Belinda Gorsuch, National Center for Health Research
December 15, 2022
It seems there is an app for everything. About 69% of adults track health indicators, such as steps, calories, and hydration [1]. But, has fitness tracking technology gone too far? Some believe our phones can help us improve our diet and exercise routines. Others claim fitness apps have branded obsessive behaviors as healthy without considering the consequences. To understand these questions, several studies reveal the good, the bad, and the future of fitness tracking technology.
Fitness apps have proven effective in helping people lose weight. A meta-analysis of data from 41 studies found that the average body mass index score (BMI) across the studies dropped significantly for the participants who used mobile fitness apps compared to those who didn’t [2]. Successful weight loss strategies are hard to come by, so this positive performance is appealing. For instance, clinicians might use apps to help patients manage their weight problems. However, evidence suggests these apps can be problematic and used in an unhealthy manner.
Unfortunately, people who use fitness apps are also most likely to misuse them. Telephone surveys found fitness apps are most popular among college educated women ages 18-29 [1]. Young, college-educated women are also especially susceptible to engaging in disordered eating [1]. Large scale studies of college students who have preexisting symptoms of eating disorders all report that students with symptoms of eating disorders are more likely to use fitness tracking apps [2, 3, 4, 5].
Mental health experts believe fitness apps can exacerbate symptoms of eating disorders because tracking numbers often induces rigid, inflexible thinking regarding health, diet, and exercise [6, 7]. Focusing on metrics such as calories provides an oversimplified outlook towards health and can encourage perfectionist “all-or-nothing” mindsets [6, 7]. A study found participants frequently reported feelings of guilt if they did not attain their goals [8]. The participants often believed that they felt guilty when the app notified them that they were failing to keep up a streak or to meet a goal [8]. These features are intended to keep users engaged, but may also have a detrimental impact. However, not everyone who uses fitness apps develops these unhealthy psychological symptoms.
Current studies indicate that people who use fitness trackers are more likely to have pre-existing symptoms of eating disorders, and that the fitness apps do not cause eating disorders. In fact, a study of 200 undergraduate women who had no preexisting symptoms and were at low risk for developing an eating disorder found that the students randomly assigned to fitness tracking apps did not respond differently to questions about their mental health compared to students who were not assigned to a fitness tracking app [9]. Because fitness tracking apps have only been found to be harmful for people who already had symptoms, it is important to consider what possible symptoms you already have before deciding to use these apps.
The people who report using fitness apps primarily for weight control or body image reasons rather than health reasons are significantly more likely to experience symptoms of eating disorders [5]. Before using fitness apps, it may be useful to ask yourself whether your motive is related to body dissatisfaction or health. A survey reported that approximately 93% of people primarily use fitness tracking apps for weight/body image reasons [5]. This statistics is worrisome, given that the people using fitness apps to change their appearance are most likely to experience more symptoms of eating disorders as a result of using those apps.
How can fitness apps continue to successfully help people manage their health without promoting eating disorders – which are a serious public health problem? In the United States, 9% of people will suffer from an eating disorder in their lifetime, and about 26% of people with eating disorders attempt suicide [10]. These problems could be reduced if app designers would reevaluate oversimplified features such as labeling “good food” and “bad food,” because these oversimplifications often promote unhealthy thoughts [6]. Instead, fitness apps would benefit from taking a more nuanced and holistic approach in how they address people’s health goals. Additionally, apps should avoid using punishment and guilt tactics to keep users engaged [7, 8]. To improve public health, these types of improvements in app design should continue to be explored.
- Fox S, Duggan M. “Tracking for Health.” Pew Research Center. Pew Research Center, January 28, 2013. http://www.pewinternet.org/Reports/2013/Tracking-for-Health.aspx.
- Villinger K, et al. “The Effectiveness of App-Based Mobile Interventions on Nutrition Behaviors and Nutrition-Related Health Outcomes: A Systematic Review and Meta-Analysis.” Obesity reviews : an official journal of the International Association for the Study of Obesity. PubMed, July 28, 2019. https://pubmed.ncbi.nlm.nih.gov/31353783/.
- Chew, HSJ, et al. “Sustainability of Weight Loss through Smartphone Apps: Systematic Review and Meta-Analysis on Anthropometric, Metabolic, and Dietary Outcomes.” Journal of medical Internet research. U.S. National Library of Medicine, September 21, 2022. https://pubmed.ncbi.nlm.nih.gov/36129739/.
- Simpson, C, Mazzeo E. “Calorie Counting and Fitness Tracking Technology: Associations with Eating Disorder Symptomatology.” Eating behaviors. U.S. National Library of Medicine, February 9, 2017. https://pubmed.ncbi.nlm.nih.gov/28214452/.
- Linardon J, Messer M. “My Fitness Pal Usage in Men: Associations with Eating Disorder Symptoms and Psychosocial Impairment.” Eating behaviors. U.S. National Library of Medicine, February 10, 2019. https://pubmed.ncbi.nlm.nih.gov/30772765/.
- Pagoto S, Bennett G. “How Behavioral Science Can Advance Digital Health.” Translational behavioral medicine. U.S. National Library of Medicine, August 17, 2013. https://pubmed.ncbi.nlm.nih.gov/24073178/.
- Pennesie, J, Wade T. “A Systematic Review of the Existing Models of Disordered Eating: Do They Inform the Development of Effective Interventions?” Clinical psychology review. U.S. National Library of Medicine, February 2016. https://pubmed.ncbi.nlm.nih.gov/26781985/.
- Honary M, et al. Understanding the Role of Healthy Eating and Fitness Mobile Apps in the Formation of Maladaptive Eating and Exercise Behaviors in Young People JMIR Mhealth Uhealth 2019;7(6):e14239 URL: https://mhealth.jmir.org/2019/6/e14239 DOI: 10.2196/14239
- Hahn PhD SL, et al. Introducing Dietary Self-Monitoring to Undergraduate Women via a Calorie Counting App Has No Effect on Mental Health or Health Behaviors: Results From a Randomized Controlled Trial. Volume 121, Issue 12, December 2021, Pages 2377-2388. Journal of the Academy of Nutrition and Dietetics. Elsevier. https://doi.org/10.1016/j.jand.2021.06.311
- Deloitte Access Economics. The Social and Economic Cost of Eating Disorders in the United States of America: A Report for the Strategic Training Initiative for the Prevention of Eating Disorders and the Academy for Eating Disorders. June 2020. Available at: https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/.