackers are an increasingly popular tool for measuring physical activity (PA) due their accuracy and momentary data collection abilities. Despite the benefits of using wearable fitness trackers, there is limited research in the eating disorder (ED) field using wearable fitness trackers to measure PA in the context of EDs. Wearable fitness trackers are often underused in ED research because there is limited knowledge about whether wearable fitness trackers negatively or positively impact PA engagement and ED symptoms in individuals with EDs. The current study aimed to assess the perceived impact wearable fitness trackers have on PA engagement and ED symptoms over a 12-week CBT treatment for 30 individuals with binge eating and restrictive eating that presented to treatment engaging or not engaging in maladaptive exercise. Participants in the maladaptive exercise group ( n = 17) and non-maladaptive exercise group ( n = 13) wore a fitness tracker for 12 weeks and completed questionnaires assessing participants’ perceptions of the fitness trackers’ influence on ED symptoms and PA engagement throughout treatment. Results demonstrated a small percentage of individuals perceived the fitness tracker influenced ED behaviors or PA engagement, and there were mixed results on whether participants positively or negatively perceived the fitness tracker influenced them to engage in ED behaviors or PA engagement. Although preliminary, these results demonstrate the need to continue using objective measurements of PA via wearable fitness trackers to further our understanding of the positive and negative effects of fitness trackers on clinical ED samples. Level of Evidence : Level 1, randomized controlled trial.

Background Dietary restraint is a key factor for maintaining engagement in binge eating among individuals with binge eating disorder (BED) and bulimia nervosa (BN). Reducing dietary restraint is a mechanism of change in cognitive behavioral therapy (CBT) for individuals with BN and BED. However, many individuals who undergo CBT fail to adequately reduce dietary restraint during treatment, perhaps owing to difficulty in using treatment skills (eg, regular eating) to reduce dietary restraint during their daily lives. The SenseSupport system, a novel just-in-time, adaptive intervention (JITAI) system that uses continuous glucose monitoring to detect periods of dietary restraint, may improve CBT to reduce dietary restraint during treatment by providing real-time interventions. Objective This study aimed to describe the feasibility, acceptability, and initial evaluation of SenseSupport. We presented feasibility, acceptability, target engagement, and initial treatment outcome data from a small trial using an ABAB (A=continuous glucose monitoring data sharing and JITAIs-Off, B=continuous glucose monitoring data sharing and JITAIs-On) design (in which JITAIs were turned on for 2 weeks and then turned off for 2 weeks throughout the treatment). Methods Participants (N=30) were individuals with BED or BN engaging in ≥3 episodes of ≥5 hours without eating per week at baseline. Participants received 12 sessions of CBT and wore continuous glucose monitors to detect eating behaviors and inform the delivery of JITAIs. Participants completed 4 assessments and reported eating disorder behaviors, dietary restraint, and barriers to app use weekly throughout treatment. Results Retention was high (25/30, 83% after treatment). However, the rates of continuous glucose monitoring data collection were low (67.4% of expected glucose data were collected), and therapists and participants reported frequent app-related issues. Participants reported that the SenseSupport system was comfortable, minimally disruptive, and easy to use. The only form of dietary restraint that decreased significantly more rapidly during JITAIs-On periods relative to JITAIs-Off periods was the desire for an empty stomach (t43=1.69; P=.049; Cohen d=0.25). There was also a trend toward greater decrease in overall restraint during JITAs-On periods compared with JITAIs-Off periods, but these results were not statistically significant (t43=1.60; P=.06; Cohen d=0.24). There was no significant difference in change in the frequency of binge eating during JITAIs-On periods compared with JITAIs-Off periods (P=.23). Participants demonstrated clinically significant, large decreases in binge eating (t24=10.36; P<.001; Cohen d=2.07), compensatory behaviors (t24=3.40; P=.001; Cohen d=0.68), and global eating pathology (t24=6.25; P<.001; Cohen d=1.25) from pre- to posttreatment. Conclusions This study describes the successful development and implementation of the first intervention system combining passive continuous glucose monitors and JITAIs to augment CBT for binge-spectrum eating disorders. Despite the lower-than-anticipated collection of glucose data, the high acceptability and promising treatment outcomes suggest that the SenseSupport system warrants additional investigation via future, fully powered clinical trials. Trial Registration ClinicalTrials.gov NCT04126694; https://clinicaltrials.gov/ct2/show/NCT04126694

Objective Sensor technologies offer exciting potential to objectively measure psychopathological correlates of eating pathology and eating disorder (ED) research utilizing sensors has rapidly proliferated in the past several years. The aims of the present review are: (1) characterize the types of sensors that have been utilized in ED research, (2) identify the psychopathological factors relevant to EDs that have been assessed using sensors, (3) describe the data supporting the validity and reliability of these sensors, (4) discuss limitations associated with these sensors, and (5) identify gaps that persist within the ED literature with regard to use of sensor technologies. Method A systematic search was conducted of PubMed, PsycINFO, Web of Science, ProQuest, and “gray” literature sources. Eligible publications were empirical studies that utilized sensors to measure at least one psychological variable among clinical ED populations. Results Sensors have been utilized with ED samples to measure eating behaviors, physical activity, sleep, autonomic nervous system activity, eyeblink startle response, visual attention, and visual‐haptic object integration. The reliability and validity of these sensors varies widely and there are a number of significant gaps that remain in the literature with regard to the types of sensors utilized, context in which sensors have been used, and populations studied. Discussion The existing literature utilizing sensors within ED research largely support the feasibility and acceptability of these tools. Sensors should continue to be utilized within the field, with a specific focus on examining the reliability and validity of these tools within ED samples and increasing the diversity of samples studied. Public Significance Statement Sensor technologies, such as those included in modern smartwatches, offer new opportunities to measure factors that may maintain or contribute to symptoms of eating disorders. This article describes the types of sensors that have been used in eating disorders research, challenges that may arise in using these sensors, and discusses new applications of these sensors that may be pursued in future research.

Objectives: Elevated glucose variability may be one mechanism that increases risk for significant psychological and physiological health conditions among individuals with binge-spectrum eating disorders (B-EDs), given the impact of eating disorder (ED) behaviors on blood glucose levels. This study aimed to characterize glucose variability among individuals with B-EDs compared with age-matched, sex-matched, and body mass index-matched controls, and investigate the association between frequency of ED behaviors and glucose variability.Methods: Participants were 52 individuals with B-EDs and 22 controls who wore continuous glucose monitors to measure blood glucose levels and completed ecological momentary assessment surveys to measure ED behaviors for 1 week. Independent samples t-tests compared individuals with B-EDs and controls and multiple linear regression models examined the association between ED behaviors and glucose variability.Results: Individuals with B-EDs demonstrated numerically higher glucose variability than controls (t = 1.42, p = .08, d = 0.43), although this difference was not statistically significant. When controlling for covariates, frequency of ED behaviors was significantly, positively associated with glucose variability (t = 3.17, p = .003) with medium effect size (f 2 = 0.25). Post hoc analyses indicated that binge eating frequency was significantly associated with glucose variability, while episodes of 5+ hours without eating were not.

Introduction: Independently, food insecurity (FI) and binge-spectrum eating disorders (B-ED) are widespread problems; moreover, FI is associated with elevated binge-eating symptoms. However, extant research has not explored how FI may contribute to the development of B-ED symptoms, nor potential impacts of FI on eating disorder treatment. Method: This study aimed to qualitatively examine (1) mechanisms by which FI impacts B-ED development and maintenance, (2) effects of past and/or present FI on ED treatment, and (3) participant recommendations for addressing FI in future B-ED treatment. Fourteen individuals who completed B-ED treatment and endorsed FI completed a 30-min interview about their experiences.Results: Participants reported that FI contributed to binge eating by maintaining dietary restraint-binge-eating cycle and by leading them to use food as a coping mechanism or for emotional comfort, both in past and present situations. Present FI interfered with treatment, particularly with adhering to treatment recommendations and food purchasing choices, however, participants did not report any impact of past FI on B-ED treatment.Participants reported that rarely was FI addressed as part of treatment; most participants suggested that future treatments work to (1) assess and problem solve present FI to minimize interference and (2) assess and understand the influence of past FI on current symptoms to validate the function of behavior.Discussion: These findings provide qualitative support that FI may reinforce B-ED symptoms and present FI may interfere with treatment. This study emphasizes the need for assessment and consideration of FI as a factor when treating individuals with B-EDs.