This article contains references to eating disorders.
They're on the phones of 311 million people worldwide and used to track calories, monitor steps, and set fitness goals. But how healthy are health and fitness apps, really?
New research from Adelaide's Flinders University suggests that while these apps are designed to promote wellness, they may also be linked to disordered eating, body image concerns, and compulsive exercise habits.
With millions relying on them for motivation and guidance, some experts are starting to worry.
Poor body image and number-obsession findings
reviewed 38 qualitative and quantitative studies to dive into the links between using diet and fitness apps, and the risk of users becoming obsessive about weight loss, body image, calorie counting and excessive exercise.
Worryingly, they found those who use these apps regularly were "more likely" to have problematic habits related to food and exercise.
"We found that young adults who use diet and fitness apps have greater disordered eating symptoms, such as harmful or restrictive diets, and have negative thoughts about body image when compared to those that don't use them," PhD student Isabella Anderberg said.
"Whilst there is evidence that these tools can be effective in increasing physical activity, we're interested in understanding whether these apps might actually be harmful for some users."
The research found that those who used diet and fitness apps were more likely to have disordered eating, like harmful and restrictive diets, and negative thoughts about body image, compared to those who don't use apps.
Diet app use was commonly related to eating-specific behaviours and attitudes, like dietary restraint, food preoccupation and eating concerns. Meanwhile, fitness monitoring apps appeared to be more commonly associated with compulsive exercise.
There were also several studies analysed that suggested those who download the apps for weight loss have a higher level of disordered eating symptoms than those who use these apps for health improvement or reaching fitness-related goals.
Only a limited amount of studies analysed separated app types, like diet or fitness, making it difficult to determine which app types were correlated with the findings.
Health and fitness apps: helpful tools or harmful triggers?
While some diet and fitness apps need to be downloaded onto your phone, others are automatically built in, like Apple Fitness, with regular reminders on where you're at with your movement levels throughout the day.
But it's not as easy to say whether these apps are good or bad, as it all depends on the person using them.
For a healthy person, diet and fitness apps might lead to healthier eating or movement.
But for those predisposed to disordered eating or those who are more vulnerable, like adolescents, these apps could potentially exacerbate symptoms.
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Anderberg said the focus on dietary restriction and weight loss in the apps "may feed into restrictive or excessive behaviours raising concerns for those people who have pre-existing concerns about their weight or body image".
"Diet and fitness apps are marketed as tools to improve health, however, they may also have unintended negative consequences, such as creating pressure to meet goals, concerns about body image as well as provoking feelings of guilt if goals aren't achieved," she continued.
Sarah Squire, head of knowledge, research and policy at The Butterfly Foundation — a charity offering support for people affected by eating disorders and body image issues — added that for the general population, health and fitness apps might promote good nutrition and physical exercise.
But she too says vulnerable people are the most at risk when it comes to the negative ramifications of health apps. She said The Butterfly Foundation hadn't collected data specifically on the impact of these apps yet, but was "not surprised" to hear about the findings.
"For people who are vulnerable to developing eating disorders or people who have already experienced an eating disorder, fitness trackers and health apps can definitely be problematic," Squire said.
"Any tool, device, tracker, and app that encourages a person to count and measure their physical activity, their food intake or their weight can be really counterproductive to a person's health and wellbeing, particularly their recovery."
Squire explained that those susceptible to eating disorders often have what she calls a "numeric logic", where they might be more inclined to look at numeric data like calories, weight, or a certain number of steps, and get "obsessive" about reaching it.
Correlation, not causation
The research might lead someone to automatically believe that using a calorie counting app or something similar leads to a higher likelihood of disordered eating symptomatology.
But it's not quite so black and white.
The study says there's only a correlation between the two — rather than an explicit causation.
This is because who is susceptible to disordered eating and body image is highly complex, and it's not that easy to say their condition is the result of an app.
"Eating disorders have multiple factors involved in their development," Squire explained. "They're what we call biopsychosocial disorders."
This means a person's medical condition is impacted by biological, psychological, and social factors, making it "very hard to actually put your finger on one thing and say that's caused an eating disorder".
"There's a whole range of influences on what causes eating disorders and these apps would certainly be in the mix with all those causes," she said.
The research also suggested those with a predisposition to disordered eating may be more likely to start using these apps to reinforce and maintain maladaptive behaviours, suggesting more in-app screening processes may be needed.
Calls for more research and greater regulation
The Therapeutic Goods Administration (TGA) does not regulate health and lifestyle apps. Instead, it says they're sources of information or tools to manage a healthy lifestyle.
But with many potential side effects of apps, Squire says there needs to be greater regulation in the industry.
"As these apps proliferate, the case for more regulation does become stronger," she said, adding that it's important for consumers to "understand what they're looking at".
Before downloading a health or fitness app, she encourages you to ask yourself a few questions:
- Who developed the app?
- Is it a commercial entity looking to make some money out of the product?
- What experts have been involved?
- Are there any trials or published evidence in peer-reviewed journal articles that show these tactics are effective?
"With a lot of these apps, it's not always clear whether they've been developed on the basis of evidence," Squire said. "Just because something is popular, it doesn't necessarily mean it's good or it's accurate."
She said while people might want to improve their eating or exercise behaviours, it's always recommended they get tailored support from qualified professionals, like dietitians or exercise physiologists, instead of solely from an app.
Squire also called for more research into the space, particularly from those with lived experience.
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So, what's next?
"This study provides a really useful starting point for people to examine their relationship with fitness apps and to really consider how these tools are broadly impacting their mental health," Squire said.
She encourages users to pay attention to how they're feeling when they use these apps. "If people notice their relationship with fitness trackers or apps is becoming problematic for themselves."
"If they feel guilt or shame for not meeting their targets or they're comparing themselves to others in a negative way – we'd really encourage them to get in contact with us via our national helpline."
For support with eating disorders or body image concerns, call Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or email, 7 days a week, 8am-midnight (AEST/AEDT).
