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.

Signed,

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
Gaudiani Clinic

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
Consultant Psychiatrist
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
Gaudiani Clinic

Lori A Schur, RN, PhD
Clinical Consultant
Torrance Memorial Medical Center Medical Stabilization Program for Eating Disorders

Mark Warren, MD, MPH, FAED
Chief Medical Officer
The Emily Program

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