Michal Čevelíček

Is it important to talk about technologies with eating disorder clients? The health care professional perspective

ABSTRACT Nowadays, the use of digital technology is an important issue that should be addressed during the treatment of people who have eating disorders. The involvement or absence of this issue reflects the understanding, experience, and atttude of health-care professionals toward their clients’ use of technology. The aim of the present study was to investigate the perceptions of health-care professionals and their assessment of their clients’ usage of digital technology while developing strategies for treatment. Semistructured interviews with 30 professionals were performed from October 2015 to June 2016 and a thematic analysis was used to analyze the data. The health-care professionals’ views could be summarized in three thematic groups: (1) technology use is not relevant for the cooperation; (2) technology use is relevant for the cooperation and addressed generally; and (3) technology use is relevant for the cooperation and addressed specifically. The results are discussed in relation to the theoretical model presented by Rodgers about the impact of technology on disordered eating behaviors and the implications for practice.

Professionals’ Reflections About the Impact of Digital Technologies on Eating Disorders

ABSTRACT The aim of this study was to explore how professionals working with clients who suffer from eating disorders reflect the impact of digital technologies on their clients. Interviews with 30 professionals were conducted. A qualitative analysis revealed the following areas: (a) the attributes of technologies that influence people with eating disorders, (b) the characteristics of people with eating disorders that influence their interaction with digital technologies, (c) the risks of technology usage, and (d) the benefits of technology usage. The results are discussed with respect to the Rodgers’s theoretical model explaining technology–eating disorder relations and the implications for practice.

Conclusions of the Book: Risks and Benefits of Digital Technology in Eating Behaviors and Eating Disorders

This chapter provides concluding remarks concerning the topics discussed throughout the whole book. First, it discusses the complexity of the studied problematic areas and points out several issues important to consider in the assessment of the impact of technology—specifically, what users perceive as beneficial might not be seen as beneficial from the point of view of society. Second, technology usage is a complex process that can result in a variety of outcomes, which may be either intended or unintended. Third, it is crucial to consider these factors on individual, social, and national levels, which are all connected to eating behaviors and technology usage. The chapter then summarizes the major risks and benefits related to topics discussed in each chapter. It specifies how digital technology usage depends on the needs, motivations, and goals of its users, which determine both the expected benefits and potential risks of their usage. This is shown in every major topic of this book, including selection and evaluation of information online, impact of media on body image, membership in online groups and communities, as well as usage of mobile health tools and applications. Then, the focus is given specifically to risks and benefits connected with usage of digital technology among people with eating disorders, issues for professionals who work with these people, and its potential for the prevention and treatment of eating disorders. Next, the chapter discusses challenges and limitations of current research on eating behaviors and technologies. In this regard, it is demonstrated how dominant attention is given to risky or beneficial phenomena but that we lack more robust knowledge about “normal eating behaviors,” which means the eating behaviors of the majority of the population. Moreover, methodological aspects are considered, such as problematic measurement and difficulties connected with sampling. Specific attention is given to the potential of further development of technologies, such as usage of smart technologies, new types of wearables, and the impact of augmented and virtual reality. These areas may be influential in the future, but their role has not yet received substantial research attention; therefore, they are not explored within this book. Final remarks are provided with regard to the overall development of technologies and their role in our lives.

Digital Technology, Eating Behaviors, and Eating Disorders

This book examines in depth the multifaceted roles of digital technologies in the eating behaviors and eating disorders. Coverage reflects a broad theoretical and empirical knowledge of current trends in digital technology use in health behaviors, and their risks and benefits affecting wellbeing, with focus on eating behaviors and eating disorders. The authors use both qualitative and quantitative data to focus on the digital lived experiences of people and their eating related behaviors. Among the topics covered: The quality of eating-oriented information online; Technology, body image, and disordered eating; Eating-oriented online groups; Using mobile technology in eating behaviors; Usage of digital technology among people with eating disorders; What healthcare professionals should know about digital technologies and eating disorders; Technology-based prevention and treatment programs for eating disorders

Using Mobile Technology in Eating Behaviors

The proliferation of digital technology among the population has caused an increased usage of health-oriented software and mobile applications, called mHealth. These are used for health services, information searches, communication about health, and monitoring health-oriented data. This chapter describes the usage of mobile technologies in health-related contexts, with special focus on eating behaviors and eating disorders. First, the chapter uncovers who are the principal users of mHealth apps. The studies report shares of mHealth app users from 20% to 56% in Euro-American countries. They also tend to be younger and have higher education. Next, the chapter identifies the mHealth apps that are used in health-related contexts, such as providing health-related education for patients or healthcare workers, patient monitoring mHealth tools, compliance and adherence apps, apps focused on behavioral change, and apps for remote data collection or monitoring, and also what are mHealth apps for healthy eating, dieting, and eating disorders. The chapter also reveals the functions of mHealth tools which are used to fulfill relevant health-related goals: planning, reminding, monitoring (e.g., calories, weight, BMI, exercise), providing feedback, counting steps, sleep monitoring, or social functions, such as communication and comparing to other users of mHealth. Next, the chapter describes the impact of mHealth tools on its users, which has been mostly found to be positive. The use of mHealth tools has the potential to motivate users toward positive behavioral change, such as weight management and healthy eating. The gamification principles can increase the motivation of mHealth users and improve the effectiveness of mHealth. Concerning eating disorders, the mobile apps can have both positive and negative impacts. Some people with eating disorders use apps to support their illness, but the apps can also help to support their treatment.

Technology-Based Prevention and Treatment Programs of Eating Disorders

The present chapter provides an overview of prevention and treatment strategies using digital technologies to target eating disorders. We review the development of the prevention and treatment discourse, which has added digital technologies to its repertoire of tools in the last two decades. Next, we review current research on approaches proven effective in technology-based prevention and treatment of eating disorders, we sum up the advantages and limitations of the use of digital technologies in this field, and we give specific examples of current prevention and treatment programs. We put more focus on methods proven effective in treatment and prevention of eating disorders, so that professionals can access knowledge which may be applied in their practice. Further, we discuss some of the basic conditions identified in research as essential for technology-based methods of prevention and treatment to be effective. For prevention, these conditions include the focus on specific characteristics of vulnerable populations, interactivity, and multi-session structured programs. In the case of treatment, psychotherapy using technology as a communication medium and guided technology-based self-help were superior to strategies which rely on unguided self-help. Generally, technology-based prevention and treatment have been proven as efficacious and cost-effective in reducing characteristics related to eating disorders. However, there is some evidence that face-to-face approaches may be more effective. In the case of prevention, it is much more difficult to reduce the incidence of eating disorders than to reduce of some eating disorders related characteristics in people.

Technology, Body Image, and Disordered Eating

The present chapter is intended to provide a theoretical and empirical overview of the link between technologies, body image, and eating behavior, particularly disordered eating. In general terms, body image refers to an individual’s self-perception and cognitive appraisal of his or her own body. On the other hand, disordered eating refers to a wide spectrum of eating patterns characterized as being detrimental to health, such as self-induced vomiting. Both body image and disordered eating have been linked to mass media exposure. The majority of research to date has focused on the influence of mass media on body image attitudes, which, in turn, can shape eating patterns. Nevertheless, the influence of technology on body image and eating behavior goes far beyond mass media technologies. For instance, several decades ago, it was not possible to use the human body to communicate with machines, and now that can be done, using brain-computer interfaces. We have divided this chapter into two major sections. The first explores key concepts related to body image and develops three theoretically and empirically grounded major frameworks: a cognitive-behavioral model, a sociocultural model, and a cognitive neuroscience perspective. In the second section, we use those concepts to demonstrate the influence of both traditional media (e.g., television, magazines), and new media (e.g., the Internet) on body image and disordered eating. Moreover, we provide current evidence showing how immersive digital technologies, such as virtual reality, can be used for improving body image among individuals with eating- and weight-related pathologies. Finally, we provide some hypotheses on how emerging technologies (e.g., smart devices) could influence body image and eating behavior in the future.

Introduction: Digital Technology, Eating Behaviors, and Eating Disorders

The first chapter of this book introduces the role of digital technology in eating behaviors and eating disorders. It provides information concerning the prevalence of digital technology usage within current society and depicts questions that have been asked with regard to the consequences of this behavior. Then it defines the key terms of the book: eating behaviors and eating disorders. With regard to eating behaviors, the chapter illustrates the book’s complex perspective upon the description of the theoretical model, which is comprised of factors on the levels of individuals, social environments, physical environments, and macrosystem. Eating disorders are presented as a specific form of unhealthy eating behaviors and are also described in relation to diverse factors contributing to their development. Then the concepts of eHealth and mHealth are defined and framed within the book’s perspective. Then, it is specified how the book focuses on a broad continuum of possible effects of digital technologies, from those enhancing healthy eating behaviors to those that encourage disordered eating. Finally, the introduction provides a short summary of all book chapters. It specifies what readers can expect from the book’s two main sections, the first of which is focused generally on the role of digital technology in eating behaviors, while the second specifically addresses the issue of this role in eating disorders development, as well as treatment. Specifically, it is described how the book provides deeper insight into issues such as the role of digital technology in health, the problematic nature of information accessible online, the impact of technology on body image, the social influence or social support found in online groups, and the use of mobile technology in eating management. In the second section, specific attention is given to the issue of eating disorders, which are discussed with regard to the experiences with digital technology of users with this disorder, recommendations for healthcare professionals, and a review of prevention and treatment programs using digital technologies.

Digital Technology and Health: A Theoretical Framework

The chapter provides an overview of the impact of technology use on human health. Nowadays, new communication technologies are widely used to address health issues. These technologies provide opportunities both to gather information and to easily communicate with health specialists or others to maintain, monitor, or optimize individual health. This chapter describes specific technology-based environments that deal with matters of health. These include websites, discussion boards, social networking sites, blogs, online video-sharing platforms, and mobile/wearable devices. The chapter then presents the most prominent theoretical frameworks mentioned in the research to illustrate and explain the relationship between the digital technology and health. Theoretical models depicted in the chapter provide a framework for explaining why people chose certain health-related media over others, the likelihood that individuals will adopt a new technology for treating health issues, the impact of excessive time spent using technology on health, and also health behavior change. Moreover, the effects of technology use on specific components of health (mental, social, and physical well-being) are discussed. There is a variety of positive effects of technology on health, such as delivering cost-effective, tailored health promotion, enabling social contacts, and providing a large amount of health-related information. However, research has revealed several risks associated with technology use, such as higher risk of stress, Internet addiction, or specific unfavorable health conditions, such as overweight, obesity, or eating disorders.

The Quality of Eating-Oriented Information Online

The chapter presents an overview of the main issues concerning the seeking and assessment of online information related to health and eating behaviors. It provides an overview of the prevalence of online health information and introduces salient factors related to the tendency to seek online information. Specifically, it discusses the role of demographics, digital and eHealth literacy, health status, and trust and distrust of diverse sources. The chapter then elaborates on the specific character of the online information with a discussion of the benefits and risks connected with its use, specifically related to quality. In this regard, the role of source expertise as well as perceived trustworthiness of diverse online and offline sources is discussed. The chapter also provides concrete examples of potential harms connected with the use of low-quality information and several examples of research evaluating health information that are available on different kinds of platforms. The last section explains how the highly variable quality of online information and absence of traditional gatekeepers raised demands for the end users in terms of their assessment of the information. It focuses on the process of the assessment of online information, specifically with regard to questions concerning evaluation of its credibility. The chapter presents the dual processing models which provide useful theoretical frameworks in the area of credibility studies, namely, the Elaboration Likelihood Model and the Heuristic-Systematic Model. Then, three specific theoretical models used in online credibility research are depicted: Metzger’s Dual Processing Model of Credibility Assessment, Fogg’s Prominence-Interpretation Theory, and Sundar’s MAIN model. Using these models, the assessment of information is described, with specific focus on the role of diverse online cues in users’ evaluation and the role of individual differences. Attention is given to diverse types of heuristics that guide users’ evaluation and judgment formation concerning the credibility of online information. Moreover, it is shown how this process is affected by literacy skills, motivation, and awareness about potential consequences for the user. Using this framework, the chapter focuses on several issues and examples specifically connected to the assessment of health and eating-oriented information. Finally, users’ abilities to assess health information, as well as the role of motivation in this process, are discussed. The chapter shows how searching and assessment strategies can often lead to low-quality content and stresses the role of eHealth literacy as a skill that helps yield more reliable outcomes of information search.