Gemma Phazey started using a health app at the beginning of 2012. Fit and toned, she didn’t need to lose weight and had never been a slave to scales. But the MyFitnessPal app was already loaded on a phone she bought, and Gemma thought it would be a simple way to track her health.
The app measured the calories she consumed and the calories she burnt through exercise. It encouraged her to set goals, so she did. Within a few months, she was setting out to end each day having burnt more calories than she’d eaten. Gemma tapped in her progress obsessively – so obsessively, in fact, that the weight starting falling off. She continued to input the data. Every mouthful. Every step. Every weight lifted. Meals were numbers. Days were a balance of intake and output – until Gemma was diagnosed with an eating disorder.
“I never felt I wanted to lose weight,” she says. “I never wanted to be super skinny and that’s the hardest thing to explain, because if you have an eating disorder that’s what people think. I just wanted control, and the app made that incredibly easy. It was like a game. It became compulsive.”
There is no doubt that MyFitnessPal and the many other diet and exercise apps like My Diet Coach, Diet Assistant and Lose It! can really help people who need to lose weight. The apps also make it clear they’re not providing expert medical advice and people are expected to use them responsibly. Thanks to increased smartphone use, they first became popular in 2009, the year the MyFitnessPal app launched (its developers sold the company for £311million).
The designers who make them employ a psychological theory called “gamification”. The idea behind it is simple: if you turn tasks such as exercise into a digital game, with digital rewards for real-life achievements, people will be more motivated to complete those tasks. The rewards can be as subtle as a congratulatory message or, if there is an eventual goal, a glimpse of how near to it you are. The process exploits the complicated brain chemistry of motivation and reward – and it’s big business. The health, diet and fitness app industry is projected to be worth £3.2billion by 2016, with the number of health apps doubling to more than 165,000 in the last two years. In the UK, 6.7 million people used apps and wearable fitness tracking technology in 2014, and by the end of 2015 that figure is projected to have almost doubled to 13.1 million.
Which is great news for people who need to lose weight. But what about those who don’t and are prone to the type of compulsive and obsessive behaviour gamified apps feed? Increasingly, psychologists and clinicians who work with eating disorder sufferers are voicing concern.
“We’ve had direct contact with many individuals who have told us that their use of fitness apps was detrimental to their health and made their symptoms worse,” says Rebecca Field, head of communications at eating disorder charity Beat. “Eating disorders are complex, multi-causal mental illnesses, and those affected require tailored treatment focusing on psychological support and normalising eating. These apps are not a substitute for that.”
At 5ft 7in and a size 8, Gemma, a 29-year-old dance teacher from Canterbury, had never struggled with obsessive calorie counting before.
“It was addictive,” she says. “At the end of every day the app gave a net calorie count and I got sucked into that and tried as hard as I could to end up with a negative figure. I was able to track every single calorie.
“It started gradually. I became vegetarian and cut out meat, began drinking black tea, then ice cream and dairy went. Eventually I had all sorts of rules: grapes had to be red – for no rational reason. The app made it easy to monitor it.
“On top of dancing every day, I was running and doing everything I possibly could to exercise,” Gemma continues. “I cut out as much food as I could in order to still be able to go to work each day and it not have a noticeable impact. I was eating the bare minimum as it was always my aim to end up in negative calories.”
After a few months, friends and family started to notice that she’d lost weight – although Gemma couldn’t see it when she looked in the mirror. A couple of months later, she started suffering migraines, kidney problems and panic attacks.
Mentally exhausted, she went to her doctor in December 2012, almost a year after she’d started using the app, and admitted everything. She was diagnosed with what is now called Other Specified Feeding or Eating Disorder (OSFED) – where symptoms don’t meet all criteria for anorexia or bulimia or are a mix of the two – and referred for specialist counselling.
Today, having undergone two years of therapy, Gemma is finally free from her addiction.
“It took a long time for me to stop using the MyFitnessPal app,” she says. “It was like a crutch – I was even using it after diagnosis. It enabled me to cheat. Counsellors would tell me: ‘We’re going to add cheese to your diet,’ and I’d think: ‘OK, they haven’t said I can’t run for longer’. I’d then calculate on the app how much extra exercise I needed to do to counteract the calories in the cheese. It was hard for me to get out of that pattern.
“I was advised to delete the app but I kept it for ages without using it, just so I knew it was still there. It took several months to get out of the mindset of figuring out what calories I was eating and how to burn them off.”
Gemma finally ditched the app earlier this year, when she changed her phone and it failed to sync across. She’s now returned to a healthy weight – and is adamant that she will never use another health app.
For people who have an eating disorder, these apps can prove even more dangerous. Rhiannon Pursall, 30, a research scientist from Warwick, suffered anorexia for a decade from age 20, later fuelled by fitness apps. At her worst, her BMI was critically low, and her heart pulsed at just 45 beats per minute rather than the usual 70.
“I felt that I had no real personality,” she says. “There was nothing special about me, so the one thing I could control was my body and my food intake and exercise. Around 2009, I started using apps to map my calorie intake and was proud when I beat the goals I set myself by initially making one target, then continually reducing it each time I reached it. I was competing against myself.”
Over the next five years, Rhiannon’s weight plummeted and she was in and out of treatment. Then last April she discovered Recovery Record – an app designed to help people with eating disorders recover. Ironically, it only made her worse.
Rhiannon explains: “I thought it would help me. It recorded the same things as the other apps, but it also asked for weights, and one of the important things about recovery is to try not to weigh yourself.”
The app asks users for an emotion rating after each meal and can be set to give messages of support. Users can share details of meals eaten. But Rhiannon found this increased negative emotions and anxiety.
“I had to turn the messages off. They constantly reminded me to eat meals and for someone who ate nothing all day and then just had dinner in the evening, it was terrifying. They made me feel as if I would never be able to eat as much as the app told me I should.
“Logging emotions was depressing. Every day the app asked: ‘Did you eat what you intended?’ My answer would be ‘no’. It would then ask: ‘How do you feel?’ I felt rubbish – it was reminder of just how miserable life was.”
Within a few months, Rhiannon’s anorexia spiralled out of control. “I was having blood tests and heart monitoring every week,” she says. “Everything was irregular – I looked horrendous, my body ached. I was dizzy and struggled to stand. I put everything into exercise, and after I’d done it I was barely able to move.
“I couldn’t believe it when I looked in the mirror – my face was hollow, my buttocks had gone and my veins bulged. Maybe I’d looked like that for a while and I just suddenly noticed. I’d never realised how bumpy the skeleton is – my back looked like a xylophone.”
Fearing her heart would stop if she flew off on her planned holiday to Lanzarote, Rhiannon’s doctor insisted on confiscating her passport last September. It was the wake-up call she needed to commit to beating anorexia.
Today Rhiannon is in recovery and her BMI is a marked improvement from a year ago, but is still under the normal range for a woman. She’s an outpatient at an eating disorder clinic and is monitored and receives counselling. She doesn’t use any apps and doesn’t know exactly how much she weighs.
“In my experience they facilitate eating disorder behaviour, even the recovery ones,” she says. “They give you numbers and figures, targets to beat. It becomes an equation – what goes in, what comes out. When you have a disorder you think about targets all the time. Anything that reminds you what you’ve eaten and how that makes you feel isn’t good.”
Dr Bijal Chheda-Varma is an expert in eating disorders and weight management at Nightingale Hospital in London. In her opinion, the biggest danger is that health apps seem harmless when you first start using them.
“However, self-scrutiny may lead to self-criticism, and this can lead to an eating disorder as people discipline themselves to meet the standards they set themselves,” she says. “Health apps can facilitate a rule-based lifestyle.
However, a spokesperson for MyFitnessPal says: “Our app has been developed to support individuals on their personal journey to achieving a healthy lifestyle. It is always advised to follow the regulated government guidelines for calorie intake for women and men. MyFitnessPal supports this with an alert to remind you what it is, so that you are aware if you are not maintaining this. We understand the potential risk of misuse from those with eating disorders and to address this, the app also provides a helpline.”
These days, millions of pounds are being ploughed into marketing health apps and associated wearable technology, such as Fitbit wristbands. “Technology is ever-present in our lives,” says Dr Chheda-Varma. “People wear fitness bands to monitor their every move, their sleep patterns and every mouthful of food that passes their lips. Data can be instantly shared as everyone is constantly plugged in to social media, making people’s commitment to their diet and lifestyle very public,” she explains.
Last year, Apple added to the health app debate when its iPhone software update included a new app simply called Health. It’s designed to aggregate data from other fitness apps and is a constant monitoring system. For most, it’s a welcome help. But for others it could be a time bomb. And unlike the apps Gemma and Rhiannon removed from their phones as part of their recovery, it can’t be deleted.
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