Preferences for coaching strategies in a personalized virtual coach for emotional eaters 109 5 Introduction With 13 percent of the world’s adult population, 18 years and older, suffering from obesity3 and 39 percent meeting the criteria of being overweight [1], both health care and public health need to find additional approaches, such as virtual coaching systems, to combat this pandemic. Emotional eating is the tendency to overeat in response to negative emotions, and is considered a risk factor for weight gain, obesity and eating disorders [2-9], and is seen as a key characteristic of overeating and binge eating. Emotional eating is an atypical stress response. A normal reaction to negative emotions, such as stress, is a loss of appetite, prompted by bodily reactions that prepare humans for a fight or flight response, suppressing appetite [10-12]. Therefore it is our aim to develop a personalized virtual coach that focuses on counteracting emotional eating, here defined as the urge to (over)eat in reaction to negative emotions [13-14]. Face-to-face therapy and counseling, such as personal coaching, personal feedback, and education, as provided in behavioural therapies such as Cognitive Behaviour Therapy (CBT), and Dialectical Behaviour Therapy (DBT), are effective means of helping the emotional eater [4, 15-21]. However, to prevent or reduce emotional eating behaviour and getting adequate help in time to the recipient is not always easy. Firstly, the patient or client is often distanced from health care (because of shame or embarrassment). Emotional eaters will have difficulties contacting care providers on their own initiative. Secondly, therapists are not available when the need is most urgent for the emotional eater. We distinguish two proto-typical problem situations here 1) when experiencing cravings or 2) just after having given in to cravings [21-22]. Thirdly, health care is overburdened – the waiting lists are very long. There is too little specialist care available for this specific group of patients. And lastly, this patient group should have a greater presence in the public health system as emotional eating is a risk factor for weight gain and obesity. In order to improve right-on-time coaching for emotional eaters, providing ehealth solutions may be a good addition to existing treatments [23-28]. Digital technologies have demonstrated that they can provide user-friendly solutions in the capacity of smartphone applications that offer appropriate exercises or personalized content. A personalized virtual coach might assist the user by providing good advice, education, 3 For adults, WHO defines overweight and obesity as follows: overweight is a BMI greater than or equal to 25; and obesity is a BMI greater than or equal to 30. The abbreviation BMI stands for Body Mass Index.
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