Health Care Providers for the Elimination of Kurbo/WW Dieting App for Children/Teens
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September 30, 2019
We are a multidisciplinary group comprised of physicians, dietitians, and therapists who are experts in the medical aspects of eating disorder care. We write to express our significant concern about the safety of the recently launched Kurbo app by WW, aimed at children and adolescents ages 8-18. Our concerns in this letter focus specifically on the medical safety of Kurbo, as this is the expertise of the main authors. We are grateful that so many diverse eating disorder professionals subsequently chose to sign on to this letter.
As a group we fundamentally disagree with the dissemination and use of the WW Kurbo app.
An editorial published on August 19, 2019, by Christy Harrison in The New York Times, “I Help People Recover From Disordered Eating. Don’t Give Your Child This App,” very capably reviews the literature and well expresses the sentiment of this group. Rather than reiterate what this article covers, we include the link: https://www.nytimes.com/2019/08/18/opinion/weight-watchers-kids.html?searchResultPosition=1
Medically, children and adolescents are meant to be diverse in size and shape. Pubertal processes mandate significant weight gain during these critical years in order to ensure bone, brain, and other organ health by adulthood. Body image and self-esteem, both of which are protective against other high-risk behaviors in adolescence and adulthood, are under threat during these years and are positively impacted by body acceptance. (1) Weight loss disrupts important physiologic milestones, and even just asking youth to change their body size to become smaller can cause serious harm to their mental health. (2)
In addition, dieting —by whatever means, and especially to include an app designed for children and adolescents—is associated with weight cycling, which has been proven to result in worse health outcomes. (3) This is in part because human brains respond to the perception of inadequate caloric intake by shifting myriad physiological processes to slow metabolism, as a result of which most caloric restriction results in short term weight loss but is nearly always followed by weight increase back to baseline and often higher. (4)
Good evidence indicates that dieting among adolescents leads to greater weight gain. (5) In addition, diets can result in secretive eating, which can lead to more disordered eating-related psychopathology and dieting behaviors as well as loss-of-control eating than those who do not eat secretly. (6) Feeling ashamed of one’s body is traumatic and can lead to numerous mental health issues such as depression, social anxiety and addiction, along with eating disorders. Body dissatisfaction has been found to be the number one predictor of early onset eating disorders, and dieting is a key risk factor for the development of eating disorders. (4)
Additionally, while we understand that there were attempts made to mitigate potential harms from the app, we continue to have serious safety concerns about Kurbo. The Kurbo app does not screen adequately for eating disorder behaviors or cognitions before, during or after usage. It broadly identifies the same amount of weight loss as harmful for an 8-year-old or for an 18-year-old, when these body sizes and developmental stages are radically different. Furthermore, coaches—only available to those who pay, opening a discrepancy in access even to minimal safety features—are given only 6-8 hours of initial training prior to direct interaction with adolescents on these critical topics. Before and after testimonials are presented that may make vulnerable children and their parents believe that weight loss is common, safe, achievable, and sustainable, when copious research contradicts this. Children as young as 8 are taught to categorize food as ‘red’, ‘yellow’, or ‘green’, and directed to exercise and plan in advance to eat fewer ‘red foods’ for things as common as birthday parties, encouraging maladaptive eating and exercise practices for things that should be joyful and carefree for children.
Eating disorders are common, (7) increasingly present in younger children, (8,9) carry an exceptionally high mortality rate, (10) and are exceptionally difficult to recover from, often taking decades. Based on our collective extensive experience in this field, we recommend strongly against the dissemination and use of the WW Kurbo app.
Jennifer L. Gaudiani, MD, CEDS-S, FAED
Founder & Medical Director, Gaudiani Clinic
Theresa Fassihi, PHD, CEDS-S, FAED
Dr. Josephine Neale, MBBS, BSc, MRCPsych
Consultant Child and Adolescent Psychiatrist
Michael A. Spaulding-Barclay, MD, MS, CEDS
Lesley Williams, MD, CEDS
Abby Brockman, RN
Deb Burgard, PhD, FAED
Cupertino, CA USA
Michele Calderoni, DO
Heather A. Dlugosz, MD, FAPA, CEDS
Lisa DuBreuil, MSW, LICSW
Alison I. Kaufman, PsyD
Dr. Ashish Kumar
Clinical Lead for Eating Disorder Service for Young People North West Boroughs Health Care NHS Foundation Trust
Rebecka Peebles, MD
Board-Certified Pediatrician and Specialist in Adolescent Medicine
Rachel Bachner-Melman, PhD, FAED
Senior Lecturer, Ruppin Academic Center and Hebrew University of Jerusalem Founder and Director, Koli, the Jerusalem Center for Recovery from Eating Disorders
Suzanne Dooley-Hash, MD, FAED
The Center for Eating Disorders
Ann Arbor, Michigan
Vikas Duvvuri, MD, PhD, FAPA
President, Sunol Hills at Oakview Lafayette, CA
Honorary Clinical Lecturer, University of Liverpool
Andrea LaMarre, PhD
Amanda Lerman, MD, MSHP
Adolescent Medicine Physician
Margo Maine, PhD, FAED, CEDS
Maine & Weinstein Specialty Group
Beth Hartman McGilley, PhD, FAED, CEDS-S
Licensed Clinical Psychologist
Rachel Millner, Psy.D., CEDS-S
Millie Plotkin, MLS
Leslie Richmand, LCDW, CEDS
Ellen Rome, MD, MPH
Head, Center for Adolescent Medicine, Cleveland Clinic Children’s Hospital
Elissa Rosen, MD, CEDS-S
Lori A Schur, RN, PhD
Torrance Memorial Medical Center Medical Stabilization Program for Eating Disorders
Mark Warren, MD, MPH, FAED
Chief Medical Officer
The Emily Program
1 Andrew R, Tiggemann M, Clark L. Predictors and health-related outcomes of positive body image in adolescent girls: A prospective study. Dev Psychol. 2016 Mar;52(3):463-474. doi: 10.1037/dev0000095. Epub 2016 Jan 4. PubMed PMID: 26727595.
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