Developing a Personalized Virtual Coach for Emotional Eaters 31 2 Introduction The fast growth of obesity is a major threat to society. Treatment of obesity and obesityrelated conditions imposes a heavy societal burden due to high healthcare costs, reduction of life spans and increased risk of developing other chronic conditions such as diabetes, heart disease, osteoarthritis, and certain cancers [1-4]. Obese patients often suffer from psychological comorbidities, such as depression and low self-esteem [5]. Obesity is defined as an abnormal or excessive fat accumulation that may impair health and is classified as such by a Body Mass Index (BMI) of 30 kg/m2 or higher [6]. Nearly 50% of the Dutch population suffer from being overweight and 12% from obesity [5]. Obesity is associated with poor eating habits and lack of physical activity, unhealthy family lifestyle and low socio-economic status. Increasing physical activity and reducing food intake (dieting) are considered cornerstones in the prevention and treatment of obesity. However, though many of the existing interventions are successful and help patients lose weight in the short run, long-term randomised studies demonstrate that “diets are not the answer” [7]. Existing interventions and online weight loss programs, such as Weight Watchers [8], My Diet Coach [9] and Lose it! [10] focus primarily on the ‘Big Two’ aspects, namely: eat less, exercise more. They do not provide the necessary support in the long run, as people are unable to maintain their bodyweight over a longer period. Emotional eaters and obesity Recent studies have shown that a considerable group (40%) of the obese population overeat due to negative emotions [11]. Emotional eating is an atypical stress reaction. A normal reaction to stress and negative emotions would be loss a of the appetite. Emotional eaters show this atypical behaviour because they confuse negative emotions with hunger. They have a narrow view of what happens in their bodies (poor interoceptive awareness) and they are experiencing difficulties identifying and describing emotions and feelings (alexithymia). Emotional eaters are facing problems with emotion regulation – the ability to keep one’s emotional system in a healthy condition [12]. Diets and behaviour therapies do not help people with high degrees of emotional eating as they do not tackle the underlying emotional regulation difficulties, that lead to emotional eating [13-14]. Most emotional eaters have a long history of dieting, followed by the inevitable overeating and starting dieting again. They gain weight because of poor emotion regulation, not just due to poor eating habits or an insufficient level of physical activity [15]. Many times, they have tried to lose weight and when the emotional eating behaviour kicked in again, they ended up being heavier than when they started their previous
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