The Skinny on Diet and Health Apps

last week's numbers two. But I'll admit sometimes I wonder if my fitbit really makes me any more fit. Welcome to Prognosis, Bloomberg's podcast about the interception of health and technology and the unexpected places taking us. I'm your host, Michelle fe Cortes. Even if you never use it, you most likely have a health app installed on your phone. Apple Health, which comes with every iPhone, can clock everything

from steps to sleep. Some three thousand digital health apps are competing for a share of the market to help you track your calories, watch your blood sugar, guide your workouts, or help you meditate. In the last episode, we told you what these apps are doing with your data. This time, my colleague Naomi Krasky looks into what the health apps

can do for their users. For us, My app addiction started last year when a friend of a friend told me he was using an app as a smart alarm clock set to ring when he was sleeping most lightly in the morning. I was super intrigued. I downloaded the app and pretty soon realized it would also grade in my sleep on a hundred point scale. I love being told whether I'm doing things right, so soon it became the first thing I looked at every morning. But that

wasn't enough. I wanted to know why I was sleeping well or poorly, so I caved and bought the premium version. That was my first real sign of app addiction. Another friend gave me a bunch of recommendations for other apps to try. I started using a period tracker and telling that app about way more than just my menstrual cycle. I recorded gastro intestinal side effects, my moods, my sex life. That app knew more about me than most real humans did.

And at the same time I was researching apps for diabetes patients for a magazine article, and then eventually also started using a life tracking app linked to my sleep app. That one shows you where you are during the day, work or shopping or home, et cetera. So I could watch how long I spend bicycling to work, walking, or at the gym. It felt like being able to watch all these elements of my life so closely was giving me more control over them somehow. But the big question

was whether it was actually improving my health. For example, the sleep app showed me almost immediately what helps me sleep well, things like meditating before bed and working out, and what kills my sleep basically booze parties and early morning light. But my sleep only really improved after my life slowed down. I had just come off a jam packed spring and summer in which I had moved, finished

a big project at work, and gotten married. So I figured my next step should be collecting more data, which meant downloading more apps. I'm part of a team of reporters who write about European health and consumer goods companies, so I asked my colleagues for recommendations. The top pick was the hugely popular my Fitness Pal app. Sportswear company under Armour bought this app in for four hundred and

seventy five million dollars. Here's Michael Lagardia, under Armour's senior vice president of Digital Products, explaining why we look at fitness as a holistic activity. That it's about the fuel that you put into It's about the activity that you do, and my Fitness Pal is there to help you keep track of that. The central function of my Fitness Pal, like so many other fitness apps, is counting calories in

calories out Now. I am almost forty years old and had, if you believe it, actually never tried to do this in a systematic way before. It's not that I didn't read food labels or think about calories. It's just that I had always been too lazy to write them down and had relied on a combination of exercise and metabolism to burn them off. But my colleagues assured me that I would be able to find the calorie and nutrition

facts for almost anything in my Fitness Pal. So in February one, I logged my first day's worth of meals. The app told me I had eaten about calories, about a third of which came from snacks, cookies, and peanuts. I had eatn in the office and then after work bread and patte with a colleague. Oh dear, at least I'd skipped having any wine. The app lets you set a calorie target based on whether you want to lose, maintain or gain weight. I set my target on maintain

and kept on logging. The easiest things to record were straightforward items like pieces of fruit or eggs, but logging anything I'd cooked for myself, arguably the healthiest choice, required a bit of guesswork to find out what the evidences that this app, or any app can improve its users health. I called Yucca b am Seran, a doctor and researcher at Bond University in Australia. She published one of the few overview studies of the effectiveness of digital health apps

last year. We came to this research as you know, just any other twenty one century UM citizen with smartphones, and we started seeing a lot of UM news and articles on how smartphone apps are treating this thing and that thing, and it's you know, being UM taught it as the next big thing in health and tech. World. Science is very specific about how we know medical treatments work, but that's not the case when it comes to consumer products.

Like most health apps a Yucca started looking for rigorous studies. She surveyed almost eight hundred trials of apps conducted between two thousand eight and but once she looked more closely, she found only a handful of the studies showed the apps have some meaningful effect on health outcomes. Since then, drugmakers have started looking more at apps that could be

used as therapies. Swiss Droukes Giant Novardes got US approval for one to treat substance abuse last year, But across the app world, YUCA says evidence still remains a rare commodity. We would estimate that less than one percent of all of these apps are actually been tested, and for apps that aren't being reviewed by health regulators, just having done any kind of test can be a marketing point, no matter what the outcome was. The term for this is experrammercial,

a combination of experiment and commercial. And when the study doesn't show any benefit, they don't mention it, but they would mention in the app description that our app has been scientifically tested, and that kind of gives this false notion of legitimacy to the potential customers and consumers. My Fitness Pal was among the few apps or Youka found that had been tested in an independent clinical trial conducted

about five years ago in Los Angeles. The study randomly assigned two hundred and twelve overweight adults to either use the app or to pursue and I quote any activities you would like to lose weight. After six months, neither group lost much weight. The researchers did speculate, though, that the app might be useful for patients who are already trying to watch their calorie intake. I asked Michael, the

under Armour executive, for his thoughts on the results. That's absolutely directly in line with our experience with this app. You know, like I said, it's not We don't think of it as a health to it. We don't think of it as something that someone would say, put this on your phone, you will get better. But we think of it as an integral part in someone's journey when they've made the decision I'm going to change my life, I'm going to hit some fitness goals. Will be there

to help. Maybe that was the problem with my diet app experiment. I didn't start out with a particular fitness goal. I wasn't actually trying to change my body or my life, and in fact another force was at work, won a lot stronger than willpower or workouts. I was pregnant, and so for the first time practically since puberty, my body

felt like it was careening out of my control. Low carb diet hard to handle when you need to eat toast practically as soon as you open your eyes in the morning in order to settle your stomach, and I knew I would have to gain weight, not maintain it, let alone lose it. Still, I kept logging my meals and my exercise. I started to read more about the nutrients I would need for a healthy pregnancy, and I started to get a little obsessed of about making sure

I logged them. When my fitness pal inexplicably didn't record the calcium in my brand of yogurt, it felt like a personal insult. I started keeping a very very close eye on my protein intake, and I started worrying about whether I was getting too much vitamin A, something that would never have occurred to me before, from eating too many a rugulas salads. I started to wonder whether I

was monitoring myself a little too much. Today we're being reminded every single minute of how sub optimized we are and what we should be doing in order to be more optimized. That's Carl Staderstrom, an associate professor at Stockholm Business School. He co wrote a book called The Wellness Syndrome, in which he argued that the pressure to become ever healthier is actually anything but healthy. For another project, he

also used himself as a guinea pig. So what I did was that I was using an app to log everything that I was eating. I was also using one of these wearables of rest band that logged my sleeping and logged the activity I was doing during the day. And then I was spending all my days in the gym, and I was over the course of that month gaining something like eight kilos. And the month ended with me participating in a weightlifting competition which I incidentally ended up

coming last in. Carl writes about our society's obsession with wellness as being part of an individualistic culture where you need to demonstrate that you're performing at your peak, where there's a moral value linked with how your body looks, and also where workers who spend their days emailing and organizing seek satisfaction or at least a sense of having something to show for their efforts from improving their bodies.

He says health apps are a lot like an idea from Freud, where your conscience prodes you to do what you know you should do but don't want to. So it is using an app as this little angry man sitting on your shoulder constantly telling you that what you do is wrong and what you should be doing is this or that. And I think it's says something about how difficult it is for for all your humans have probably always been to live the way that we are

supposed to be living. And I think to some extent, the whole idea of being human is that we are imperfect. There's no way of always being able to do everything that we're supposed to be doing. But I think what's different today than in the past, and the health apps are a big part of this, is that we are being reminded seven as we're not living up to that

idealized version of ourselves. Carl argues that this focus on self optimization is part of a larger political development in which health is viewed more as an individual concern and less as a broader social good, and the more society moves in that direction, the easier it becomes to demonize and ridicule people who do not have the resources to look after their own health. Talking to Carl made me think about my own app experiments in a different way.

There I was obsessing about vitamin A and analyzing the nutrition content of the free protein bars in the Bloomberg pantry. The whole thing seemed so narcissistic. There was one time, though, that an app did help me do something that's actually objectively healthy. I quit smoking a couple of years ago. As any former smoker would know, the way cigarettes fit into your daily ritual is one of the things that make it super hard to quit. I used to love

smoking in the late afternoon. It's a little moment to rest my brain before the last few hours of my work day. So once I quit, I started using a meditation app called Headspace as a replacement. I didn't think of Headspace at the time as a health app per se. It has more than one million paying subscribers and offers everything from a cat's and boats soundscape for falling asleep

to meditation prep for students who are taking exams. But when I talked to the apps chief science officer Megan Jones bell I found out that they actually do see themselves that way. The company says there are sixty seven randomized clinical trials being done on its app, including studies on everything from quitting smoking to managing stress and pain.

There are a number of ways that people can use meditation to improve their health and happiness, and that can range from using it as we think about it as kind of a vitamin, which means that you are um using it more on a preventative health capacity, such as trying to boost your resilience to stress, which is something that we have researched in a number of our trials and have a number of very rigorous studies underway looking at how that actually has proven out in brain changes.

The company is also working on a separate version of its app that doctors could prescribe to their patients like a medicine. This is more complicated because Headspace needs to figure out with the Food and Drug Administration how best to test the new app and regulate it to make sure it works. Headspace hasn't started these trials yet and it could be a couple of years before the new

product is approved. I asked Megan why Headspace would spend money in the meantime testing its consumer app too, when there's no regulator demanding data. I think, because we're really playing the long game here, our science strategy is not unlike the way that we've approached redefining the brand of meditation.

You can think about headspaces origins and really changing the cultural perception of meditation and mindfulness, and you know, we've certainly lifted all ships in the process of doing that and really helping create this market and moving it out of this kind of more woo woo experience into something that is very approachable for a diverse range of of consumers.

A few studies are also being done on headspaces big competitor the app Calm, So when these trials read out, assuming the results are published, we should get a better idea if at least this particular corner of the app market works. Some in the health apps industry think that an evidence space will become more necessary across the market as a whole, not just for apps that could be

prescribed as medicines. I talked to Carl Johann Hateroth, CEO of sleep Cycle, the alarm clock app that got me started on this project it's really really interesting for us. I think the whole industry is heading in that direction. I think this industry is going to be regulated in some way the coming years. I don't know exactly how, but I think it will. And I mean, we like that. And now I have a confession to make. Like a lot of health app users, I wound up using what

kept me entertained and dropping the rest. I'm still using sleep Cycle, partly because I like to compete with my husband to see who gets a better night's sleep, and because I take a morbid interest in seeing how much worse my sleep might get as I get more and more pregnant. Well you know what I mean, bigger and bigger. But my fitness pal was more complicated. The turning point was around the time when I was moving from the she ate too many burritos to the is that a

bump stage of pregnancy. I noticed that on the weekends when I would skip the app, I felt so much better about my food intake. And during the week when I was worrying about protein and calcium and vitamins and calories, I felt like I was going crazy. I would look up online calculators to reassure myself that my weight gain was within normal parameters, and then beat myself up for not hitting a nutrient target even though I had exceeded my calorie goal for the day. My husband Philip actually

started to worry about me. I mean, I wouldn't say it was crazy. You used the worst crazy before. I wouldn't say it was crazy, But definitely you were a bit obsessed. I remember you always telling me like not to worry so much about weight during pregnancy, and I wonder whether some of the experience with this was just tied together with that as well. That could definitely be the case. I mean, I do remember that you asked very often like, oh God, am I too big? Am

I gaining too much weight? And I then, I mean, I even get angry about this question because it's not a competition of like who gains more or who gains less weight during pregnancy. Your body does. What your body does in each pregnancy is difficult different. At some point in time, I was afraid that you would, I don't know, stop eating when you if you thought that you had gained too much weight, which would maybe have been unhealthy

for you or the baby. And if an app makes you even consider something like that, it's definitely not a good app. After Philip told me that I quit using the app. But not everybody is as neurotic as I am, and with so little evidence about health apps and health, I think the bottom line here is that you can take what's good for you and just leave the rest behind, and that sometimes the more you try to control things to optimize yourself, as Carl would say, the more you

eventually realize that you just need to let go. And that's it for this week's prognosis. Thanks for listening. Do you have a story about health here in the US or around the world we want to hear from you. Find me on Twitter at bay Cortes or email m Cortes a Bloomberg dot net. If you are a fan of this episode, please take a minute to rate and review us. It really helps new listeners in the show, and don't forget to subscribe. This episode was produced by

Liz Smith and topor Foreheads. Our story editor was Rick Shine Francesco Leavie as head of Bloomberg Podcasts. We'll be back with our next episode on July four. See you then,