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!