Ecological Momentary Interventions in the Management of Eating Disorders and Obesity: A Systematic Review

This systematic review evaluated the feasibility, efficacy, adherence, and methodological quality of ecological momentary intervention (EMI)-based treatments for individuals with diagnosed eating disorders (EDs) and/or obesity.

Eight electronic databases were systematically searched from inception to January 2026. Randomized, non-randomized, and uncontrolled studies evaluating EMI-based treatments for individuals with diagnosed EDs and/or obesity were included. Data on intervention characteristics, clinical and behavioral outcomes, feasibility, acceptability, and adherence were extracted. Risk of bias was assessed using RoB 2 and ROBINS-I, and findings were synthesized narratively.

Fourteen studies met inclusion criteria (eight obesity-focused, six ED-focused), including nine randomized controlled trials. In ED studies, EMI-augmented interventions were associated with significant within-group reductions in binge-eating frequency and ED psychopathology. However, superiority over active cognitive-behavioral therapy-based controls was inconsistent and primarily observed during maintenance phases. Obesity-focused trials demonstrated small to moderate within-group improvements in weight-related outcomes, with generally small and non-sustained between-group effects. Feasibility and acceptability were generally high, although retention and engagement varied across studies. Risk of bias was low in most randomized trials but higher in non-randomized studies.

EMIs appear to be a feasible and acceptable approach for extending evidence-based treatments for EDs and obesity into daily life. Current evidence suggests that EMIs may exert a beneficial adjunctive effect by enhancing engagement and improving short-term behavioral outcomes. However, their impact on long-term clinical outcomes remains limited and inconsistent, underscoring the necessity for conducting rigorously designed clinical trials with extended follow-up periods.