Post-Meal Activity and Eating Disorder Behaviors: An Ecological Momentary Assessment (EMA) Study

Mealtimes are associated with heightened distress among individuals with eating disorders (EDs) and are frequently accompanied by ritualized eating behaviors that maintain psychopathology. In inpatient settings, post-meal rest is commonly prescribed to prevent compensatory behaviors. Yet, enforced inactivity may exacerbate anxiety and ritual engagement. This study used ecological momentary assessment (EMA) to examine whether structured light post-meal activity is associated with a reduced likelihood of ritualized eating behaviors in an inpatient ED sample.

Participants were 33 inpatients who completed a 2-week counterbalanced within-subject crossover protocol, consisting of 1 week of standard post-meal rest and 1 week allowing structured light post-meal activity. EMA prompts were delivered six times daily. Ritualized eating behaviors were assessed following reported eating episodes and coded dichotomously. A binomial generalized linear mixed-effects model with random intercepts for participants tested whether the likelihood of ritualized eating behaviors differed between conditions.

Participants completed 1503 EMA prompts (81.3% compliance). Across 1192 meal-related assessments, ritualized eating behaviors were reported in 30.8% of prompts during the rest condition and 24.2% during the post-meal activity condition, with substantial variability across individuals. Participants were significantly less likely to engage in ritualized eating behaviors during weeks allowing post-meal activity compared with rest-only weeks (B = -0.70, SE = 0.19, p = 0.0002), corresponding to an ~50% reduction in odds.

The findings suggest that supervised post-meal movement may help interrupt ritual engagement during a high-risk period and demonstrate the utility of EMA for examining behavioral mechanisms in inpatient care.