Winter 2014

Body By Smartphone

Can the thousands of mobile apps on the market aimed at diet and fitness really make us healthier?

By Jacqueline Mitchell

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Illustration: Blair Kelly

We love our smartphones. Since they marched out of the corporate world and into the hands of consumers about 10 years ago, we’ve relied more and more on our iPhone and Android devices to organize our schedules, our social lives, our finances and now, even our bodies.

Americans are increasingly downloading health and fitness apps designed to help them get in shape, lose weight or manage a variety of health issues. Because our phones are always with us, these apps promise to make it easier to start the long-term lifestyle changes that promote good health, such as getting more exercise and eating more balanced diets. And now that 91 percent of Americans own a mobile device, health and fitness apps are available to traditionally underserved communities, too. But can these little bits of software really make the difference in the seemingly intractable problem of getting people to eat better and exercise more?

“Thirty-one million pounds and counting.” That’s how much weight people using one of the more popular weight-loss apps called Lose It! have lost since its debut in 2008, noted Charles Teague, CEO of the app’s parent company, when he spoke as a panelist at a Friedman School seminar on mobile fitness technology at Tufts earlier this year.

Lose It! is like a lot of weight-loss programs, such as the venerable Weight Watchers, in that you need to keep track of what you eat each day and try to meet certain nutrition and calorie goals. “This approach has been around 20 to 30 years; it’s not like we have some breakthrough,” says Teague. Indeed, many if not most fitness apps, including Calorie Counter, MyFitnessPal and countless others, follow a similar formula.

“Studies have shown it’s very useful to track diet and physical behaviors,” says Jennifer Sacheck, N01, an associate professor at the Friedman School and coauthor of the recent diet book Thinner This Year, which advocates small and steady lifestyle changes. “Tracking allows you to see how you’re progressing. You’re more likely to make changes when you get that positive feedback.”

Recent research into how people use their mobile devices shows the potential reach of the new market. As of January 2014, nearly 60 percent of American adults owned smartphones, according to the Pew Research Center. Pew figures from 2012 showed that 20 percent of smartphone owners had downloaded at least one health-and-fitness app. African-Americans and Hispanics—two groups that disproportionately lack access to health-care services—were more likely than whites to own smartphones and use their mobile devices to look for health or medical information online.

Gaps in Content

So how can consumers know which diet apps to choose? Few scientists have had a chance to take a hard look at the crowded field of apps that has sprung up in just the last three or four years.

In a study published in the journal Translational Behavioral Medicine in 2011, public health researchers conducted what they considered the first survey of 204 weight-loss apps available in Apple’s App Store in 2009. Scientists from George Washington University and Duke University Medical Center created a list of 13 “evidence-informed” weight-loss strategies endorsed by the federal government, including keeping food records, getting more exercise and eating more fruits and vegetables. The team found the vast majority of apps available at the time incorporated three or fewer of the 13 strategies.

In a more recent study published in 2013, also in Translational Behavioral Medicine, public health researchers from the University of South Carolina found that not much has changed. Of the 57 apps they assessed—this time targeting pediatric obesity—the team found that fewer than half included any evidence-based recommendations at all. Among those that did, many suggested healthier eating and getting more exercise, but failed to recommend starting the day with a good breakfast or cutting back on time in front of the television—two proven ways to accomplish both goals.

Tipping Point

Putting too much emphasis on an app’s diet- and exercise-tracking abilities may overlook the smartphones’ real advantage: connectivity.

Lose It!, like many of its competitors, allows its users to form groups with other users, whether they know them in real life or not. These apps also can link to Facebook pages or Twitter accounts so people can crow about their accomplishments to their existing social networks. 

Sacheck would like to see the day when an app or fitness monitor not only tells a user what he has done, but suggests why and how he could do a little more.

It’s already catching on. Sacheck reports that she will be using social networking in her effort to get school kids to exercise more. She’s found that one way to encourage kids to walk or run more is to set up an online competition between schools. “The social aspect is a big thing,” she says. “It has to be cool to engage in a healthy lifestyle.”

Sacheck would like to see the day when an app or fitness monitor not only tells a user what he has done, but suggests why and how he could do a little more. She’d like to see a diet-tracker notice that someone isn’t consuming dairy and then offer a web link to alternative sources of vitamin D. She’d also like to see a calorie counter be able to congratulate people on their activity levels, and then suggest engaging in some higher-intensity workouts.

“The technology today is at the tipping point. Initially, it helps people’s awareness. But I think the novelty can wear off if there’s not going to be more to it,” Sacheck says.

And, of course, as useful as linking to the Internet would be for dieters and exercisers, it could be true that smartphones’ most useful trick is why Alexander Graham Bell invented phones in the first place—letting us talk to each other. Fortunately, some apps are already moving in that direction.

For an app called Good Measures, produced by a Boston company of the same name, subscribers have the chance to interact in real time with dietitians and nutritionists who have access to users’ dietary logs. The arrangement allows people to use Good Measures technology to make all the changes they can on their own, and then take advantage of an expert’s help to make some of the bigger ones.

“We have people we work with who come to us already having learned insights from the app,” says Good Measures’ Emily Stone, N08. “It’s amazing how it forwards the conversation. Then their counseling session can be more focused on deeper behavior change needs.”

Maybe the Good Measures model provides a glimpse into the future of health and fitness apps or apps in general for that matter. Their usefulness might lie less in compiling and providing information than in creating powerful connections among people.

“For any meaningful and sustained behavior change, you need not just the expertise of a registered dietitian, but of someone who cares and is supporting you along the way,” says Kris Widican, N06, also involved with Good Measures. “That human component is essential.”–Jacqueline Mitchell

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