Combining ecological momentary assessment, wrist-based eating detection, and dietary assessment to characterize dietary lapse: A multi-method study protocol

Digit Health. 2021 Feb 2;7:2055207620988212. doi: 10.1177/2055207620988212. eCollection Jan-Dec 2021.


Objectives: Behavioral obesity treatment (BOT) produces clinically significant weight loss and health benefits for many individuals with overweight/obesity. Yet, many individuals in BOT do not achieve clinically significant weight loss and/or experience weight regain. Lapses (i.e., eating that deviates from the BOT prescribed diet) could explain poor outcomes, but the behavior is understudied because it can be difficult to assess. We propose to study lapses using a multi-method approach, which allows us to identify objectively-measured characteristics of lapse behavior (e.g., eating rate, duration), examine the association between lapse and weight change, and estimate nutrition composition of lapse.

Method: We are recruiting participants (n = 40) with overweight/obesity to enroll in a 24-week BOT. Participants complete biweekly 7-day ecological momentary assessment (EMA) to self-report on eating behavior, including dietary lapses. Participants continuously wear the wrist-worn ActiGraph Link to characterize eating behavior. Participants complete 24-hour dietary recalls via structured interview at 6-week intervals to measure the composition of all food and beverages consumed.

Results: While data collection for this trial is still ongoing, we present data from three pilot participants who completed EMA and wore the ActiGraph to illustrate the feasibility, benefits, and challenges of this work.

Conclusion: This protocol will be the first multi-method study of dietary lapses in BOT. Upon completion, this will be one of the largest published studies of passive eating detection and EMA-reported lapse. The integration of EMA and passive sensing to characterize eating provides contextually rich data that will ultimately inform a nuanced understanding of lapse behavior and enable novel interventions.Trial registration: Registered clinical trial NCT03739151; URL:

Keywords: Dietary lapse; dietary assessment; ecological momentary assessment; passive sensing; weight loss.

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