Tuesday, March 22, 2011

Where Diet Apps Fail. Record Keeping That Shifts Your Perspective

The Wall Street Journal did a piece yesterday on diet apps, those free or modestly priced software programs for phones and mobile devices. Under the bold heading Counting Calories they stated:

“Certainly dietitians and nutritionists would say that keeping track of what you eat every day is a big step toward eating better and possibly eating less. But many of these apps go a step or two further.”

Here’s where their assumption falls short. Yes, tracking your intake makes you more aware and has a known benefit for weight management. But the apps tend to mislead you. In spite of their comprehensive database of foods and nutrition info (from the USDA), they are only as good as you are at honestly and accurately estimating your portions. And it is well established that we simply don’t do a very good job at this. In general, most individuals tend to significantly underestimate their food intake, while those who are underweight and those with anorexia tend to overestimate their food intake.

Often patients come in proudly displaying their high tech proof that their eating is in range. But a closer look reveals that their approximation of their portions was far from the mark, making this seemingly perfect app anything but.
More importantly, any nutrition professional that’s worth seeing is looking far beyond calories and counting. We are evaluating patterns of food intake, hunger ratings, and eating triggers such as stress, anxiety, boredom, misinformation, emotions, self-weighing and other influences. And for long-term weight management, we are looking at clients’ perceptions of their eating and the negative and positive impact that has on subsequent meals and snacks.

Take a look at what I read on Sharon’s food record last week:

“I hate eating breakfast! It makes me hungrier the rest of the day.”
“Weighing myself—a big mistake!”
“I am so fat and shouldn’t have eaten so much this week.”
“I’m starving.”
“I blew it. May as well keep eating.” 

“What’s wrong with me? Why can’t I stop eating?”
“I feel awful and super fat!”
“Binged. Not even hungry, just want to eat. I’m stressed and feel fat anyway.”
“Ate a small salad and feel even fatter.”
“Triggered by therapy. It always makes me want to binge and purge. I know it’s wrong but it helps me relax.”
“I don’t want to eat but I just can’t stop thinking about food

Now what do you imagine Sharon’s food record looked like? Full of true binges, out of control, excessive feeding frenzies? Multiple items, or very large quantities of a single item, like cookies, ice cream, even cereal? Forbidden foods, generally, but not necessarily. In fact, her eating may have been fully ‘controlled’. It may have even been planned, a not uncommon occurrence. She may hate it, but plan to binge anyway, perhaps with the intent of getting rid of it. Or not.  The eating feels out of control, but ironically it is something she may have very much decided when and how to do.

But that was not what I read on Sharon’s food record last week. Her pages were filled not with surplus calories from binges, but with voids—calorie-free diet beverages, salads with fat-free dressings, coffees and “light” products. More than a report about her food, it revealed the most about the distortion in her thinking.

And had we only looked at an app’s analysis, perhaps the totals wouldn’t have appeared too bad. But the pain and the struggle keeping her stuck in this cycle would certainly be overlooked.
Identify with Sharon? Hoping to get past this place, but petrified, so you stay stuck? Consider this: If keeping things the same isn’t working, you may as well take the risk and try something different.
Now, back to Sharon’s comments.

Why the full feeling? If you’ve gone through a period of severe restriction, or have been purging, you likely are experiencing fullness when eating. And it’s not just in your head. These behaviors result in slowed movement of food through your digestive tract. It takes longer for food to move through, so yes, you will feel full longer. But the feeling passes, doesn’t it? Take note of how long the discomfort lasts. For most, it starts to feel better after about 40 or 45 minutes.

Why so hungry? Could be that the fullness was a temporary fix, not due to adequate or excessive calories. A 2-liter bottle of Diet Coke will make you feel full, stomach full. You’ll likely feel bloated, with a distended stomach. Yet it contains no calories. No fuel to serve your body. And so the feeling passes and then you’re left starving.

Or maybe you purge and then get hungry again later. You’re so focused on how much you ate, that you minimize that you got rid of much of your food. Of course your body is looking for fuel and signals that you are hungry!

Perhaps you really ate frequently throughout the day. But how adequate were those meals or snacks? Did they only look adequate? Were the portions large in volume, but low in substance? Did you omit fats from your diet, leaving you hungry soon after eating?

Aren’t you being unfair, expecting to subsist on so little, and beating yourself up when that strategy fails you?

Sharon has a long way to go. But at least now she is including food, multiple times, in the daytime. This is a giant shift from her old pattern of going all day without eating, followed by a binge and a purge. At least now she manages to get through some days with a more adequate intake, with neither a binge nor purge. At least she is seeing her potential. At least she is starting to shift her perspective.

Yes, these photos were taken by me, in my kitchen. But not while eating!
Her thinking does remain distorted—in part because she is still starved. Small changes won’t cure that immediately. Sharon’s got to push herself further out of her comfort zone to start to see things more clearly. And she needs to learn other ways to tackle her anxiety, versus sticking with what is familiar—her eating disorder.

As for those apps—if they truly want to have an impact and “go a step further”—they should allow for self-reporting hunger levels, moods, distractions while eating and thoughts. Then users could bring them to their visits with an experienced professional. And yes, an RD with a behavioral focus would be a great place to start!

Perhaps you have a different perspective? Care to share it? Please leave me a comment below!


  1. My personal favourite are the apps that give you a daily calorie count-down. As though 'this phone will self destruct in 500 calories!'
    Makes you think something terrible might happen if you eat more than you are 'allowed' to! Yay for more guilt - really helpful (not!)
    I'm sure as a tool it can be of assistance, but using guilt to moderate your eating is such a slippery slope - and certainly doesn't leave any room for that flexibility that you so wisely advocated in your last post :)

  2. I would hate it when the counter went over 1200 calories in a day. But I did take it a bit further, I would weigh every thing that I ate. I would weigh the bread then put on the butter or whatever to get exact weights (think weighing slices of an onion). My RD and therapist didn't like it so now I starve all day and binge at night. They don't like that either. I think I need to get that app.

  3. @Eating Alone-Actually, it sounds like it's not the app you need but perhaps a higher level of care. Best of luck in your recovery.

    @PJ-Yes, that's exactly the issue with counting calories! It's the setting of an upper limit which is inappropriate and often goes against what our bodies demand.

  4. First, I will immediately confess and say I am a user of one such app (MyFitnessPal, if you're curious). And I absolutely agree with PJ's comment - there is this "oh my goodness what happens when I go over my daily allotment?!" feeling that can come with an app like this.

    Luckily, I have a really wonderful RD who has helped me figure out not only what to eat, but what it really means to eat healthfully (giving the body what it needs) AND healthily (i.e. avoiding behaviors that are not conducive to healthy eating like eating mindlessly, out of boredom, etc.). So with her help, as well as by really taking to heart some of the lessons on this blog (the biggest for me - eating mindfully!), the app ends up being more of a guide than anything else. If I'm at the upper end of what I'm supposed to eat every day and I'm hungry, then I should eat! (This was admittedly a bit of a tough lesson to learn, since I'm trying to lose weight).

    But yes, Lori, I totally agree with your post in that the apps are lacking in a variety of ways. They neglect every component of healthful and healthy eating, with the exception of telling you how many calories (and fat, carbs, protein) you've eaten. MyFitnessPal also has a website where people can post to message boards, and it's actually both nerve-wracking and distressing to see how many people will take the app's information at face-value and panic if a) they are at their calorie "limit" but are still hungry or b) have not eaten all the app says they "should" and aren't hungry. It seems that a major risk of these apps is that people begin to believe that a computer program, and not their own bodies, knows what's best for their health and well-being.

  5. Thanks, Sara, for your very fair and balanced response! I will plan to do another post on the calorie counting/awareness subject in the very near future! Thanks for reading.

  6. I don't have the fancy phone apps, but I did start out using, because someone told me about it, and to be honest, in the beginning, I did not trust myself to know exactly how "off the mark" my portions actually were! So, it was helpful. I did feel some anxiety as the calories "counted down" but then saw I had another option for adding more calories -- exercise. (It provided inspiration to do so!) It was one of the features of that I did like. Being able to plug in a workout and get the calories burned. I've moved away from it as I've gotten more comfortable with trusting myself, slowly by slowly... Sometimes I think "a reality check" is good when starting out, honestly.... It opened my eyes to just how many calories I was consuming and made me get more honest. It's easy to downplay or minimize until you take accountability. But ultimately, I appreciate the approach that you need to learn to trust yourself to achieve the necessary "balance" in either gaining or (in my case) losing weight. I think it's awesome that these free resources are available on the internet, and they can be used to find calories based on portion size, and has an impressive database of such information. But only as a tool, not a replacement for learning to trust self.

  7. No doubt, these apps are an eye opener! Used with caution, and integrated with the strategies described above, they do have some value. I will be posting more on the topic of calorie counting shortly!