Weight Loss App for Kids: Backlash 'Swift and Severe'

I cannot turn away from the crisis on my doorstep.

I'm a pediatric endocrinologist in Mississippi, the poorest and unhealthiest state in the nation. Currently, 43.2% of our children have excess weight or obesity.^[1] I now see children with type 2 diabetes daily, and about a quarter of my patient referrals are seeking help for abnormal weight gain and obesity-related disease.

The nutrition counseling I provide with my registered dietitian often seems like brand-new information to my patients—evidence of overall poor health literacy, especially concerning food. At least weekly, a family is surprised to learn that sweet tea and fruit juices are as unhealthy as soda. Multiple times daily, families admit to feeling overwhelmed by seemingly conflicting dietary information.

Regardless of the numbers on the scale, I want all of my patients to exercise, avoid smoking, favor plant-based foods, and avoid sugary beverages. But when I discuss these behaviors with families whose members have obesity, my message is often obscured by other influences, from media to school bullies to family members. When patients have already been berated about their weight from multiple directions, they have experienced trauma before crossing my clinic threshold. These conversations are delicate and often end in tears, no matter how positively we frame the motivation for healthy lifestyle change.

Some children and their parents come to me desperate for help after multiple failed attempts to improve their health. They often request a written diet plan. We work with them to learn the plate method, encourage them to eliminate added sugar, and brainstorm ways to increase fruits and vegetables, with the end goal of empowering them to make healthy choices, not follow a "diet"; we know that diets fail. But many times, this approach doesn't provide the structure that families seek.

We've asked patients to keep food journals for us to review at their return appointments. The reality of their true caloric intake and how much it exceeds recommendations can be startling. In my experience, when patients track their food, the conversation can shift from a tone of confusion and perceived healthy habits to one of ownership and readiness to adopt sustainable healthy eating patterns.

Weight Watchers to the Rescue?

In this climate, I've often longed for national, commercially successful, and familiar programs like Weight Watchers (now known as WW) to step into the arena with us to help make measurable change in the childhood obesity epidemic. Some parents in my practice have attended WW meetings and extended the philosophies of making low-fat, high-fiber choices most of the time to their entire family, with healthy results for all. WW also has published success rates in peer-reviewed studies,^[2] unlike the many fad diets that promise fast results.

I've personally used the WW app with the desired outcome of weight loss, and found the program much easier to follow than others, with long-lasting lessons of incorporating more fruits and vegetables, for instance. Thus, I expected the medical community to rejoice along with me upon hearing the news that WW had applied Stanford University's well-researched and successful program, Kurbo, to provide a free app for children over age 8 that gives support for weight loss and healthy food choices, with coaching available for a fee.

Instead, the backlash was swift and severe. The National Eating Disorders Association issued a statement expressing concern that the app would lead to disordered eating. The hashtag #wakeupweightwatchers contained many petitions and protests against the app, and social media was ablaze with expletive-laden missives against the perception that children were being told by society that their size determined their worth.

At first, I was flabbergasted; my emergency aid to the trenches was under fire! But after examining the app with a critical eye—as a pediatric endocrinologist, as a mother of girls, as a woman scarred by the trillion-dollar diet industry built on making me hate my body—I join many of my colleagues with a raised eyebrow.

I applaud the work done at Stanford that created the Kurbo program. I am ecstatic at any attempt to help protect children from rapid abnormal weight gain that will harm their health. I perceive that many critics misunderstand the intended purpose of Kurbo: Trying to encourage prepubertal children to look better in a swimsuit is not the goal. The "red light/yellow light/green light" program has been used for more than 50 years in a variety of pediatric programs (notably, this familiar approach may have failed, given the rise in child obesity). The app-based method is brilliant for our technology-driven youngsters. However, it does have some glaring problems.

A Problematic Plan

First, a child of any BMI can join with the intention of weight loss, not just children with unhealthy BMIs. This opens the door for dieting to achieve some ideal, rather than making better choices for overall health. Second, many of our children need to have healthier lifestyles, not just those with obesity, so weight loss should not be the only focus.

The stated motivations for weight loss can be disturbing ("to make my parents happy" is one possible reason for staying on-plan). Putting the directive on the child is also upsetting; any successful lifestyle intervention for children must involve the entire family.

The diet plan itself is problematic. It skews very low-fat, which makes satiety difficult and may be inappropriate for children with ongoing neurodevelopment and pubertal change. Grilled chicken and beans are "yellow" choices, while avocado and unsweetened peanut butter are "red." I'd venture that these foods are not the reason why our children are struggling to maintain healthy weights. The plan may be difficult to follow for children living in poverty and those who are dependent on school-provided food options.

Worst of all, there is no screening mechanism to predict which children are at greatest risk for disordered eating. Indeed, the greatest predictor of an eating disorder in children 14-15 years of age is a history of dieting.^[3]

So I continue in the trenches alongside my patients and their families, who only represent those who have the luxury of healthcare access. We need better policies surrounding food in this country, period. We need multidisciplinary approaches involving not only medical professionals but also school officials and community leaders. We need to reframe the conversations around healthy diet and exercise. And perhaps with some work and feedback from those of us on the ground, app-based programs like Kurbo can help properly selected patients who have supportive families and medical oversight.

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