Digital weight management aids- we need guidance, not more apps.

By Mia Campbell, a postdoctoral researcher in health psychology

 

In a blog post aptly named “Digital Health or Digital Hell’’ on the 10^th of January this year, Dr Julia Bailey expressed concerns over the enormous number of digital aids available to assist with adopting various health behaviours. A sizeable chunk of those technologies aim (and claim) to help with weight management, be it dietary regulation or broader self-regulatory behaviours related to weight control.  As a rule, (but not always), weight management apps tend to be eye-pleasing and well thought out in terms of presentation, colours and functionality.  But research suggests that their content is very rarely evidence and theory-based and sometimes may even provide outright fake information (e.g. placing your phone on your stomach to break up fat cells through the vibrate function).  In my field of research- yoyo dieting – you are most likely to encounter savvy, experienced dieters, who have become experts in their own weight loss. While they are unlikely to buy into such dubious solutions, dieters are likely to try apps that appear to present legitimate advice.

Here is where the problem lies. In yoyo dieting trying is not always a good thing. Trying hard, over and over again does not always mean getting better at it.  For chronic dieters, the number of weight loss attempts matters. Every round of dieting that does not provide desirable results affects the way people experience self-efficacy and dietary learned helplessness. Perceived unsuccessful dieting has harsh psychological costs: guilt, sense of failure, self- blame and self-criticism. It keeps repeat-dieters trapped oscillating in a never-ending, negative spiral, because that is what dieters do- they tend attribute weight control lapses to their own failures.

My work so far has taught me that limiting people’s choices is not the answer to this problem.  As with most things in life, in weight management variety is a force for good. The idea that there is only one right way to lose weight and maintain weight loss does not hold up to scrutiny. It is important that dieters have options and that we, as researchers and practitioners, let them know of this. Evidence from my PhD work suggests that if you have been trying to lose weight repeatedly, using just one method and you have not been as successful as you had hoped to be, then maybe it is time to give something new a try. Digital weight management apps and websites could be just the thing. But it is imperative that their content is not based on erroneous ideas about behaviour change. Daily inspiration quotes are not a behaviour change technique, there is no evidence to suggest they make any meaningful impact on your behaviour. Breakfast is not the most important meal of the day and you really do not have to force yourself to eat it. Research has thoroughly challenged the role of skipping breakfast in obesity. We know well that goals work, but only when you set them following certain rules. For instance, it would not be a good idea to formulate goals around the amount of weight you want to lose, because you have no control over this. We know that such goals are likely to fail and leave you worse off – emotionally, cognitively and behaviourally. If your weight management app promotes any of the above, things probably will not work out.

When it comes to weight management, dieters are already faced with a jungle of strategies, plans, diets and programs out there. What we do not have is a coherent, systematic approach to guiding people through this jungle. In his keynote speech for the UKSBM 2016 conference, Professor Falko Sniehotta of Newcastle University rightly referred to this as an “organised cacophony “, but even that was too kind a description. At present, digital weight management apps mainly add to the chaos.

In summary: Digital weight management aids are an exciting development in behaviour change. Instead of working on more apps and websites, shouldn’t we be focusing on reviewing apps with regard to their evidence based utility, and creating guidance to help users navigate what already exists?

 

BIO: Mia Campbell is an early career postdoctoral researcher in health psychology at Northumbria University of Newcastle. Her research focuses on weight cycling and weight management. She is also a co-applicant on a grant on altered eating (losing the ability to eat well) in several clinical populations. Her research interests include intervention development and evaluation and eating behaviours.

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References:

Azar, K. M., Lesser, L. I., Laing, B. Y., Stephens, J., Aurora, M. S., Burke, L. E., & Palaniappan, L. P. (2013). Mobile applications for weight management: theory-based content analysis. American journal of preventive medicine, 45(5), 583-589.

Breton, E. R., Fuemmeler, B. F., & Abroms, L. C. (2011). Weight loss—there is an app for that! But does it adhere to evidence-informed practices? Translational behavioral medicine, 1(4), 523-529.

Byrne, S., Cooper, Z., & Fairburn, C. (2003). Weight maintenance and relapse in obesity: a qualitative study. International journal of obesity, 27(8), 955-962.

Casazza, K., Fontaine, K. R., Astrup, A., Birch, L. L., Brown, A. W., Bohan Brown, M. M., … & McIver, K. (2013). Myths, presumptions, and facts about obesity. New England Journal of Medicine, 368(5), 446-454.

McKee, H., Ntoumanis, N., & Smith, B. (2013). Weight maintenance: self-regulatory factors underpinning success and failure. Psychology & health, 28(10), 1207-1223.