Over the years, various diet-focused smartphone applications have emerged. The overall intention of these phone applications is to help people lead healthy lifestyles. These phone applications often provide toolboxes that help individuals set goals, make plans to achieve these goals, and to monitor their progress on these goals - a set of capacities referred to as self-regulation (Anderson et al., 2007). Such application design is grounded in research identifying that individual capacities for such goal planning can help facilitate changes in behavior (Anderson et al., 2007, Franco et al., 2016). For example, an individual who desires to increase their daily vegetable intake might make a grocery shopping list, plan in time to go shopping, make a plan for when said vegetables were going to be consumed, and subsequently track their progress. The applications also offer guidance for their users to stay “on track” by adding notifications and positive reinforcement for logging behaviors.
These smartphone applications have the potential to help individuals with specific health-related goals, however they also have the potential to trigger, maintain, or worsen disordered eating symptoms (Miller, 2015). Dieting, in general, has been identified as a potential risk factor for developing eating disorders (Stice, Marti, & Durant, 2011). For example, in a paper reviewing research on pathological dieting, it was suggested that 35% of “typical dieters” developed disordered eating attitudes and behaviors and 15% of those individuals continued to further develop symptoms and meet partial or full criteria for an eating disorder (Shisslak & Estes, 1995). Concerning specific smart application usage, 26.1% of participants in one study described that fitness/exercise/weight loss applications further perpetuated their disordered eating behaviors and attitudes (Tan, Kuek, Goh, Lee, & Kwok, 2016). This is concerning since smart phone use has become such a staple in society. In another study focused on the effects of calorie-counting applications on college students, Simpson and Mazzeo (2017) found that those who identified regular calorie tracking on a smart phone application also endorsed disordered eating. The researchers suggested that monitoring an individual’s caloric intake on a device such as an app, might actually intensify the rigidity associated with calorie counting. This means that the inflexible thinking appears to strengthen as an individual with this characteristic continues to track their calories.
How do health-tracking apps affect individuals with diagnosed eating disorders?
As health-tracking applications have become more and more popular among smart phone users, researchers have started speculating how these apps might affect individuals with diagnosed eating disorders. In 2017, Levinson, Fewell, and Brosof decided to explore this by directly investigating the use of one of these popular applications and its effects on individuals with an eating disorder diagnosis. In this specific smart phone application, users were able to log their weight, food and water intake, exercise, and observe any changes through descriptive charts. The researchers hypothesized that the application would be highly utilized in individuals with diagnosed eating disorders and that a large percentage of individuals would also self-report impairment from using this smart phone application. To investigate this, the study’s 105 participants took the following measures: the Eating Disorder Diagnostic Scale, a brief self-report measure used to diagnose eating disorders; the Eating Disorder Examination-Questionnaire, a 38-item questionnaire designed to measure behaviors and attitudes associated with eating disorders over the past 28 days; and two additional questions asking if the participant used this application to track calories and if they felt the application contributed to their eating disorder. Of the participants, 74.3% reported using this app as a form of calorie counting. Of those individuals, 73.1% identified the app as a contributor to their eating disorder symptoms. This means that the majority of the study’s participants also identified the calorie counting application as a factor that maintained their disordered eating. Moreover, Levinson et al. (2017) found that the more likely a participant was to report that the app had contributed to their disorder, the more likely they were to have increased disordered eating symptoms. This suggests that the use of this application may be a perpetuating factor for certain eating disorder criteria. This finding is consistent with Simpson and Mazzeo (2017) in which they identify that the act of calorie counting may increase the rigidity associated with eating disorders.
Are health-tracking apps always harmful?
It is important to note that not all users of weight management applications move on to develop disordered eating. Research has identified that it is not necessarily about the application, but may be more about the personality traits of the individual using it. It has been suggested that particular personality traits are more susceptible to developing eating concerns. Cassin and Ranson (2005) identified the following traits associated with eating disorders: Obsessive-compulsiveness, impulsivity, sensation-seeking, narcissism, sociotrophy, autonomy, and perfecionism. The act of recording food, water, and exercise on a smart phone may satisfy a piece of someone’s personality. Even so, it is not an absolute that an individual will move on to develop an eating disorder if they possess certain traits and use a weight management app.
For those who have developed eating disorders, treatment-oriented smart phone applications have been created for the purpose of recovery. For example, Recovery Record, an empirically-based application, was specifically designed for individuals with eating disorders with an emphasis on communication between the patient and the treatment team. Using a cognitive behavioral approach, the application allows patients to track and reward their progress while having access to coping skills. Since the app is HIPAA compliant, treatment team members can observe from afar. Applications like Recovery Record have the potential to be beneficial in conjunction with therapy (Juarascio, Manasse, Goldstein, Forman, & Butryn, 2015).
Weight management applications have become popular in the age of the smart phone. They are easily accessible at the tip of your fingers. Though they have the potential to be a beneficial source of support for specific health-related goals, they can also be detrimental to individuals with eating disorders. Research has been conducted on specific “Healthy Eating” applications and has suggested that it can contribute to an individual’s eating disorder symptoms (Levinson et al., 2017). This is an important finding because clinicians and patients can be more skeptical of their usage. This is especially significant for those that struggle with rigidity and inflexible thinking (Simpson & Mazzeo, 2017). With younger and younger children using smart phones, this reinforces the importance of parents of individuals with eating disorders to be mindful about the type of support their child receives from smart phone applications. Even so, it does not mean individuals who use weight management applications will develop or continue to have eating disorders. For those with disordered eating, empirically-based applications now exist as a healthier means towards recovery. Thus, when deciding whether to track your daily intake, it would be important to take into account whether the type of application will be mentally and physically healthy for you and then to be a careful observer of what happens to your food and body preoccupation in the weeks following initiation of an app. Be your own wise investigator: keep what works, have support people observe and contribute what they notice, and be willing to switch strategies if an app does not seem to be in your best interest.
By Chantal Gil, PsyD
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