If a Smart Scale Tells You to Stop Binge Eating, Will You?
Apps will supportively tell you aloud the reasons NOT to binge.
Posted Jan 08, 2019
We should assume that sooner or later technology will be a major player in helping us lose weight, become fitter, stop disordered eating and maybe even increase our vegetable consumption.
Of course, we already have many apps and some physical devices to support us in these goals (if we let them). There is a scale that sends your weight to your cell phone and computer so you have a record of gains or loses, assuming that you step on the scale. Tracking your physical activity, even when you are asleep, has been around for a while, and many wearable devices do this along with several apps. So-called personal digital assistants (PDAs) are available to track your mood, whether or not you are skipping meals, the state of your food cravings, and even deliver audio coaching to decrease the likelihood of uncontrolled eating.
Research on the efficacy of these virtual therapists is now underway, in places like Drexel University in Philadelphia. In a recent conversation with Adrienne Juarascio, a faculty member in the department of psychology at Drexel University and director of practicum training in their Center for Weight, Eating and Lifestyle Science (WELL Center) clinic, I learned that several studies are now underway to compare the use of a PDA with conventional treatments of obesity, binge eating, and bulimia. The idea is to supplement the therapeutic strategies of dieticians, therapists, and life coaches offered in an office setting with reminders and self-monitoring prompts on the cell phone. The user of such a PDA is asked to check in several times a day to note how she is feeling, and she is asked about current stress or other triggers that might lead to uncontrolled eating. Reminders to eat meals on schedule, not to skip meals which may cause late in the day overeating, to exercise, to get enough sleep, and to try certain relaxation techniques can be put into the program. For example, it will be possible to develop a program that contains the individual’s particular triggers causing binge eating. Professor Juarascio emphasized that patients with eating disorders such as binge eating and bulimia would always be under the care of a physician and therapist. Cell phone-generated advice was not intended to be a substitute, but rather an enhancement of programs to minimize disordered eating.
Of course, the patient has to interact with the program on the device for it to have a therapeutic effect. Self-monitoring, the willingness to check in several times a day, the discipline to hold off starting a binge until locating stress triggers, and then following advice to abort the binge: All of these behaviors have to be followed for such a technological intervention to be successful. The willingness to seek help and recognize the limitations of one’s will power seems similar to what is asked of alcoholics who have a sponsor to help them attain abstinence. They too must check in and seek help when they recognize their inability to stay sober. The weight-loss organization, Overeaters Anonymous, also uses sponsors who oversee food plans and can be contacted if the dieter feels a loss of control.
Perhaps someday soon the robotic personal assistants that sit on a desktop and tell you to take your umbrella because it is raining outside will be programmed to offer verbal assistance to the binge eater or dieter. Verbal reminders such as “eat breakfast” or “ it is time for bed” might be more effective than seeing the same advice on a cell phone screen. Indeed, if outfitted with appropriate surveillance equipment, a device like Alexa could set off a siren or whistle if the dieter opens a container of ice cream or a bag of Oreos.
On the other hand, words of encouragement when weight is lost or when the ice cream is put back into the freezer can be extremely effective. Anyone who uses a fitness tracker cannot fail to respond, even for a nanosecond, to “Congratulations, your best running/walking/biking/workout yet.” We know there is an algorithm behind those words, but we may still smile at the compliment. So too a dieter or binge eater might feel reassured and pleased when receiving a computer-generated message of “well done” or “thank you for not eating the ice cream.” Indeed, it is possible that such a remark made by a spouse would be less well received than the same remark made by a computer.
Limitations to the efficacy of computer-based self-help are obvious, however. First, it is easy to ignore. Think about how easy it is not to weigh yourself when you are worried that you have gained weight. You can take off that fitness bracelet or fail to look at the app tracking your steps when you know you have skipped workouts or walking. Unless the dieter or binge eater is willing to report in constantly, day after day to the program on the personal digital assistants, the program is useless. In the old days when people still used paper and pencils, keeping food records were considered the gold standard for weight loss. If you wrote down everything you ate, then you could see where your excess calories were coming from and remove them. Of course, people got bored or indifferent or cheated and lied. “Do you really think I was going to count potato chips as I was eating them?” a weight loss client once told me. It is doubtful that counting potato chips and reporting them to a computer is any more likely to happen.
Triggers that cause weight loss failures or binge eating may be predictable, such as after a spousal argument or overwhelming job obligations, and put into a personalized computer self-help program. But what about the ones we don’t see coming, like an IRS audit or unexpected health issues? The objective of all therapeutic intervention, be it human or by computer, is for the out-of-control eater to learn how to be in control regardless of the stress. But the reason eating occurs in times of stress is that for some it numbs the emotional pain, helplessness, anger, frustration, despair, and anxiety that the stress has left in its wake. Can technology find an alternative to eating when this happens? We shall have to wait and see.