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A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, and other specified eating or feeding disorders) have a combined prevalence of ...

Karolinska Institutet

Close food proximity leads to increased short-term energy intake, potentially contributing to the long-term development of obesity. However, its precise effects on eating behaviour are still unclear, especially with food available for extended periods of time. This study involved two similar high school student groups (15-17 years old), which had ad libitum access to grapes, chocolates and crackers during an hour-long experimental session. In the distal condition the foods were placed 6 meters away from the students (n = 24), in contrast to the proximal condition (n = 17) were the food was placed near the students. The identification of the type and the quantification of the amount of each food selected, for each individual serving, was facilitated through use of food scales and video recording. In the proximal condition individuals served themselves grapes and crackers more often and consumed more chocolate than in the distal condition. In total, participants in the proximal condition ingested significantly more energy (726 kcal vs. 504 kcal; p = 0.029), without reporting higher fullness. Food proximity also affected the temporal distribution of servings, with the first five minutes of the sessions corresponding to 53.1% and 45.6% of the total energy intake for the distal and proximal conditions, respectively. After the first five minutes, the servings in the distal condition were strongly clustered in time, with many students getting food together. In the proximal condition however, students displayed an unstructured pattern of servings over time. In conclusion, this study strengthens past evidence regarding the important role of food proximity on individual energy intake and, for the first time, it associates continuous food proximity to the emergence of unstructured eating over time. These conclusions, expanded upon by future studies, could support the creation of meaningful intervention strategies based on spatially and temporally controlled food availability.

Objective quantification of the food proximity effect on grapes, chocolate and cracker consumption in a Swedish high school. A temporal analysis.

Manipulating food properties and serving environment during a meal can significantly change food intake at group level. However, the evaluation of the usefulness of such manipulations requires an understanding of individual behavioural changes. Three studies were conducted to explore the effect of unit size and meal occasion on eating behaviour characteristics (food intake, meal duration, number of bites and chews). All studies used a randomised crossover design, with a one-week wash-out period, starting with a familiarisation meal, with the participation of healthy, normal weight females between the ages of 18⁻35 years. In  ( = 19) three cube sizes (0.5, 1.0 and 1.5 cm³) of vegetable hash and chicken were compared. In  ( = 18) mashed potatoes and mincemeat were compared to whole potatoes and meatballs. In  ( = 29) meals served at lunch time (11:00⁻13:00) were compared to identical meals served at dinner time (17:00⁻19:00). The largest food unit size lead to significantly increased meal duration in  (mean difference 0.9 min, 95% confidence interval (CI) 0.0⁻1.8), but not in  (mean difference 1 min, 95% CI 0.1⁻2.0). There was a significant increase in number of chews in the large unit size condition of both  (mean difference 88, 95% CI 12⁻158) and  (mean difference 95, 95% CI 12⁻179). Different serving occasions did not significantly change any of the eating behaviours measured. Except for number of bites in  ( = 0.60), most individuals maintained their eating behaviour relative to the group across unit sizes and serving occasions conditions ( > 0.75), which suggests single meal testing can provide information about the behavioural characteristics of individual eating styles under different conditions.

The Effect of Food Unit Sizes and Meal Serving Occasions on Eating Behaviour Characteristics: Within Person Randomised Crossover Studies on Healthy Women.

School lunches contribute significantly to students' food intake (FI) and are important to their long-term health. Objective quantification of FI is needed in this context. The primary aim of this study was to investigate how much eating rate (g/min), number of food additions, number of spoonfuls, change in fullness, food taste, body mass index (BMI), and sex explain variations in school lunch FI. The secondary aim was to assess the reliability of repeated FI measures. One hundred and three (60 females) students (15⁻18 years old) were monitored while eating lunch in their normal school canteen environment, following their usual school schedules. A subgroup of students ( = 50) participated in a repeated lunch (~3 months later). Linear regression was used to explain variations in FI. The reliability of repeated FI measurements was assessed by change in mean, coefficient of variation (CV), and intraclass correlation (ICC). The regression model was significant and explained 76.6% of the variation in FI. Eating rate was the strongest explanatory variable, followed by spoonfuls, sex, food additions, food taste, BMI, and change in fullness. All explanatory variables were significant in the model except BMI and change in fullness. No systematic bias was observed in FI (-7.5 g (95% CI = -43.1⁻28 g)) while individual students changed their FI from -417 to +349 g in the repeated meal (CV 26.1% (95% CI = 21.4⁻33.5%), ICC 0.74 (95% CI = 0.58⁻0.84)). The results highlight the importance of objective eating behaviors for explaining FI in a school lunch setting. Furthermore, our methods show promise for large-scale quantification of objectively measured FI and eating behaviors in schools.

Food Intake during School Lunch Is Better Explained by Objectively Measured Eating Behaviors than by Subjectively Rated Food Taste and Fullness: A Cross-Sectional Study.

Large portion sizes and a high eating rate are associated with high energy intake and obesity. Most individuals maintain their food intake weight (g) and eating rate (g/min) rank in relation to their peers, despite food and environmental manipulations. Single meal measures may enable identification of "large portion eaters" and "fast eaters," finding individuals at risk of developing obesity. The aim of this study was to predict real-life food intake weight and eating rate based on one school lunch. Twenty-four high-school students with a mean (±SD) age of 16.8 yr (±0.7) and body mass index of 21.9 (±4.1) were recruited, using no exclusion criteria. Food intake weight and eating rate was first self-rated ("Less," "Average" or "More than peers"), then objectively recorded during one school lunch (absolute weight of consumed food in grams). Afterwards, subjects recorded as many main meals (breakfasts, lunches and dinners) as possible in real-life for a period of at least two weeks, using a Bluetooth connected weight scale and a smartphone application. On average participants recorded 18.9 (7.3) meals during the study. Real-life food intake weight was 327.4 g (±110.6), which was significantly lower ( = 0.027) than the single school lunch, at 367.4 g (±167.2). When the intra-class correlation of food weight intake between the objectively recorded real-life and school lunch meals was compared, the correlation was excellent ( = 0.91). Real-life eating rate was 33.5 g/min (±14.8), which was significantly higher ( = 0.010) than the single school lunch, at 27.7 g/min (±13.3). The intra-class correlation of the recorded eating rate between real-life and school lunch meals was very large ( = 0.74). The participants' recorded food intake weights and eating rates were divided into terciles and compared between school lunches and real-life, with moderate or higher agreement (κ = 0.75 and κ = 0.54, respectively). In contrast, almost no agreement was observed between self-rated and real-life recorded rankings of food intake weight and eating rate (κ = 0.09 and κ = 0.08, respectively). The current study provides evidence that both food intake weight and eating rates per meal vary considerably in real-life per individual. However, based on these behaviours, most students can be correctly classified in regard to their peers based on single school lunches. In contrast, self-reported food intake weight and eating rate are poor predictors of real-life measures. Finally, based on the recorded individual variability of real-life food intake weight and eating rate, it is not advised to rank individuals based on single recordings collected in real-life settings.

Predicting Real-Life Eating Behaviours Using Single School Lunches in Adolescents.

Ultra-processed food consumption is a risk factor for obesity and has a negative environmental impact. Food companies spend billions of dollars on advertisements each year to increase the consumption of ultra-processed food. In Australia, USA, and New Zealand, most food advertisements around schools and in train stations promote ultra-processed food, but no similar studies have been conducted in Sweden. The aim of this study was to explore the proportion of ultra-processed food advertisements in two districts of Stockholm, Sweden with low vs. high socioeconomic status (SES).

Ultra-processed food advertisements dominate the food advertising landscape in two Stockholm areas with low vs high socioeconomic status. Is it time for regulatory action?

Eating behavior can have an important effect on, and be correlated with, obesity and eating disorders. Eating behavior is usually estimated through self-reporting measures, despite their limitations in reliability, based on ease of collection and analysis. A better and widely used alternative is the objective analysis of eating during meals based on human annotations of in-meal behavioral events (e.g., bites). However, this methodology is time-consuming and often affected by human error, limiting its scalability and cost-effectiveness for large-scale research. To remedy the latter, a novel "Rapid Automatic Bite Detection" (RABiD) algorithm that extracts and processes skeletal features from videos was trained in a video meal dataset (59 individuals; 85 meals; three different foods) to automatically measure meal duration and bites. In these settings, RABiD achieved near perfect agreement between algorithmic and human annotations (Cohen's kappa κ = 0.894; F1-score: 0.948). Moreover, RABiD was used to analyze an independent eating behavior experiment (18 female participants; 45 meals; three different foods) and results showed excellent correlation between algorithmic and human annotations. The analyses revealed that, despite the changes in food (hash vs. meatballs), the total meal duration remained the same, while the number of bites were significantly reduced. Finally, a descriptive meal-progress analysis revealed that different types of food affect bite frequency, although overall bite patterns remain similar (the outcomes were the same for RABiD and manual). Subjects took bites more frequently at the beginning and the end of meals but were slower in-between. On a methodological level, RABiD offers a valid, fully automatic alternative to human meal-video annotations for the experimental analysis of human eating behavior, at a fraction of the cost and the required time, without any loss of information and data fidelity.

Validation of a Deep Learning System for the Full Automation of Bite and Meal Duration Analysis of Experimental Meal Videos.

Obesity interventions face the problem of weight regain after treatment as a result of low compliance. Mobile health (mHealth) technologies could potentially increase compliance and aid both health care providers and patients.

Formative Evaluation of a Smartphone App for Monitoring Daily Meal Distribution and Food Selection in Adolescents: Acceptability and Usability Study.

Unintentional weight loss has been observed among Parkinson's disease (PD) patients. Changes in energy intake (EI) and eating behavior, potentially caused by fine motor dysfunction and eating-related symptoms, might contribute to this. The primary aim of this study was to investigate differences in objectively measured EI between groups of healthy controls (HC), early (ESPD) and advanced stage PD patients (ASPD) during a standardized lunch in a clinical setting. The secondary aim was to identify clinical features and eating behavior abnormalities that explain EI differences. All participants ( = 23 HC,  = 20 ESPD, and  = 21 ASPD) went through clinical evaluations and were eating a standardized meal (200 g sausages, 400 g potato salad, 200 g apple purée and 500 mL water) in front of two video cameras. Participants ate freely, and the food was weighed pre- and post-meal to calculate EI (kcal). Multiple linear regression was used to explain group differences in EI. ASPD had a significantly lower EI vs. HC (-162 kcal,  < 0.05) and vs. ESPD (-203 kcal,  < 0.01) when controlling for sex. The number of spoonfuls, eating problems, dysphagia and upper extremity tremor could explain most (86%) of the lower EI vs. HC, while the first three could explain ~50% vs. ESPD. Food component intake analysis revealed significantly lower potato salad and sausage intakes among ASPD vs. both HC and ESPD, while water intake was lower vs. HC. EI is an important clinical target for PD patients with an increased risk of weight loss. Our results suggest that interventions targeting upper extremity tremor, spoonfuls, dysphagia and eating problems might be clinically useful in the prevention of unintentional weight loss in PD. Since EI was lower in ASPD, EI might be a useful marker of disease progression in PD.

Lower Energy Intake among Advanced vs. Early Parkinson's Disease Patients and Healthy Controls in a Clinical Lunch Setting: A Cross-Sectional Study.

Anorexia nervosa is one of the more severe eating disorders, which is characterized by reduced food intake, leading to emaciation and psychological maladjustment. Treatment outcomes are often discouraging, with most interventions displaying a recovery rate below 50%, a dropout rate from 20% to 50%, and a high risk of relapse. Patients with anorexia nervosa often display anxiety and aversive behaviors toward food. Virtual reality has been successful in treating vertigo, anxiety disorder, and posttraumatic stress syndrome, and could potentially be used as an aid in treating eating disorders.

Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study.

[This corrects the article DOI: 10.2196/24998.].

Correction: Virtual Reality App for Treating Eating Behavior in Eating Disorders: Development and Usability Study.

Individuals with Anorexia Nervosa are often described as restless, hyperactive and having disturbed sleep. The result reproducibility and generalisability of these results are low due to the use of unreliable methods, different measurement methods and outcome measures. A reliable method to measure both physical activity and sleep is through accelerometry. The main purpose of the study was to quantify the physical activity and sleeping behaviour of anorexia nervosa patients. Another purpose was to increase result reproducibility and generalisability of the study.

Billy Langlet

Department of Neurobiology,
Care Sciences and Society,
Department of Neurobiology, Care Sciences and Society

Karolinska Institutet

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Billy Langlet

.css-o250i3{font-size:18px;font-family:Open Sans,sans-serif;line-height:21.6px;}Department of Neurobiology,Care Sciences and Society,Department of Neurobiology, Care Sciences and Society

Karolinska Institutet

A Computer-Based Platform for Aiding Clinicians in Eating Disorder Analysis and Diagnosis

Department of Neurobiology,
Care Sciences and Society,
Department of Neurobiology, Care Sciences and Society