An app, licensed by Weight Watchers, promises to help overweight children shed pounds. But the questionable evidence, and potential for harm, is a reminder of the complexity of childhood obesity.
By Amitha Kalaichandran, M.D. — Aug 19, 2019
Last week, the organization formerly known as Weight Watchers (now branded as “WW”) announced they were launching a ‘diet app for kids,’ called Kurbo. Everyone from celebrities like Jameela Jamil, who has been open about her own weight struggles, to dieticians, piped in with concerns. Soon enough, even parents expressed dismay and the National Eating Disorders Association (NEDA) released a statement warning about the risks of using the app. Then, over the weekend a petition on Change.org gained ground. As of this writing, they are close to 80,000 signatures.
Obesity affects one in six children in the US and 41 million globally. Kurbo was founded several years ago by an earnest entrepreneur and promises to be a convenient ‘weight management coach in your pocket’ for kids. It has also been marketed as a gamification of a reputable ‘analog’ pediatrics weight management program.
In my view, there are three considerable problems with Kurbo that are difficult to reconcile.
The first issue is that, even though Kurbo claims it’s backed by science, this is stretch. As a general rule, if a company says that their product is backed by ‘science’ or ‘evidence,’ and they don’t clearly support this statement with robust peer-reviewed literature, those claims should raise eyebrows. In this case, Kurbo doesn’t list any peer-reviewed articles on their site.
The evidence simply isn’t there. The behavioural science in adults shows that consistency of tracking can be an issue due to poor adherence; one of the best trials looking at mobile technology for weight loss in young adults found that changes weren’t sustained at 18 and 24 months after.
In kids specifically, there is very limited research for weight management apps. I could only find one small systematic review, that was of poor quality and limited in its conclusions. A pilot study that followed girls aged 9–14 found a small change in weight, but the follow-up period was limited to only three months. Another study, using an app with a wearable, found no significant impact on weight loss in children. All of these findings are complicated by publication bias and reproducibility: it’s harder to publish results that show ‘no difference’ and tough to replicate studies in order to show consistent results. Six years ago, a published analysis pointed out several issues with pediatric apps for weight loss, namely that most young kids don’t have their own phone, and the guidelines isn’t evidence-based. As well, as a recent scoping review found, many app companies don’t involve collaborators with the right scientific expertise, and as a result, they end up with a product that lacks evidence, and thus one with very limited impact.
Kurbo’s own research isn’t readily found in the peer reviewed literature, though a summary was presented in abstract form (with the founder as the sole author). Very recently, however, an article reported that the app wasn’t effective, likely due to adherence issues. It’s possible that the ‘science-backed’ claims of Kurbo were extrapolated from the pediatric weight management program they had hoped to gamify, and not the app itself. Yet, any time an analog program is translated into an app, there are significant changes — it’s like taking a medication from the lab or clinical trial and transporting it directly to the bedside: real life variables get in the way which impact the measurable results. The most concerning factor here is the tracking component which uses a traffic light system (an approach that also has inconsistent evidence), which may lead to children becoming hyperfocused on tracking.
This leads into the second problem, which is that the principles behind Kurbo fly in the face of two major recommendations of the AAP: healthy ways to manage children’s weight and screentime concerns. In 2016 the AAP released a clear stance that childhood obesity must be managed in a way that doesn’t encourage eating disorders. Even physicians sometimes miss these signs. From Kurbo’s website site, it seems most of the coaches are college students and their training isn’t transparent in terms of the tangible ability to detect warning signs. While Kurbo has made a statement that there is no evidence of increased risk of an eating disorder, this may be based on extrapolating from adult studies of formal in-person programs and disregards the fact that children are highly impressionable and, as most doctors know ‘not simply little adults.’ To make things worse, given the reliance on smartphones, Kurbo may even be counter to the AAP’s recommendations around screentime, which, independently (and ironically) may be a contributor to lifestyle issues like obesity.
Lastly, the association with WW doesn’t help. Despite the rebranding, Kurbo has, whether they realize it or not, adopted some of the problematic issues of the Weight Watchers brand. For instance, it’s hard not to see the parallels between the traffic light and their divisive points system. On the website a girl named Libby is named, with her age and ‘before’ and ‘after’ photo, which is reminiscent of Weight Watcher’s classic marketing strategies, a strategy that can be harmful even to adults.
Creating meaningful impact in health innovation is difficult — we need only look to Theranos to see that, unfortunately, hype around ‘disrupting’ health can take a company far, primarily because most tech investors are unable to critically appraise medical innovation. Recognizing this, in recent weeks, there was a new announcement about “MDisrupt,” headed by two industry leaders tasked to provide this vetting. As well, there was a call for health technology companies to take a Hippocratic Oath. These are two very welcome advancements in health innovation, from both a scientific and ethics point of view.
While it’s unclear what the impact will be with the Change.org petition, the controversy has certainly shed light on the fact that childhood obesity is a complex issue, and often a symptom of something larger, so solutions rely on more than the food children choose. Some promising work has come from researchers looking to create neighbourhood and community-based approaches such as the Massachusetts Childhood Obesity Research Demonstration (MA-CORD) study, which is also in California (CA-CORD). Family-based obesity treatment may also provide a cost-effective approach.
It doesn’t mean that an app can’t be part of tackling childhood obesity, indeed technology in general can help us make strides in tough-to-tackle conditions, particularly chronic diseases in children. However, a more prudent approach would address both the upstream factors (food security, poverty, stress, mood disorders, sleep disturbance, lack of education) as well as minimize potential risks. Though Kurbo may have been created with the best intentions, pivoting towards an innovation that is based on solid evidence with minimal risk is crucial: this may require blending a comprehensive lifestyle management and “wellness” approach that is not divorced from the social determinants of health that lead to childhood obesity, all while minimizing risks of harm. It’s the least we owe our children.
Amitha Kalaichandran, M.H.S., M.D., is a resident physician (pediatrics), epidemiologist, and writer based in Ottawa, Canada. Follow her on Twitter at @DrAmithaMD.