Apps and Eating Disorders: The Good and The Bad

Can an app help with eating disorder recovery?

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New technology in the form of applications (AKA “apps”) offers potential risks and benefits for patients with eating disorders.

Although the impact of fitness trackers on clients with eating disorders has not yet been studied, anecdotal evidence suggests these applications may be detrimental. People with eating disorders frequently obsess about the number of calories they are consuming and expending.

Many health apps emphasize tracking the ingestion and expenditure of calories. In addition, they encourage the user to reduce intake, increase expenditure, and set increasingly extreme goals. One client related that her app even congratulated her on a certain number of consecutive days at a low calorie count. It is clear how this software can potentially fuel the disordered and obsessive thinking of clients with eating disorders.

On the other hand, there are also several eating disorder recovery apps that may be helpful to clients with eating disorders. Some of these applications embody or support principles of evidence-based treatments such as Cognitive Behavioral Therapy (CBT). One particularly important feature that some apps provide is self-monitoring, which is also a hallmark of CBT for many mental disorders. In the treatment of eating disorders, self-monitoring involves recording food consumed along with accompanying thoughts and feelings.

App-based self-monitoring offers several advantages over paper monitoring. As most individuals keep their smartphones with them much of the time, using the apps may facilitate more real-time monitoring, providing both greater convenience and accuracy.

While fitness apps and eating disorder recovery self-monitoring apps both incorporate tracking, each differs in focus.

Fitness apps primarily track numbers and data, such as caloric intake. Eating disorder recovery apps, on the other hand, are concerned more with tracking the thoughts and feelings associated with eating than with the specific amounts. This distinction is significant.

Below is information about two of the more popular eating disorder apps that include self-monitoring.

Recovery Record

A 2014 study by Jurascio and colleagues found Recovery Record to be the most comprehensive eating disorder treatment app on the market. It contains features including self-monitoring, personalized coping strategies, social connections, and a portal to connect with the user’s clinician. It also contains components of cognitive-behavioral based interventions. Users can enter food, thoughts, feelings, and urges to use compensatory behaviors. The app offers assistance with coping strategies and goal setting in addition to the ability to set reminders. Additional features include meal planning, rewards, affirmations, and the potential to connect with others.

Rise Up & Recover

Rise Up is another popular and well-regarded app. Rise Up has a comparable self-monitoring feature that allows for recording of daily meals and snacks, emotions, and “target behaviors” such as bingeing and purging. The app encourages the use of coping skills during times of distress. Users can share motivational quotes, images, and affirmations. They can access additional information sources such as music, podcasts, articles, and a treatment directory. The app can also export meal data to share with members of the user’s treatment team.

What to Look for in an Eating Disorder Recovery App

Apps come and go. Depending on when you read this, the suggestions above may no longer be state of the art or available. Finding an app with the right features is more important than any specific title. I offer the following suggestions in what to look for:

  1. Self-monitoring of food intake without calorie counting. Self-monitoring is a well-researched and important element of eating disorder treatment. Calorie-counting, however is not recommended because it may increase obsessive thinking.
  2. Fields to log behaviors, thoughts, and feelings. Recovery involves becoming more aware of feelings and thoughts as well as changing behaviors. Thus, an app used for recovery should have fields to log this information.
  3. Motivation and/or coping strategies. Apps that incorporate ways to remind you of what you might want to try or already know (but can need a reminder in the moment) can be supportive.

Remember that an app is not a substitute for treatment. It is always a good idea to discuss the use of an eating related app with your treatment team.

References

Fairburn CG, & Rothwell ER (2015). Apps and Eating Disorders: A Systemic Clinical Appraisal. International Journal of Eating Disorders.

Juarascio AS, Manasse SM, Goldstein SP, Forman EM, Butryn ML (2014). Review of smartphone applications for the treatment of eating disorders. European Eating Disorder Review, 23: 1–11.

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