More on EMA and Childhood Obesity


Recently we discussed a study carried out by a team from Children’s Hospital of Pittsburgh, and specifically from the Weight Management Center, combining Ecological Momentary Assessment (EMA) and Ecological Momentary Intervention (EMI). These researchers, who of course looked at previous studies before designing their own, mentioned a troubling side note — one indicating that, as always, more research is needed:

Moreover, given exclusion criteria in many pediatric obesity trials, children with mood disorders (depression) and medical comorbidities (sleep problems) do not receive the interventions. Domains such as mood and sleep may be essential dimensions of assessment as mediators or moderators of weight-loss treatment.

A 2010 study looked into “the feasibility, acceptability, and validity” of an EMA protocol using mobile phones. There were 121 kids between the ages of 9 and 13. The number of girls and boys were very close to equal, and 40% of the subjects were either already overweight or at risk.

They were monitored mostly outside of school hours, from Friday afternoon to Monday evening, and were surveyed between three and seven times per day. The report says:

Items assessed current activity (e.g., watching TV/movies, playing video games, active play/sports/exercising). Children simultaneously wore an Actigraph GT2M accelerometer. EMA survey responses were time-matched to total step counts and minutes of moderate-to-vigorous physical activity (MVPA) occurring in the 30 min before each EMA survey prompt.

The ideas behind EMA and EMI are obviously proliferating, reaching such institutions as the Center for Childhood Obesity Research. The Center conducts interdisciplinary research to help build the evidence base that will hopefully reveal what causes the increasingly alarming statistics.

The officials who make policy need to know these things, and so do clinical practitioners and therapists of all kinds. The Center’s literature states:

This center combines the research strengths of the College of Health & Human Development, including preventive interventions; attention to biology, behavior, and family relationships; medical and community partnerships; and real time ecological momentary assessment of health via data from sensors, accelerometers, and smartphone technology.

Making use of data already collected and curated, researchers in Warsaw, Poland, conducted a meta study whose results were published in 2013. Their goal was to “assess the value of ecological momentary assessment in evaluating physical activity among children, adolescents, and adults,” and also determine whether EMA lives up to the urgent need for validity, reliability, objectivity, norms, and standardization.

Frankly, there was not that much to pick from, because the whole notion of using EMA to evaluate kids’ physical activity is relatively new. The team looked at 20 journal articles, all concerning studies in which EMA procedures were “precisely documented and confirmed to be feasible.” The conclusions were:

Ecological momentary assessment is a valid, reliable, and feasible approach to evaluate activity and sedentary behavior. Researchers should be aware that while ecological momentary assessment offers many benefits, it simultaneously imposes many limitations which should be considered when studying physical activity.

Out of the 20 articles team scrutinized, 14 addressed physical activity versus sedentary lifestyle in kids and teens, and six were about EMA and adults. They found that the electronic tools like phone surveys and electronic diaries are used more with the younger set. Now, what about measurement characteristics?

The findings demonstrate that the EMA approach constitutes a valid, reliable, and feasible measurement tool, which clearly indicates that EMA can be considered a suitable method for assessing PA among children, adolescents, and adults.

Your responses and feedback are welcome!

Source: “Utilizing Ecological Momentary Assessment in Pediatric Obesity to Quantify Behavior, Emotion, and Sleep,”, December 2009
Source: “Investigating children’s physical activity and sedentary behavior using ecological momentary assessment with mobile phones,”, December 2010
Source: “The Center for Childhood Obesity Research,”, undated
Source: “Using Ecological Momentary Assessment to Evaluate Current Physical Activity,”, July 2013
Photo credit: kellybdc via Visualhunt/CC BY

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About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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