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Can Fitbit Retrigger Eating Disorders?

Can Fitbit Retrigger Eating Disorders?

“Can Fitbit Retrigger Former Eating Disorders?”

By Elizabeth Roberts
Columbia University Graduate School of Journalism
Tactical Technology Reporting 2016; 4/21/16


Veronica Goldhagen was shopping when her friend asked if she could hold her bags. She wasn’t tired of carrying them; she wanted to ensure her arms could move freely back and forth so her Fitbit could count the steps she walked. Goldhagen found that watching her friend quantify her steps reminded her of the obsessive tendencies that often accompany eating disorders. “She just refused to take it off,” Goldhagen said. “There’s a compulsive aspect to eating disorders and tracking devices can really play a big part in that.”

Created in 2007, Fitbit is a wearable fitness tracker that became known for counting the number of steps a person takes in a day. By 2015 the $4.1 billion business had sold approximately 20.8 million devices since 2011, according to CNN. Worn on the wrist, Fitbit can track a user’s physical activity (miles ran, etc.), weight, food intake and even sleep. In addition to the statistics readily available on a user’s wrist, most of the Fitbit models can sync to cell phones (iOS and Android), as well as the Fitbit website.

There is a sense of community for Fitbit users who post on the company’s discussion board about their weight loss progress or fitness goals achieved: “119 pounds lost and feeling good” and “Would love some new friends on the app to help cheer me on when I do good.” What seems like promotion of a healthy lifestyle can be anything but for some users.

Goldhagen, a freshman at CUNY’s Guttman College, is a volunteer at the National Eating Disorders Association (NEDA). While the shopping incident with her friend happened a few years ago, she said it was enough to show her that using a Fitbit can be addictive to the point of never wanting to take it off. She hasn’t used Fitbit before, and does not plan to, because she doesn’t think it would be helpful to her recovery.

“There are some people who don’t understand what triggers them,” Goldhagen says. “I can only imagine how triggering [wearing a Fitbit] would be since I would personally never use one... When I got out of treatment at sixteen, that’s when they told me avoid weighing myself. I’m twenty now and I’m still following that system.”

Avoiding a relapse for a former anorexic can be a lifelong challenge, not the kind of short-term milestone that monitors like Fitbit often emphasize.

Nutritionist Melainie Rogers, an eating disorder specialist of 14 years, says that while Fitbit can be very helpful for the average user, it’s an unhealthy approach for those affected with disordered eating- particularly for people who suffered from anorexia.

“Those who have anorexia tend to have higher anxiety and higher compulsive tendencies so that means they’re a little more vulnerable to getting obsessive,” Rogers says. “I’m not saying that someone with bulimia would not be affected, but the obsessive compulsive traits are more prevalent in those identifying with anorexia. They feel as if they need to hit a certain number every day.”

“Hitting a number” can mean different things to someone with an eating disorder- a weight they feel needs to be maintained or lost, a numeric breakdown of calories, the tallied minutes dedicated to working out. The fact that Fitbit offers these features in the device, without giving recommendations for healthy limits, makes the product dangerous for those who have suffered from eating disorders in the past.

Lisa DeFeciani, PhD., has specialized in eating disorders for the past 16 years as a clinical social worker. “There are some clients I don’t think Fitbit would be helpful for because they have obsessive compulsive traits and they would be too focused on it; with their relationship with food they would get stuck,” DeFeciani says. “With other clients, that wouldn’t happen. It depends on other underlying issues that the client is coming in with. One size doesn’t fit all here; it has to be individualized with the patient.”

NYU master’s student and former NEDA volunteer Nathalie Qin has been in recovery from anorexia for five and a half years. She used nutrition tracking devices at different stages in her recovery and found that a device similar to Fitbit made her relapse. “I would try to make sure my gross calorie-intake by the end of the day (when compounded with the calories burned during my work-outs) was either zero or negative,” Qin says. To make sure she was losing weight, she constantly weighed herself.

Qin says she took the calorie intake goals as a challenge and if she failed to meet the goals, she felt shame and disappointment. “The fact that it was an app made it feel like it was scientifically basedand therefore justified my restriction,” Qin says. “It didn't feel like I was arbitrarily making a decision to eat less, I was ‘following a program.’”

The “achievement badges” Fitbit users can gain are meant to be positive reinforcement. But for individuals recovering from eating disorders, the idea of gaining points for losing weight can lead to detrimental health choices such as over-exercising and excessive calorie cutting.
Fitbit declined to comment and referred me to their message board where Fitbit users can post comments about the device. Typing in “eating disorder” to the search engine brings up several posts relaying concerns about some of Fitbit's features that users consider detrimental to their recovery.

On Sept. 8, 2015, Fitbit user “MorgnsGrl” asked Fitbit to make the calorie counting feature optional. “There are those of us in the Fitbit community in recovery from eating disorders, and having ‘calories’ as a non-optional goal on the dashboard, so that we have no choice but to see it constantly, can be detrimental to recovery. I hope this is going to be dealt with. I am a dedicated Fitbit user -- for my health, so that I stay active -- but I can't be subjected to unavoidable calorie information -- FOR MY HEALTH, both emotional and physical.”

Within 45 minutes, a Fitbit moderator responded with a link to a “Feature Request” and said “I'd urge you and anyone else who is interested in this change to vote and comment on that request so that we can pass it along to our developers.”

MorgnsGrl follows up five days later on the discussion thread to ask if there’s been any progress made on the feature request. “I am on the verge of setting aside my Fitbit and moving on to a different product specifically because of this one issue (the inability to avoid the calorie information that is harmful to my health.)” As of this writing, there has been no response from a Fitbit moderator.

The implication is that had there been more posts that similarly said Fitbit’s mandatory calorie counting factor was triggering, the feature request may have been taken more seriously. Certified Nutrition Consultant Bonnie Witler has worked with eating disorder patients for 18 years. She says that for people with former eating disorders who use fitness and nutrition monitoring devices, the tracking can become obsessive. “Calorie counting is terrible for anyone, it makes even the average person hyperaware of everything they eat,” Witler says. “But for those who have had problems with disordered eating in the past, it can definitely trigger dormant eating disorders.”

Dr. Maureen Dymek-Valentine of UNC’s Center of Excellence for Eating Disorders has been researching and treating eating disorders for over nine years. She says that Fitbits do not cause eating disorders; the disease is caused by genetics, psychological factors, and environmental factors.

“Most people who use Fitbits will not develop an ED, and many people with EDs have never used Fitbit,” Dymek-Valentine says. “However, anecdotally, I can say that I have seen ED patients who have used their activity trackers for unhealthy means, e.g. setting lofty goals such walking 25k steps per day and punishing themselves with food restriction when such goals aren't met.”

NEDA reports that in 2011, 20 million women and 10 million men in America suffered from “a clinically significant eating disorder at some time in their life, including anorexia nervosa, bulimia nervosa, binge eating disorder or EDNOS.” Eating Disorder Not Otherwise Specified (EDNOS) means eating disorder symptoms that do not meet the criteria of the eating disorders listed above.

Fitbit can be a valuable tool for users to learn more about how their bodies work through tracking nutrition, monitoring fitness and mapping sleep patterns. The “quantified self” movement extols personal data collection as a way to make our lives more convenient and easily understandable through statistics. More data is always better, right? But when there’s a possibility of a device becoming so habit forming that it logs and affects daily food intake and exercise regimen, data can actually exacerbate existing problems. For an eating disorder survivor, daily fitness and nutrition data may dredge up an unhealthy, life-altering, and potentially life-threatening fixation.

Photo Credit: Brookstone

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