The Use of Weight Loss Apps by Women with Eating Disorders

It is estimated that 20 million females in the United States have an eating disorder, and many more have unhealthy eating behaviors [17, 21]. Two eating disorders that are more common among females than males are anorexia and bulimia nervosa [1]. Approximately 1 in 200 females will develop anorexia nervosa, and 1-3 in 100 will develop bulimia nervosa [13]. The prevalence of these eating disorders has been continuously increasing [21]. While biological and psychological factors play a role in an individual’s predisposition and development of eating disorders [5], researchers in psychology have highlighted the sociocultural perspective, which is used to understand how social and cultural factors, such as media, affect an individual’s mental processes and behaviors [2]. Much of this research has focused on conventional mass media, such as magazines and television. In recent years, researchers have been calling for more work in understanding the impact of new media, such as online content, on the thin ideal, body image, and eating disorder symptomology [15]. Recent work has shown that online content, such as social media, is associated with poor body image and eating disorders, especially among females [7, 12, 20]. Missing in this research are studies on the impact of weight loss applications (“apps”) on eating disorders even though they contain similar content. Weight loss apps are becoming increasingly popular [8]. They allow users to track their calories, exercise, weight, and other factors. Weight loss apps enable and promote dieting, which is a risk for developing an eating disorder [14]. In Human-Computer Interaction (HCI), there has been a great deal of research on apps for diet and/or physical activity [3, 4, 18, 19]. While HCI researchers have focused on designing these apps to promote behavior change, they have largely viewed weight loss app users as having similar needs and have paid little attention to other factors that may influence their app use, such as eating disorders. However, not all weight loss app users have the same needs or challenges. In order to understand the potential negative effects of these apps and the best ways to address these problems, researchers and designers must understand the various types of users who utilize weight loss apps. One such subgroup is women with anorexia and bulimia nervosa. This is an important user group to study because many females frequently suffer from disordered eating behaviors, and anorexia and bulimia nervosa are most common among females [1, 9]. On one hand, research has shown that people with behaviors indicative of eating disorders use technology to maintain the symptomology of their disorder [11, 16]. On the other hand, technology can also be used to aid in eating disorder recovery [10, 22]. However, there has been little research examining the role of weight loss apps in enabling eating disorders or in supporting eating disorder recovery and maintenance. There may be aspects of weight loss apps that are helpful for eating disorder recovery; however, there may also be aspects that impede user recovery or promote the maintenance of eating disorders. In spite of the popularity of weight loss apps, few studies have considered the role of these apps on women with eating disorders. My work aims to fill this gap by examining both users’ and healthcare providers’ perceptions of weight loss apps on women with eating disorders, specifically anorexia and bulimia nervosa. Although the sociocultural perspective views sociocultural influences as contributing to eating disorders, my research aims to examine both the positive and negative aspects of weight loss apps. I use qualitative methods in order to understand how and why women with these eating disorders use weight loss apps. In my preliminary study, I conducted a qualitative content analysis of users’ posts on an online forum associated with a popular weight loss app. Through this study, I found that users with underweight Body Mass Index (BMI) goals have various perceptions of the app’s abilities to reduce eating disorder behaviors and to exacerbate eating disorder behaviors. This study showed there are users with eating disorder behaviors utilizing apps intended for weight loss. These findings can shed light on problems with using weight loss apps for eating disorder recovery and the needs of users with eating disorders. Specifically, weight loss apps focus too heavily on weight and calories and allow unhealthy eating plans. For recovery, users with eating disorders want a way to track their eating behaviors and a tailored healthy plan. Prior research shows that many current eating disorder recovery apps lack a way to track these behaviors but also do not make good use of smartphone capabilities [6, 10], which may help explain why users with eating disorders turn to mobile weight loss apps. In my future work, I will explore these concepts further and seek to expand the understanding of not only how these apps are used, but also explain why. In my main study, I will use think-aloud-inspired exercises and interviews to further examine the role of weight loss apps on young women with a history of anorexia or bulimia nervosa both from a user perspective and a healthcare provider perspective. With users, I will use two data collections methods: 1) thinkaloud-inspired exercises and 2) formal semi-structured interviews. 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