Earlier this year Twitter’s CEO Jack Dorsey asked his 4.19 million followers a question:
Been playing with fasting for some time. I do a 22 hour fast daily (dinner only), and recently did a 3 day water fast. Biggest thing I notice is how much time slows down. The day feels so much longer when not broken up by breakfast/lunch/dinner. Any one else have this experience?— jack ??? (@jack) January 26, 2019
He got 0ver 6,000 replies. One of which was from the author Roxane Gay:
While they might sound like '90s weight loss methods, fasting and calorie counting are having a moment, thanks in no small part to the 'fitness' tech that comes out of Silicon Valley.
Search 'fasting' on the App Store and you’ll find multiple apps which claim to help you track how much (or, rather, how little) you’re eating. The most popular is Zero, which times fasts. Alongside them, you’ll find calorie tracking apps, which are having a moment too – the most ubiquitous of these has to be MyFitnessPal which, for the uninitiated, allows you to catalogue every morsel that passes your lips, see how many calories it contains, what nutrients are in it, track your exercise, see how many calories said exercise burns and set daily calorie limits as low as 1,200 a day for a woman and 1,500 a day for a man (the NHS suggests that 2,500 for men and 2,000 for women are healthy).
Dorsey’s tweet is testament to that cultural shift which has seen fasting rebranded as a biohack which can make you faster and sharper, and calorie tracking for its own sake – regardless of nutrition – which was once the preserve of Weight Watchers, become part of day-to-day 'healthy' living. You, like me, have probably had someone chew your ear off about their intermittent fasting regime recently, reeling off health benefits like a supermarket shopping list. They were probably chugging a Huel or Soylent meal replacement shake at the same time, or perhaps they were holding a copy of Michael Mosley’s 5:2 diet book, which advocates eating 500 calories on two 'fasting' days a week.
Used as intended, all of these apps are couched as health hacks – to help us get fitter and healthier by tracking what we’re eating, seeing what nutrients our food contains, staying on top of how many calories we’re burning and, if we’re getting into intermittent fasting, monitoring its efficacy by timing how long we can go without food.
But for those suffering with or in recovery from eating disorders, health tracking apps can be anything but healthy because they are easily misused and have the potential to exacerbate dangerous behaviours. All over the internet, with just a few clicks you’ll find pro-ana (pro-anorexia) forums and websites awash with tips about intermittent fasting, hailing it as the most effective way to lose weight and using language not so different from that used by those who advocate fasting for productivity reasons, like Dorsey. It’s here that you’ll find Vora filed under 'Best Fasting App Ever'.
Eating disorder charity Beat estimates that around 1.25 million people in the UK have an eating disorder. Around 25% of them are male, the rest are women and girls. Of course, for as long as there have been adverts, magazines, size zero models, the Victoria’s Secret show and online forums, there has been a discussion about how sociocultural factors impact eating disorder-type behaviours and intersect with eating disorders. However, there is now research which confirms that there is a direct correlation between the use of tracking apps and eating disorders.
Two studies (both published in 2017) have found a link between tracking apps and eating disorders.
One, conducted by the department of psychology at Virginia Commonwealth University, concluded that tracking apps "could do more harm than good". Those they spoke to who used calorie trackers showed "higher levels of eating concern and dietary restraint" while "fitness tracking was uniquely associated with [eating disorder] symptomatology".
Another, titled "It’s Definitely Been a Journey: A Qualitative Study on How Women with Eating Disorders Use Weight Loss Apps", conducted by Elizabeth Eikey and Madhu Reddy, found that young women who had a history of eating disorders reflected that apps had made their condition worse.
For those suffering with or in recovery from eating disorders, though, health tracking apps can be anything but healthy.
This is something that 23-year-old Annie* knows all too well. She was diagnosed with anorexia when she was 13 years old and is now in recovery.
"It was when I was particularly unwell that I was really drawn towards pro-anorexia websites and forums," she explains. It was there, at her lowest ebb, that she discovered fitness apps. "Other users would recommend apps like MyFitnessPal and Vora as a way of 'keeping track of what you eat' and 'sticking to calorie goals'," she says.
That was when apps – particularly MyFitnessPal – became a tool for Annie to manage her eating disorder. She began to "keep track of literally everything" in granular detail, even checking "the calorie content of squash and toothpaste".
Before discovering the manifold ways in which she could use tech to track everything she consumed, Annie kept a paper diary of what she ate. As she sees it, it’s not so much that fitness apps cause eating disorders but that they exacerbate the behaviours associated with them by encouraging and even rewarding obsessive and restrictive behaviour.
"My diaries were never as accurate as these apps can be," she says. "The compulsive tracking and counting are disordered behaviours which I would have been doing anyway but the point is that the app was the best possible tool for me to do it with – I couldn’t have designed it better myself. They enabled the behaviours by telling me exactly how many calories I had burned, how many I had eaten and, what’s more, it gave me constant reminders to log in. Apps are designed to make your life easier, to get you to use them."
It feels like a game. These apps encourage you to succeed.
MyFitnessPal not only reminds you to log in but congratulates you if you manage to do so for multiple days in a row. Even for those not suffering with an eating disorder, it feels like gamified weight loss, a competition in which your only opponent is yourself but nonetheless you must win. Fasting apps employ similar strategies. Whether you’re using Zero, Vora or another fasting tracker, they all present you with a timer, which shows how long you’ve managed not to eat, and send you updates as you go. Once again, it feels like a game. These apps encourage you to succeed, which for those who have or are recovering from an eating disorder, is particularly damaging.
Natalie*, who is now 23 and working in politics had a similar experience to Annie. She downloaded a variety of tracking apps when she was 16 years old and growing up in Aberdeen. It got to the point where she was consuming "under 1,000 calories or only one meal a day".
"I felt like I was winning if I was successful at not eating," Natalie says. "My eating disorder was definitely exacerbated by the apps. It’s similar to a game in the way that you set yourself objectives and feel like you’ve really accomplished something when you achieve it. There is definitely an element of 'winning' and 'losing' to it which is really stressful because not 'winning' seems like a terrible thing. That would make me feel really anxious."
It’s worth noting that Zero also tells you about celebrities who endorse intermittent fasting. Hugh Jackman and The Rock are into it, they say. The app also extols fasting’s health benefits such as "ridding the liver of glycogen", helping "the body begin using ketones for fuel" and activating "autophagy to rid the body of damaged cells".
These claims, as consultant dietitian Kirsten Jackson tells Refinery29, are not "based on any strong scientific proof". In fact, she says, "if anything, not eating regularly and fuelling your body is likely to leave you feeling quite tired."
"As a dietitian," Kirsten added, "my main concern with fasting would be the ability for someone to get all the micro and macronutrients they need into just one or two meals a day. Managing to have 30g of fibre per day in two meals would be quite difficult for some. So over time, it is likely that someone's diet would be deficient in certain areas."
Once in recovery, Annie struggled to give up her tracking apps, deleting and re-downloading several times. "It was really hard for me," she says, "one of the nurses who was treating me at the time was just like 'you have to stop now' but I was addicted to it, I had to delete it a few times before I was able to let go for good."
Under Armour, which owns the MyFitnessPal software, told Refinery29 that they acknowledge this issue and are mindful of the ways that the app could potentially be misused. They said that they employ "specific safeguards to reduce its attraction for individuals attempting to use it to enable detrimental eating behaviours".
Users who complete their daily diary with too few calories are encouraged to review their goals and are informed that a congratulatory post will not be generated for that day.
Users attempting to sign up with a goal weight that will put their BMI under 18.5 (considered 'underweight') are redirected to a weight gain or maintenance goal.
The company's terms and conditions of use and MyFitnessPal community guidelines clearly state that they do not promote unsafe weight loss techniques.
They added that they "continuously work to update the MyFitnessPal app to ensure that it provides users with the best experience possible".
However, Beat's director of external affairs, Tom Quinn points out that "many people with eating disorders count calories or track weight loss to the point of obsession, and fitness tracking apps can facilitate or exacerbate such behaviours and make recovery harder."
He thinks "there needs to be greater awareness around the risks that fitness tracking apps can pose to people with or vulnerable to eating disorders" and believes that the responsibility for that should fall with the companies which produce the apps.
"They should ensure people are directed to discuss the purchase or use of fitness trackers with a medical professional if they have a history of an eating disorder," he says, "and also ensure that notifications on the apps do not come on automatically so that people are not unwillingly exposed to intrusive messages that can trigger their eating disorder behaviours or thoughts."
So, it’s questionable whether the safeguards Under Armour has put in go far enough. In any case, Natalie thinks that they fail to understand just how complex an eating disorder can be.
"I think these apps are almost too effective," Natalie says. "My eating problems stem from wanting to feel in control of my life. I used to trick MyFitnessPal, for instance, by putting in my exercise so it didn’t necessarily register that I was constantly living in a severe calorie deficit."
Of course, it’s simply not true to say that everyone who uses a tracking app has or will develop an eating disorder. Thirty-four-year-old Laura says that she has actually found tracking apps really useful in improving her anxieties about food and body image as she recovers from problematic restrictive eating.
"For 20 years I felt like I was eating too much and so I would deprive myself of food," she says, "but now I can monitor what I’m eating and see exactly how many nutrients that food contains, it really helps me to control those anxieties, to hush those thoughts because I can see that I’m not splurging at all, I’m eating a healthy amount. It reassures me and helps me to eat. You don’t necessarily know how many calories are in everything so I find apps really helpful for that as well as tracking exercise."
Nonetheless, Deanne Jade, founder of the National Centre for Eating Disorders, says she would go further than Tom. She would like to see a government health warning put on tracking apps.
"Everybody wants a quick fix these days," she says, "and these apps are great for that, some of them are clearly really good, too. But experts saying 'these apps are going to do harm', it’s a bit like trying to tell the population that Boris Johnson has emotional problems...we could just make people more likely to vote for him. Warning people of the dangers of fasting or extreme calorie tracking when that’s their goal will only make them more likely to use an app."
She’s right to be concerned. Earlier this year it was reported that hospital admissions for eating disorders had surged to their highest level in eight years, more than doubling from 7,260 in 2010-11 to 16,023 in the year to April 2018.
Weight Watchers has recently rebranded, moving away from calorie counting and dieting in an attempt to embrace the wellness trend and you’ll be hard pushed to find someone openly drinking Slimfast, let alone boasting about it on social media. So perhaps there’s a bigger point to be made here, one which speaks to Deanne’s desire to see tracking apps come with a health warning.
Whether they have an eating disorder or not, Eikey and Reddy note that "women’s motivation for using these apps is often to lose weight even if they are technically at a healthy weight". There is a universal pressure, they say, "to be thin and beautiful" which has created what they call "normative discontent" – a state of being unhappy with one’s weight as a woman regardless of what weight you are. As they see it, this dissatisfaction is driven by the media and technology, in a world where losing weight is synonymous with health and success.
It is estimated that 35% of dieters develop eating disorder behaviours while of those, a further 20-25% go on to develop partial or full-blown eating disorders. However you slice it, the fact that tracking apps normalise these behaviours is, as Deanna says, something we should all be concerned about.
*Names have been changed to protect identities
If you are struggling with an eating disorder, please call the National Eating Disorder Information Centre hotline at 1-866-633-4220. Support and information is available.
Refinery29 UK contacted both Vora and Zero for comment but they did not respond.