WW (formerly Weight Watchers) launches a new weight loss program aimed directly at kids and teens. Is this new venture appalling, or a good way to address the obesity epidemic by hitting it where it starts?
Before we even jump into the discussion, let's address some statistics that are the motivation behind the creation of the program in question...because it's always good to have a little background right!?
A proponent of the program, and obesity specialist and assistant professor Michelle Cardel pointed out in a recent article how important addressing the health issues like obesity in children, is. "[Obesity] affects almost one of every five children from 2 to 19 years old, and one in four children in lower socioeconomic groups. It is linked to cardio-metabolic disease and certain types of cancer, and also affects a child's emotional health." This statement is based off of the stat from the US Centers for Disease Control and Prevention that specifically cites that about 18.4% of 6- to 11-year-olds and 20.6% of 12- to 19-year-olds in the US are classified as obese (2019).
Back in 2018, WW acquired child-centered weight loss app, Kurbo, and with some changes made, relaunched the program this past August. The app, targeted at kids 8-17, uses the 'traffic light' approach to monitor a child's diet and teaches them tips and tricks for healthier eating. This approach, scientifically backed by Stanford's Pediatric Weight Control Program, is combined with education about portion sizes, and even interaction with a health coach (for an additional fee), and was designed to be "..a partner for families..to reward and inspire kids, teens and families to get the tools and guidance they need to manage their environment and build and sustain healthy habits", according to Gary Foster, Chief Scientific Officer at WW.
So while the intention of the app was to address this serious issue, there are many that question whether the program, and those similar, are actually helping, or causing even more serious issues. And trust me, there are MANY questions. The launch was met with social media outcries, and even though the program from WW was released in just early August of this year, there's already been a rebuttal petition signed by close to 90,000 people, that argues that the approach is irresponsible and could lead to children to develop serious eating disorders early on.
How It Works
Let's examine the mechanics. The traffic light approach categorizes foods based on their nutritional quality, labeling them 'green' if they're considered all healthy, 'yellow' if they're moderately healthy, and 'red' if they should be limited in a child's diet. The goal of is approach is to encourage kids to eat more 'green', and less 'red', and has been shown as an effective way to improve weight related outcomes in kids, when coupled with family support within a comprehensive program. However, though there are options for family participation, the app is aimed directly at children, not their parents. And while kids 13 and under need parent permission to download, 13+ do not. The free version allows for food tracking and monitoring using the light system, while the paid version allows for weekly interactions with a designated health coach. While the app purports other benefits such as healthy habit formation, it's main goal is clearly to help the child 'lose weight'.
So let's begin the argument shall we? :)
There's no denying childhood obesity is a prevalent epidemic, and there's obvious research that shows it leads to further complications later in life. Mindy Grossman, WW's CEO stated that "we have a tremendous opportunity, but also responsibility, to help kids, teens, and families." Dr. Elsie Taveras agreed asking, "What are we supposed to do with this large number of children who not just have obesity but severe obesity and its associated chronic diseases — do we not think that some changes in their nutrition are warranted?".
And that seems to the obvious intent of the program, though misconstrued.
The hidden pro here, is the amount of conversation alone that the issue has stirred. Remember the old saying...'even bad press is press'? Perhaps just the launch of the program drumming up conversation amongst parents and others, will examine its effectiveness and possibly bring to light the issue to a level where a more beneficial solution will more quickly be developed.
On a more evidentiary basis, the 'traffic light system' is based off of an actual proven system that has since been used by a variety of obesity scientists in multiple clinical trials to improve eating behaviors and weight status of children, and was given a grade of ‘‘1’’ which is the highest level of evidence in the Academy of Nutrition and Dietetics Evidence Analysis Library, saying there's ‘‘good or strong evidence’’ to support the statement that the this particular diet is an effective way of managing energy and food intake in children.
Another reason the app shouldn't be dismissed outright is its method of delivery. The use of technology alone for providing health services is a very convenient, flexible, and cost effective way for families to receive help. Benefits of 'tele-health' style interventions include ease of self monitoring and increased access to services for families living in remote areas or areas of limited access to care, especially since many can't afford to see a dietician or full nutritional team with no health insurance. In a Kurbo conducted self-study, they reported 90% of participants maintained or reduced their weight, and experienced higher levels of happiness, self confidence, an self esteem.
Since this claim has not yet been researched scientifically or independently, it leads us to the cons of the issue in question...
The short comings here stem not from the delivery, but the way in which the solution was approached. According to Dr. Perri Klass, it's not so much about the app, as it is about what you say to the children who are gaining weight too fast as they grow. The bottom line is...an unsupervised app that emphasizes the goal of 'weight loss', and that encourages kids to track their 'weight', carries the dangers of body image issues and disordered eating. Not to mention, the methods in which the app and system teaches, requires means that are generally out of kids' hands anyway.
Allow me to expand.
1) Unsupervised use of a weight loss focused approach increases the association between self reported dieting and increased risk of binge eating disorders and behavioral issues. I mean unsupervised in two ways: one, the app is marketed towards kids heavily, and doesn't require parent supervision (unless under 13). Secondly, there is an option to speak with a health coach, but many interventions in the past have dealt with in-person professional healthcare providers, not an app interface. Face to face interventions do decrease the prevalence of eating disorders being developed, according to a systematic review, but those were professional clinical interventions, not apps. There are MANY questions regarding the effectiveness of this approach as stand alone. Especially since a focus on weight loss itself has been shown to increase the likelihood of developing disordered eating, depression, and self esteem issues. Couple that with a lack of clinical, intervention could be disastrous. Rachel Egan, one supporter of the petition, mentioned that "Some of the behaviors that Kurbo encourages such as tracking your food intake, categorizing foods as good or bad and compensating for what you have eaten [with exercise] are all behaviors which fueled my anorexia and made it harder for me to recover."
2) The app encourages solutions that are largely out of a child's hands, and shifts the responsibility to them, which could encourage feelings of internal failures. These solutions are those such as food choices, what's bought, and time and resources to prepare. All of this can have roots much deeper than lifestyle choices. Consider that 'privileged' individuals always have more options to change their lifestyle choices. But those in lower socioeconomic brackets, from different social backgrounds, are of different wealth statuses, and even different locations, have varying degrees of access to affordable healthy choices, and could lack time and resources for meal planning and preparation. An app won't solve these problems if targeted towards kids at an age they're most psychologically influenced and vulnerable.
3) Marketing materials focus on 'weight loss' as the overarching goal and include visuals to support that claim. While they claim to want to help develop healthy eating habits, the marketing messages are heavily weighted to weight loss, and as we know, marketing is king. Their materials are riddled with images of "before and after pictures", of children as young as 8, as success stories. Not to mention, there are social posts from Kurbo after its launch of the program, like a video of a slim 12-year-old girl, slicing vegetables and talking about how she had been "so tired and so sick," but after using Kurbo, she says "her [running] mile time has dropped by three to four minutes."
Finally, we know dieting to be a 'short term' approach, even in adults. An app that doesn't encourage the full integration of healthy long term habits is destined to fail. Dr. Cardal mentions in her opinion article that "Compliance is king, not what you eat but what can you stick to over the long term".
According to the CDC, almost half of Americans were on a 'diet' from 2013-2016, yet obesity is still on the rise. 'Dieting' in itself might be what's making the situation worse. This report indicates that the typical long term response, not the exception, to dieting is weight regain, or yo-yo cycling. Furthermore, as we see the mental effects of focusing on weight loss and appearance in children, these concepts are shaky grounds to focus on during an intervention.
Though, as we see promising results from systems such as Kurbo, perhaps there's more to the equation. According to the creators, the program was never meant to be used as a stand alone strategy, and should not be considered one. Dr. Taveras, a Harvard Medical School Nutritionist mentioned in the recent article, 'Let's Not Just Dismiss the Kurbo App', that she "[I] never say to a child that I am putting them on a diet, and [I] never use the word dieting, and I never use the word weight loss, because of the negative connotations.” This implies, that while we have a social responsibility to address this issues, 'weight loss' isn't always the right goal, and the focus here should not be on weight loss, but on health in general, encouraging and teaching healthier overall choice and lifestyle behaviors. For Kurbo clients, weight loss and health - and weight loss and success - are one in the same, though for many that's not the case.
We've seen from the data that 'dieting' and calorie deprivation is a risk factor for both eating disorders, and future weight gain in adulthood. With eating disorders being on the rise, kids are being diagnosed younger and younger. We also know that babies and children are naturally intuitive eaters, eating when their body signals hunger. And it's a developmental necessity for kids to put on weight as they age, thus a restrictive diet might not be the best choice. Thus, our best approach would be to help children with their intuitive eating choices, educating them about the nutritional value of foods and helping them make the choices, when the time comes, for better foods. On top of that, the nutritional approach needs to be expanded to include the family modeling healthy eating, allowing a child in on cooking and shopping, and not speaking negatively about weight. Emphasis should be put on the cognitive aspects of things that matter to them like strength, energy, feeling good, and other behaviors that develop healthy patterns for life, and that is enjoyed..(side note, this is my view for ANYONE's approach to optimal health! Adults..listen up :) ).
Though the intuitive eating approach sounds good in practice, it's not the only puzzle piece. We must realize that the tools needed to be successful with this is largely out of a child's hands, especially at this age. Parent's are obviously the ones here with the resources to make this happen, them being the ones who buy and prepare food, encourage regular meals an plenty of exercise, and are themselves role models that children largely mimic. Hence, programs such as Kurbo should not be aimed directly at children, or encourage them to do it alone without a parent's involvement.
However, this is ignoring the point that there are other factors that contribute to higher weights. This includes time for parents to prepare healthy meals, their access to clean and healthy foods, and their financial ability to afford such meals for their children, which leads to another issue; socioeconomic inequality. If parent's have a low income and can't afford food much less healthy food, chances are 'healthy eating or 'healthy education' won't be top of mind. This aligns with the state reported earlier that 1 in 4 lower socioeconomic class children are overweight.
Bottom line, children model what they see. And the mechanisms that improve most influential on a child's health are largely out of their hands...so why use an app that combines a 'slim image' that could promote mental disorders, with recommendations that kids can't adhere to anyway? Thus, our solution will come at a combination of education and encouragement around intuitive eating and healthy choices coupled with an entire community that is behind us, supporting the parents if they can't support themselves. Our culture must emulate health, and health must be everywhere a child sees: through the parents, in the home, in businesses and food joints, within the government, the media, and especially the schools. Collective programs that are implementable across the board, though a tall order, are going to be a beneficial step forward in addressing this this issue in our youth.
Thankfully, during my research I stumbled upon one such program entitled CHOICES, or 'Childhood Obesity Intervention Cost Effectiveness Study that is doing just that. This Harvard School of Health program is identifying cost effective measures in addressing and preventing childhood obesity by making resources readily available to chosen partners, such as parents, the community, schools, and after school care. They work with stakeholders to develop methods to identify policy and program changes that are showing the most promise.
It is no question that childhood obesity is an epidemic that can carry forward in one's life and increase the chances that they remain that way, or contract one (or multiple) chronic diseases. According to this model from the Childhood Obesity Intervention Cost-Effectiveness Study (CHOICES):
"If nothing is done to change current trends, 57% of today’s children will have obesity at age 35. This is a large increase, given that 37% of adults now have obesity. In addition, the study found that excess weight in childhood is highly predictive of adult obesity. This is especially true for children with severe obesity, even at very young ages. The team estimated that 79% of two year-olds with severe obesity will still have obesity by the time they are 35 years old, as will 94% of 19 year-olds with severe obesity. Racial and ethnic disparities in obesity are already present by the age of two and persist into adulthood."
The overwhelming evidence that something should be done here is a sign that we need to act. However, while the WW program's intentions might be sound, there are questions regarding the effectiveness of it's approach. There's no doubt we have a childhood obesity problem, but there are also problems with encouraging children to 'lose weight'. Given that the mental state of children of that age are so easily influenced, and the even bigger fact that choices and environment of children at that age are rarely in their hands, and most often decided upon by the parents, such a program is only one piece of the puzzle. Effective solutions will only come when a child's total environment is partaking in interventions; friends, family, government, businesses, and especially schools. A collective approach teaching and encouraging healthy behaviors for life will truly be the saving grace for our future youth, driven by community fueled programs similar to CHOICES.
For more on health and wellness trends, tips, and weight loss advice, visit www.nikkicohnbyrd.com and sign up for my weekly newsletter!