Living F.R.E.E. (Focused on Reducing Excessive Eating) Lab
Creating a Digital Eating Disorder Intervention for Black Women
CORE TEAM
Rachel Goode, Ramine Alexander, Sarah Godoy, Tyisha Harper
Since 2017, led by Director Dr. Rachel Goode, assistant professor in the School of Social Work, the Living F.R.E.E. (Focused on Reducing Excessive Eating) Lab has been pursuing a range of initiatives to develop and evaluate non-diet interventions to treat and prevent obesity and its associated conditions. These pathbreaking initiatives have already garnered the lab nearly $1.5 million from major funders including the National Eating Disorders Association; the National Institutes of Diabetes, Digestive, and Kidney Diseases; and the American Diabetes Association.
A set of recent lab projects center on eating disorders among Black women, among the U.S. populations most affected by obesity and least served by eating disorder support services. To Goode, these disparities highlight broader historical trends in the evidence base of eating disorder research. “Eating disorder knowledge has traditionally grown out of samples of thin, affluent White women,” Goode noted, “but anyone can be impacted by an eating disorder.”
With funding from the National Institutes of Health ($800K), Goode’s lab is enriching the eating disorder evidence base in order to design the first digital health intervention for treating binge eating and obesity tailored to Black women. Not only that, Goode added, “Black women are going to inform this intervention at all levels.”
The lab is building this intervention from the ground up, beginning by collecting interview data from a sample composed exclusively of Black women who report binge eating. This data provided Goode’s team with invaluable insights into culturally relevant facilitators of binge eating among Black women, such as negative emotions stemming from racism, or understandings of eating as a means of self-care.
I avoid recommending many health apps to my clients because they risk promoting disordered eating or an unhealthy relationship to exercise. LISTEN solves this issue: it engages clients in health behavior change from an eating disorder-informed perspective, so that we’re not creating mental health problems as we try to solve physical ones.
SARAH STERLING, MSW, LCSW,
LCAS Team Lead, Behavioral Weight Management, UNC Chapel Hill Department of Family Medicine
From this analysis, Goode’s team has already designed and beta tested LISTEN, a three-month digital health intervention for binge eating and weight stabilization among Black women. Via online learning modules developed from prior research evidence and initial interview data, LISTEN shows participants how to listen to and honor their body’s signals of hunger and fullness.
LISTEN’s digital design is intended to break down disparities in treatment access faced by Black women, who are less likely to be diagnosed with eating disorders in primary care settings, and less likely to seek treatment once diagnosed. “Primary care doctors are often uncomfortable or unfamiliar with eating disorders, and instead talk to patients about weight,” said Goode. “Our hope is that LISTEN will provide doctors with an accessible, evidence-based, and culturally relevant intervention to offer to patients with disordered eating.”
The next step, planned for 2023, is to recruit 60 participants for a randomized control trial — the gold standard trial design for establishing evidence of program effectiveness — of an intervention including LISTEN’s online modules, weekly weighing, Fitbit activity monitoring, and meetings with a dietician or counselor.
Goode’s aspiration is to develop LISTEN into a full-scale eating disorder and weight management integrated treatment offered in primary care settings, where Black women are more likely to seek care for weight management than for disordered eating, though the two may be related. Eating disorder and weight management clinicians have been “talking to the same issue at different places,” observed Goode. By drawing together two persistently siloed care fields under one roof, patients will have a continuum of resources that address and show the possible connections between co-occurring issues, such as binge eating and weight gain.
by Jordan Wingate
The Big Picture
- $800,000 funding from the National Institutes of Health
- $1.5 million in grant funding since the Lab’s inception in 2017
- Five currently active grants, two from federal funders
Advancing equity. Transforming systems. Improving lives.
UNC School of Social Work
The University of North Carolina at Chapel Hill
Tate-Turner-Kuralt Building
325 Pittsboro Street | Campus Box 3550
Chapel Hill, NC 27599-3550