Perspectives on remote monitoring via smartphones and wearables among individuals with lived experience or at risk of eating disorders (“This could go very, very wrong”): qualitative interview study

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Background: Remote measurement technology (RMT) is increasingly used in health research to collect real-world data relevant to clinical states (e.g., sleep, activity, stress). Concerns exist about the impact of remote tracking via personal devices and wearables on individuals with or at risk of eating disorders by promoting a focus on exercise, diet and appearance. There is a lack of research applying RMT to eating disorders. Objective: This study aimed to examine how smartphone- and wearable-based RMT influence eating-, exercise- and weight-related experiences among individuals with or at risk of eating disorders, and to identify perceived benefits, harms, and recommendations for their use in this population. Methods: Fourteen semi-structured interviews were conducted with former participants of RADAR-MDD, a two-year digital health study tracking depression outcomes via RMTs. Participants were included in this follow-up if they had disclosed a comorbid eating disorder or were within the at-risk age range (18-30) for eating disorders during RADAR-MDD and classified as at-risk (Eating Disorder Diagnostic Scale). Interviews explored the impact of app engagement and wearables (‘Fitbits’) on food, activity and weight-related behaviours and attitudes. Thematic analysis was adopted using a template approach to capture themes guided by the focus on eating disorder-relevant domains. Results: Six themes captured participants’ experiences with RMTs. Many appreciated the convenience and reflective potential, while some described emotional strain linked to constant self-tracking. Health data impacted participants’ eating and exercise habits through a dynamic process from awareness to cognition to action, fostering healthy routines or reinforcing obsessive patterns, depending on emotional state, eating disorder presentation and recovery stage. Participants with greater self-insight used self-tracking more intentionally by supporting recovery or avoiding known triggers. Recommendations for future studies in eating disorders stressed balancing autonomy with safeguards for vulnerable individuals. Conclusions: Findings offer an important foundation for understanding how RMTs impact individuals with eating disorder experiences, suggesting these technologies may not be inherently beneficial or harmful but shaped by age, distance from active illness and contextual factors. Self-tracking may mirror illness stage, supporting recovery when met with insight, but reinforcing compulsions during vulnerable phases. This underscores the need for sensitive RMT designs in eating disorder research tailored to the study population, including device selection, restricted data access and transparent communication.

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