Assessing Behavioral and Environmental Facets of Obesity Unobtrusively Utilizing Digital Tools: Introducing the BETTER4U Indicators
Abstract
ABSTRACT Understanding obesity involves evaluating numerous contributing factors. Collecting the necessary data for this can impose a significant burden on both research participants during clinical studies and real‐life deployments of digital tools aiding obesity management. The BETTER4U project (European Union's Horizon Europe, Grant Agreement ID 101080117) introduces 36 behavioral and 9 living environment indicators designed to unobtrusively and efficiently capture daily life through passive monitoring using market‐available smartphones and smartwatches while accounting for environmental confounders. This concise set, intended for dietitians, physical activity experts, and healthcare professionals as a standard for assessing obesity‐related behavior, summarizes the behavioral and environmental profile of a person with obesity/overweight. We present the selected indicators, their selection and implementation methodology and the high‐level plan for their verification, describing their conceptual foundations and technical realization. These indicators can be deployed in a modular framework: by transforming raw sensor data into structured, interpretable measures they provide a scalable foundation for long‐term monitoring of obesogenic behaviors, individual assessment, and evaluation of interventions targeting physical activity, diet, stress, and sleep. The indicators are intended for an expert‐facing dashboard within the BETTER4U Intervention Platform, a participant‐side interface within the BETTER4U application, and as input to the BETTER4U AI‐based causal model, supporting relationship modeling between behavior, environment, and obesity outcomes to inform personalized interventions. This work lays the basis for data‐driven validation of these indicators following the “BETTER4ALL Pilot Study” ( ClinicalTrials.gov ID: NCT07120802), ahead of their use in the BETTER4U RCT among individuals with obesity/overweight.
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Authors: Chrysa Episkopou, Dimitrios Aletras, Afroditi Kita, Aleksandra Łuszczyńska, Maria Kafyra, Eva Karaglani, Yannis Μanios, Maira Bes‐Rastrollo, Anna E Ek, Ioannis Ioakeimidis, Ioanna Panagiota Kalafati, Ana Isabel Rito, Alexis Kyriacou, Anestis Dougkas, Julie‐Anne Nazare, Louise Seconda, Gillian Santorelli, Vassilios Fanos, Karri Silventoinen, Terho J. Lehtimäki, George V. Dedoussis, Anastasios N. Delopoulos
Institutions: Karolinska Institutet, University of Helsinki, Inserm, Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement, University of Thessaly, Lyon 1 Université, Hospices Civils de Lyon, Administração Regional de Saúde de Lisboa e Vale do Tejo, Aristotle University of Thessaloniki, Mediterranean University, University of Cagliari, Istituto Nazionale di Fisica Nucleare, Sezione di Cagliari, Tampere University, Harokopio University of Athens, University of Cyprus, Tampere University Hospital, Navarre Institute of Health Research, Instituto Nacional de Saúde, Bradford Teaching Hospitals NHS Foundation Trust, Academy of Nutrition and Dietetics, Uniwersytet SWPS, Centre de Recherche en Nutrition Humaine Rhône-Alpes, Bradford Institute for Health Research