Assessing Behavioral and Environmental Facets of Obesity Unobtrusively Utilizing Digital Tools: Introducing the BETTER4U Indicators
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.
Authors
- Eva Karaglani (ORCID: https://orcid.org/0000-0001-5395-7023)
- Maira Bes‐Rastrollo (ORCID: https://orcid.org/0000-0002-9139-4206)
- Dimitrios Aletras
- Anastasios N. Delopoulos (ORCID: https://orcid.org/0000-0001-8220-8486)
- Afroditi Kita (ORCID: https://orcid.org/0000-0002-3714-8493)
- George V. Dedoussis (ORCID: https://orcid.org/0000-0002-7798-6221)
- Aleksandra Łuszczyńska (ORCID: https://orcid.org/0000-0002-4704-9544)
- Ioannis Ioakeimidis (ORCID: https://orcid.org/0000-0002-7208-1722)
- Ana Isabel Rito (ORCID: https://orcid.org/0000-0002-4356-6202)
- Gillian Santorelli (ORCID: https://orcid.org/0000-0003-0427-1783)
- Julie‐Anne Nazare (ORCID: https://orcid.org/0000-0003-3545-3264)
- Maria Kafyra (ORCID: https://orcid.org/0009-0005-9665-0829)
- Alexis Kyriacou (ORCID: https://orcid.org/0000-0003-1695-0580)
- Yannis Μanios (ORCID: https://orcid.org/0000-0001-6486-114X)
- Anna E Ek (ORCID: https://orcid.org/0000-0002-2179-8408)
- Karri Silventoinen (ORCID: https://orcid.org/0000-0003-1759-3079)
- Terho J. Lehtimäki (ORCID: https://orcid.org/0000-0002-2555-4427)
- Anestis Dougkas (ORCID: https://orcid.org/0000-0002-1954-1531)
- Chrysa Episkopou (ORCID: https://orcid.org/0009-0002-6211-5746)
- Ioanna Panagiota Kalafati (ORCID: https://orcid.org/0000-0001-5572-7491)
- Vassilios Fanos
- Louise Seconda
Institutions
- Université Claude Bernard Lyon 1 (FR)
- University of Helsinki (FI)
- University of Thessaly (GR)
- Inserm (FR)
- University of Cagliari (IT)
- Aristotle University of Thessaloniki (GR)
- Mediterranean University (ME)
- Academy of Nutrition and Dietetics (US)
- Karolinska Institutet (SE)
- Harokopio University of Athens (GR)
- University of Cyprus (CY)
- Uniwersytet SWPS (PL)
- Institut National de Recherche pour l'Agriculture, l'Alimentation et l'Environnement (FR)
- Hospices Civils de Lyon (FR)
- Administração Regional de Saúde de Lisboa e Vale do Tejo (PT)
- Navarre Institute of Health Research (ES)
- Centre de Recherche en Nutrition Humaine Rhône-Alpes (FR)
- Tampere University Hospital (FI)
- Istituto Nazionale di Fisica Nucleare, Sezione di Cagliari (IT)
- Tampere University (FI)
- Instituto Nacional de Saúde (MZ)
- Bradford Teaching Hospitals NHS Foundation Trust (GB)
- Bradford Institute for Health Research (GB)
Publication Details
- Journal
- Obesity Reviews
- Published
- 2026-10-15
- DOI
- https://doi.org/10.1111/obr.70242
- Primary Topic
- Mobile Health and mHealth Applications
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- Government of the United Kingdom
- UK Research and Innovation
- European Commission
- HORIZON EUROPE Framework Programme
- Staatssekretariat für Bildung, Forschung und Innovation
- European Health and Digital Executive Agency