Effects of diet and fitness apps on eating disorder behaviours: qualitative study

Measures of nutrition status and health for weight-inclusive patient care: A narrative review

In healthcare, weight is often equated to and used as a marker for health. In examining nutrition and health status, there are many more effective markers independent of weight. In this article, we review practical and emerging clinical applications of technologies and tools used to collect non-weight-related data in nutrition assessment, monitoring, and evaluation in the outpatient setting. The aim is to provide clinicians with new ideas about various types of data to evaluate and track in nutrition care.

Exploring weight-related self-monitoring as a potential risk factor for eating disorder symptoms in adults - A systematic review and meta-analysis

OBJECTIVE

Weight-related self-monitoring (WRSM), which involves the intentional tracking of body weight metrics, has been considered a potential risk factor for eating disorders. Therefore, the aim of this study was to systematically summarize the current state of the literature and to quantify the possible association between WRSM and eating disorder symptoms in adults.

METHOD

Preregistration was carried out using PROSPERO (ID CRD42022366133). The PubMed, PsycInfo, and Web of Science databases were searched until December 21, 2023. A study had to be 1) be available in English or German, 2) be peer-reviewed and quantitative, 3) include adult participants (age ≥18 years) from the general population, 4) assess eating disorder symptoms via at least one of the following questionnaires: EDI, EAT, FEV, TFEQ, DEBQ, EDE-Q, Munich ED-Quest or IEG, and 5) include WRSM. Data analyses included descriptive analyses and three-level meta-analysis, corrected for correlations, for the global score and the different subscales of the eating disorder questionnaires.

RESULTS

A total of 28 studies (n = 17,370 participants), with an overall fair methodological quality, were included in the systematic review. Out of these studies, nine studies with n = 13,507 participants were ultimately analyzed in the meta-analysis. The three-level meta-analysis did not reveal a significant association between WRSM and the eating disorder global score (r = 0.13, 95% CI [-0.02, 0.28]; p = 0.08), with this pattern also being evident in the subgroup analysis (diet monitoring).

DISCUSSION

WRSM alone does not generally translate into an increased risk of disordered eating symptoms in the general population. We assume that individual factors are likely to determine whether the use of WRSM could lead to eating disorder symptoms. These factors should be accounted for in future research.

Factors associated with food label use: focus on healthy aspects of orthorexia and orthorexia nervosa

PURPOSE

This study aimed to investigate the potential relationships between the use of different section of food label, and healthy and pathological aspects of orthorexia among adults.

METHODS

This cross-sectional study was conducted using an online survey (n = 1326). Inclusion criteria were being 19-64 years and graduated from at least primary school. Pregnant and lactating women were excluded. Data were collected using questionnaire including socio-demographic variables, lifestyle factors, body weight and height, frequency of reading different sections of food label ("always", "when buying a food for the first time", "when comparing similar packaged foods", "rarely", "never"), food label literacy, and Teruel Orthorexia Scale. Participants were categorized as nutrition facts panel-users, ingredients list-users or claim-users if they read at least one item from the relevant parts.

RESULTS

The proportions of nutrition facts, ingredients list, and claims sections users were 72.3%, 76.3%, and 79.9%, respectively. Both healthy and pathological aspects of orthorexia were associated with reading food labels. The healthy orthorexia had the strongest association with using the ingredients list (OR 1.76, 95% CI 1.41-2.20), whereas the orthorexia nervosa showed the highest association with using nutrition facts panel (OR 1.48, 95% CI 1.20-1.81). While women, physically active participants and those with higher food label literacy were more likely to use all sections of food labels; older age, having children, and chronic disease increased the likelihood of using claims and ingredients list (p < 0.05). Besides, following a diet was associated with higher use of nutrition facts and ingredients list (p < 0.05).

CONCLUSIONS

The study demonstrates that food label users have higher orthorexia tendencies compared to non-users. Of the food label sections, healthy orthorexia showed the strongest association with use of the list of ingredients, while pathological orthorexia showed the strongest association with use of the nutrition facts panel.

LEVEL OF EVIDENCE

Level V, cross-sectional study.

["Dark patterns": manipulative design strategies in digital health applications]

Among other things, digital health applications offer users support in better understanding their physical and mental health through digital data, thereby promoting positive health behavior. In addition to state-approved digital health applications (DiGA) and digital care applications (DiPA), there is a wide array of other commercial health applications available to users. Particularly in non-approved applications, developers often deploy manipulative design strategies (dark patterns), intentionally or unintentionally, to deceive users into making specific decisions. This article provides an overview of current and widespread dark patterns and assesses the risks posed by them in digital health applications.In the future, "light" should be shed on dark patterns by creating more transparency for users, providing regulators with a more accurate understanding of dark patterns, and paying more attention to the implementation of guidelines. Thus, users may gain autonomy using healthcare applications and their data can be better protected.

Unveiling Skin Manifestations: Exploring Cutaneous Signs of Malnutrition in Eating Disorders

The intricate interplay between eating disorders, malnutrition, and their cutaneous manifestations is the focal point of this comprehensive review. The review delves into the clinical significance of recognising and understanding these visible signs in the context of eating disorders. It highlights the vital role of nutrition in maintaining healthy skin and addresses the challenges associated with relying solely on cutaneous signs for diagnosis. Emphasising a multidisciplinary approach involving dermatologists, psychiatrists, and nutritionists, the review underscores the holistic nature of the treatment. Addressing psychological aspects alongside nutritional rehabilitation is underscored with a forward-looking perspective on future research avenues. This review is valuable for healthcare professionals by synthesising existing knowledge and identifying research gaps. It aims to improve the diagnosis, treatment, and preventative strategies for individuals dealing with the complex challenges of eating disorders and malnutrition.

Preventing chronic fatigue in Czech young athletes: The features description of the “SmartTraining” mobile application

This study describes a beta version of a mobile application (app) that focuses on preventing chronic fatigue in Czech youth athletes. The first version of the SmartTraining app was developed for athletes as a way to prevent chronic fatigue via alertness and education. For alertness, a multistage process was developed using a combination of parameters about training responses, such as tiredness, well-being, heart rate, energy balance and psychological, and health-related aspects. According to the combination of the multistage parameter outcomes, the algorithm classifies the risk of fatigue based on semaphore light: green corresponds to low, yellow to moderate and red to high risk. The education presented in the app consisted of written and “animated videos” material about the variables involved in training, such as training demands and athletes’ responses, regeneration, nutrition and communication between athletes, coaches, and parents. Subsequently, a beta version of the app was created and freely available to download for Android or iOS mobile. The app can be used in daily routines to reduce the risk of chronic fatigue from inadequate training dose response. Prevention can minimise the risk of injury or physical and emotional burnout in youth. Informing athletes on how to carefully handle the training factors can improve athletes’ awareness of their performance and health status. Collaboration between sports scientists and the commercial sector allows for the efficient development of an easy-to-use and low-cost tool for use in sports settings. Future steps should be performed to validate the app’s accuracy in its alertness and in the efficiency of the educational process.

Usage of Mobile Applications or Mobile Health Technology to Improve Diet Quality in Adults

The use of mobile applications for dietary purposes has dramatically increased along with the consistent development of mobile technology. Assessing diet quality as a dietary pattern or an indicator across key food groups in comparison to those recommended by dietary guidelines is useful for identifying optimal nutrient intake. This systematic review aims to explore mobile applications and their impact on the diet quality of the user. The electronic databases of The Cumulative Index to Nursing and Allied Health Literature (Cinahl), The American Psychological Association’s (APA Psycinfo), and PubMed were systematically searched for randomised and non-randomised controlled trials to retrieve papers from inception to November 2021. Ten studies with 1638 participants were included. A total of 5342 studies were retrieved from the database searches, with 10 articles eligible for final inclusion in the review. The sample sizes ranged from 27 to 732 participants across the included studies, with 1638 total participants. The ratio of female to male participants in the studies was 4:1. The majority of the mobile applications or M-health interventions were used to highlight dietary health changes (six studies), with the remainder used to reduce weight or blood sugar levels (four studies). Each study used a different measure to quantify diet quality. Studies were either assessed by diet quality scoring or individual dietary assessment, of the ten studies, six studies reported an improvement in diet quality following diet-related mobile application use. Mobile applications may be an effective way to improve diet quality in adults; however, there is a need for more targeted and longer-term studies that are expressly designed to investigate the impact using mobile applications has on diet quality.