HEALTH DECEMBER 18, 2013
Rebecca Gerson says she has never had a good relationship with food. “One day, I just felt uncomfortably full,” she remembers, “so I purged, and it kind of just stuck.” Gerson was twelve years old. Within a few years, she had cut most foods out of her diet but kept a short mental list of “safe” options: brown rice, strawberries, oatmeal, a single brand of veggie burgers.
When, four years ago, she downloaded MyFitnessPal Calorie Counter and Diet Tracker to her iPhone, it seemed at first like a new tool that could help her gain control over her eating. The free app, which allows users to enter (or even scan the barcodes of) more than three million foods, calls itself the largest nutritional database in the world. Along with calculating the fat, sodium, carbohydrates, and protein in everything from raw celery to Egg McMuffins to restaurant-prepared shark-fin soup, MyFitnessPal users can input their physical activity, which is automatically converted into caloric expenditure. As Gerson began using the app more and more intensely, she found her list of “safe” foods shrinking. “It’s really easy to keep rigid track of everything you do,” Gerson says. “I started to become rigid on foods I’d never had to think about before. Nothing’s really OK anymore because everything ‘counts.’ ”
By her senior year of high school, Gerson felt as if “everything was kind of slipping”—her grades, her social life, her self control. “I couldn’t focus anymore,” she says. So she checked into treatment.
“One of the most difficult things for women to get over is calorie-counting,” says Dr. Kimberly Dennis, the CEO and medical director of Timberline Knolls, a residential rehabilitation center outside Chicago that specializes in anorexia and bulimia. Of course, calorie-counting didn’t start with smartphones. Height, weight, waistline. Calories consumed, miles ran, and all those pounds—lost, gained, celebrated, wept over. Such calculations have been around much longer than personal technology. But the arrival of these apps, Dennis notes, has exacerbated what is, in essence, “a numbers-driven disease.” She estimates 75 percent of her young-adult patients use their phones in a way that enables or encourages their eating disorders.
The iTunes store features thousands of “Health & Fitness” apps (twelve pages for ones that begin with the letter “A” alone). MyFitnessPal is the most popular free app, with more than 40 million users; each month, 1.5 million new people sign up. But there are hundreds of other apps, whose minor differences garner leagues of loyal fans. Other weight-loss gizmos include the Withings Scale to measure your body mass index and heart rate; Nike+ running shoes that sync to your smartphone; and Fitbits, whose wrist displays allow you to monitor everything from the calories you’ve burned to the stairs you’ve climbed. In April, the research firm IHS released a report predicting that global downloads of sports and fitness apps will rise 63 percent by 2017. Over the same period, IHS also projects shipments of wearable sensors and computers will climb from 43.8 million to 56.2 million. For an anorexic with an Internet connection, the world has never been more user-friendly.
This is the dark side of what The New York Times Magazine called “The Data-Driven Life” in 2010. For years, “geeks” (the Times’ word) had been using the “techniques of analysis” to self-track everything from coffee consumption to professional efficiency to the time they wasted doing roommates’ dirty dishes. The philosophy—“self-knowledge though numbers”—seduced engineers, software coders, and self-described rationalists, the kind of people who proudly declare themselves to be “on the spectrum” and are more often than not male. In the three and a half years since the article ran, its premise has gone mainstream. Nike FuelBands adorn the wrists of fashion editors and start-up entrepreneurs alike; cars display fuel efficiency in real time; the New York City subway now features pacifying “countdown clocks.” As Michael Bloomberg is wont to say, “If you can’t measure it, you can’t manage it.”
For most people, these new apps and technologies are valuable tools for self-improvement, including weight loss. But for people with eating disorders, they can abet the most destructive compulsions. When she was ten, Danielle Cauley, now 20, began logging everything she ate in an Excel spreadsheet. “If I ate something, I had to enter it,” she remembers. “It changed my behavior.” Entering too many numbers made her feel “like a failure.”
“Women have been at the forefront of self-quantification for a really long time, certainly since we started to equate slenderness with self-control,” says Clive Thompson, author of Smarter Than You Think: How Technology is Changing our Minds for the Better. Weight Watchers was among the first companies, in the pre-digital era, to recognize the marketability of calorie-counting. “The whole genius of what they did was to formalize all foods into a mechanized point system of input and output,” Thompson says. “The program allows members to have a spreadsheet-like relationship to their own bodies.”
Now, even Weight Watchers is falling behind the times: In August, just after the company’s chief executive resigned, the CFO blamed declining recruitments on “the continued sudden explosion of interest in free apps and activity monitors.”
The apps are new enough still that substantial and longitudinal studies on their psychological effects on eating-disorder patients have yet to be completed. But as Lara Pence, a clinical psychologist and director of alumni affairs at the Renfrew Center, says, “It doesn’t really take research for us as an organization or for me as a clinician to see their damaging qualities.” She notes the sense of guilt they engender—implying defeat when users go “over” their allotted calories and then recommending exercise to make it up. “In some ways,” she says, their existence “speaks to the very core pathology of the disease: If I do this, then I have to do that.”
Recovery, in this context, is more challenging than ever: Eating-disorder patients must constantly resist a culture that facilitates and streamlines the very habits that make up their disease. Though almost all in-patient eating-disorder treatment facilities prohibit computer and cell-phone use in order to encourage socialization, restrictions on technology are becoming increasingly central to rehabilitation plans, as patients learn to control calorie-counting. “It’s definitely something we address in treatment,” Dennis says. And since smartphones are an unavoidable part of life outside of treatment, there are also efforts to harness apps as part of the recovery process. Recovery Record, a “mobile-first patient management experience,” urges users to enter personal data—but of a different sort than they might otherwise be inclined to. Users input their meals but also thoughts and feelings. They can log whether they are feeling joy, guilt, disgust, anxiety, irritability, shame, anger, hope, fatigue, or physical pain, as well as rate their energy level on a scale from “very lethargic” to “hyperactive.”
Gerson, now in college in Connecticut, is two years out of treatment but still finds it difficult to eat or exercise without automatically performing mental arithmetic. “I was never really a calorie-counter before using the app,” she says, “and now I’m so good, I don’t even need it.” She deleted MyFitnessPal from her smartphone with the support of her doctor. Six months later, she bought Up by Jawbone, a wristband that tracks how much she walks. When she first started wearing it, Gerson just tried to meet the device’s generic goal of 10,000 steps per day, but soon she found herself trying to beat the number. “I go to events on campus that I have no interest in,” she says, “But I think, ‘Oh, seven hundred more steps!’
Alice Gregory is a writer living in New York City.