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Some components of commonly used, empirically supported eating disorder treatments (CBT-E and FBT) may not be suitable for patients who also have OCD. These include aspects of parental control in FBT, collaborative weighing, self-monitoring and eating schedules/meal plans, and psychoeducation about food and weight. Achieving weight gain is particularly difficult in anorexia nervosa due to fear and preoccupation with weight, eating and “becoming fat.” Low body weight and malnourishment tends to increase anxiety and obsessionality, so weight gain early on is paramount, especially for individuals with this co-occurring presentation. Through clinical observations, patients have reported that FBT may aggravate OCD symptoms, such as preoccupation with numbers and exactness, and expanding obsessionality to concerns about exercise/movement and other topics within the morality domain of OCD. The lack of control and greater uncertainty that an adolescent experiences while completing FBT may be related to increased OCD symptomatology and poor treatment outcomes.
Diet and fitness apps are often promoted in university and college settings and touted as a means to improve health with little attention given to unanticipated negative effects, especially among those at risk for or with eating disorders.
Aims
Few researchers have studied how these apps affect women with eating disorders in university and college settings. This research investigates the unintended negative consequences of engaging with these tools.
Method
Data collection sessions comprised three components conducted with 24 participants: survey (demographic and eating disorder symptoms), think-aloud exercise and semi-structured interview. Thematic analysis was used to analyse data.
Results
Participants reported that diet and fitness apps trigger and exacerbate symptoms by focusing heavily on quantification, promoting overuse and providing certain types of feedback. Eight themes of negative consequences emerged: fixation on numbers, rigid diet, obsession, app dependency, high sense of achievement, extreme negative emotions, motivation from ‘negative’ messages, and excess competition. Although these themes were common when users’ focus was to lose weight or eat less, they were also prevalent when users wanted to focus explicitly on eating disorder recovery.
Conclusions
Unintended negative consequences are linked to the quantified self movement, conception of appropriate usage, and visual cues and feedback. This paper critically examines diet and fitness app design and discusses implications for designers, educators and clinicians. Ultimately, this research emphasises the need for a fundamental shift in how diet and fitness apps promote health, with mental health at the forefront.
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