Adolescent overweight and obesity represent a major public health concern. Approximately 80% of obese adolescents will become obese adults, placing them at increased risk of developing cardiovascular disease, diabetes, and cancer. Adolescents have previously demonstrated suboptimal responses to pediatric behavioral obesity interventions which are designed for younger children. Importantly, adolescents, make their own eating decisions, many of which are problematic for weight regulation and weight loss treatment. An understanding of the underlying mechanisms that contribute to engagement in problematic eating behaviors is crucial for developing effective treatments for adolescents with overweight and obesity. 

The present study aims to understand which facets of aberrant decision-making (increased delay discounting, high levels of affect-driven impulsivity, greater perseverative decision-making) are associated with problematic eating behaviors, including reward driven overeating, loss of control eating, and rigid dietary restraint. To this end, our study team partnered with NeuroUX to develop a smartphone-based ecological momentary assessment (EMA) to measure the relationships between aberrant decision-making and problematic eating behaviors in a sample of adolescents with overweight/obesity. Parents were also included in the study to further understand the influence of family dynamics and home environment.  

The EMA study design consists of one 7-day assessment period before adolescent participants engage in a 4-month long behavioral weight loss intervention. During the assessment period, parent participants complete 6 signal-contingent surveys throughout the day while adolescent participants complete one signal-contingent morning-only survey followed by 5 signal-contingent surveys throughout the day. Additionally, both adolescents and their parents are instructed to complete an event contingent survey after they engage in an eating episode during the 7-day assessment period. 

EMA surveys include measures to capture factors such as emotional atmosphere at mealtimes, adolescent perceptions of their parent’s helpfulness, physical activity, sleep, and gastrointestinal issues which may moderate the relationship between aberrant decision-making and problematic eating behaviors. Furthermore, NeuroUX has worked with our study team to include two behavioral tasks (Go/No-go and Delay-Discounting) in our adolescent EMA protocol, enhancing the study’s ability to capture trends in decision-making processes and their association with problematic eating behavior. 

Data from this study will improve our understanding of the relationships between facets of aberrant decision-making and problematic eating behaviors which may be targeted in behavioral weight loss treatments for adolescents with overweight/obesity. 


~ Dr. Stephanie Manasse, Center for Weight, Eating, and Lifestyle Science (WELL Center),