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June 8, 2018

Eating Disorder Apps? Not So Fast!

counting calories

The internet is awash in recovery apps designed to assist recovery and many of them are now designed specifically for individuals with eating disorders. A 2015 study identified more than 800 relevant apps, of which 39 were primarily designed for individuals with eating disorders.1

Clients and staff are clamoring for them. Therapists and treatment centers have posted glowing reviews, claiming that eating disorder apps "instill accountability and independence" by "eliminating the tedium associated with pen-and-paper monitoring."2 The Eating Recovery Center has actually partnered with developers of an app called "Recovery Record," which it claims "uniquely connects patients with clinicians to provide support through the recovery process with evidence-based treatment."3

Mirasol has not jumped on the eating disorder app bandwagon. Although we are eagerly awaiting technological advances that could assist our clients during and after treatment, we remain skeptical of the current offerings. Scholarly reviews of the most popular products point to serious shortcomings in the design and implementation. A study published in the International Journal of Eating Disorders concluded that "enthusiasm for apps outstrips the evidence supporting their use."1

Most eating disorder apps incorporate a variety of functions, including monitoring of meals and associated thoughts and behaviors, and provision of advice or encouragement based on user input. Some apps also allow the client to share information with members of their treatment teams.

The 2015 study found that while the apps made it somewhat easier for clients to keep detailed food diaries, "the user experience was not as positive as we expected." Due in part to small screen size, recording meal data was no faster or less frustrating than using a paper record, and it was much more difficult to review summaries of the information entered. The authors also expressed concern that the record-keeping functions built into recovery apps could actually promote eating disorder behaviors.

"An inordinate interest in eating and related phenomena is well-known to be characteristic of people with eating disorders, and often this extends to keeping detailed records of food intake, exercising, body weight, and other phenomena. Apps provide sufferers with a new means of doing this."

Recovery apps also fall short of the mark in terms of providing meaningful emotional and psychological support for someone struggling with an eating disorder.

The 39 apps for people with eating disorders had four major functions, the most common being the provision of advice. Often the advice was less than satisfactory and in some instances it was potentially harmful. Next most common was the provision of information and this varied greatly in quality. Few apps were judged to provide sound information. Five apps allowed users to assess the presence and severity of any eating disorder psychopathology, but only two used methods that would generally be viewed as reliable.

The ability to exchange information between client and therapist is unique to the Recovery Record app. It allows the therapist to review the clients' data and exchange messages in real time. Instant two-way communciation could be a strong motivator for clients, but it could also foster co-dependence and erode the maintenance of healthy boundaries.

A more recent study explored clinicans' perspectives on the Recovery Record app. The study found that use of Recovery Record in a clinical setting could add to their work loads and potentially harm patient-clinician collaboration. The study concluded that prior to adopting the app, clinicians and managers should "discuss the objectives, advantages and disadvantages ... and outline specific guidelines for patient and clinician app usage."4

1Apps and eating disorders: A systematic clinical appraisal
2A Smart App For Your Smartphone - Recovery Record
3Eating Recovery Center Partners with Recovery Record App to Enrich Continuum of Patient Care
4Clinicians' perspective on an app for patient self-monitoring in eating disorder treatment

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