Maintenance Factors for Eating Disorder Symptoms Based on Ecological Momentary Assessment Studies: A Systematic Review
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Abstract
Several prominent theories of eating disorders maintenance exist, with most corresponding to evidence-based treatments. Ecological momentary assessment (EMA) is an ideal method for testing relationships between proposed maintenance factors and eating disorder symptoms given its ability to examine antecedents and consequences. A seminal systematic review and meta-analysis of EMA studies on affect and binge eating was published in 2011, but the literature since this time and beyond these variables has not been synthesized. We searched PsycINFO, MEDLINE, and Scopus (last search March 31, 2025) for articles using EMA to study psychological/contextual variables in relation to a core eating disorder symptom in people with an eating disorder or eating disorder symptom. After screening, 179 papers were included. The majority examined affect in relation to binge eating or loss of control (LOC) eating, although affect was also considered in relation to purging, restriction, exercise, and body checking. Whereas negative affect primarily drives binge eating/LOC eating and purging, positive affect appears more relevant for exercise and (perhaps) restriction. Surprisingly few studies have considered how ED-related cognitive, affective, or behavioral variables relate to eating disorder symptoms, despite these being primary associations in leading maintenance/treatment models of eating disorders. Most studies have investigated samples of exclusively women, with some having a small proportion of male participants, and only two samples were comprised of all or almost all men. Future EMA research on eating disorders should go beyond studying affect to test whether relationships proposed in established maintenance models can be observed in daily life.
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This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17714858.
This research is an up to date systematic review of maintenance factors and eating disorder symptoms as measured by ecological momentary assessment (EMA). Most papers included in the review related to binge eating or loss of control (LOC) eating, with 179 included in total. Positive and negative affect were the main focus of the EMA questions in these studies, and the authors of this review highlight areas for more eating disorder specific processes being addressed in EMA studies. The review demonstrates how more research which tests the theoretical models of eating disorders against day-to-day mechanisms is needed to best utilise the EMA methodology and investigate treatments more …
This Zenodo record is a permanently preserved version of a PREreview. You can view the complete PREreview at https://prereview.org/reviews/17714858.
This research is an up to date systematic review of maintenance factors and eating disorder symptoms as measured by ecological momentary assessment (EMA). Most papers included in the review related to binge eating or loss of control (LOC) eating, with 179 included in total. Positive and negative affect were the main focus of the EMA questions in these studies, and the authors of this review highlight areas for more eating disorder specific processes being addressed in EMA studies. The review demonstrates how more research which tests the theoretical models of eating disorders against day-to-day mechanisms is needed to best utilise the EMA methodology and investigate treatments more effectively.
Major strengths
Updates existing literature review findings in the field using the more ecologically and temporally valid method of EMA.
Indicates a distinction between positive and negative affect in their association with different eating disorder symptoms, providing a target for future study focus depending on symptoms of interest.
Highlights a lack of contextual factors included in EMA data collection which would add variables of interest to mechanism investigations.
Moderate issues
Cohen's kappa is unreported for data extraction or quality but it is for other measures. Transparency about the selection process for data going into this meta-analysis is important in understanding the findings, and this can be calculated and reported alongside the other Cohen's kappa scores.
Minor issues
More details of the risk of bias assessment would help an understanding of how the studies were selected on quality. For instance, some indication of why existing tools like ROBIN-E weren't used.
Cohen's kappa for title and abstract screening is low, and authors could explain why there might be low interrater reliability here.
No mention of missing data in other studies.
Reporting using the 'SWiM' – Synthesis Without Meta-Analysis – guidelines may bolster the claims made about the studies included in this systematic review.
Indicating how the methods used map onto Cochrane standards would help to contextualise the findings.
Competing interests
The authors declare that they have no competing interests.
Use of Artificial Intelligence (AI)
The authors declare that they did not use generative AI to come up with new ideas for their review.
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