Last month, WW (previously known as Weight Watchers) launched the app "Kurbo by WW", which created quite the internet discussion. I have some strong opinions about it and wanted to discuss.
What is Kurbo by WW?
Kurbo is a dieting app designed for children between 8 and 17 years of age. While using the app, the child (or parent) will track both their food intake and their physical activity. The app is free, though opting in to a paid subscription unlocks health coaching services. Kurbo was originally an independently owned startup company, but was later obtained by WW in August 2018.
The app isn’t necessarily designed for weight loss, however I must say it feels like a weight loss app. When creating a profile, you have to select a goal. For example, one goal option is "Reach a healthier weight", but other choices are not weight related, such as "Eat healthier", "Get stronger & fitter", "Boost my confidence", etc.
When tracking foods in the app, every food is designated as green light, yellow light, or red light. Green light foods include your typical healthy options, such as fruits and vegetables, and according to the app may be eaten at any time. On the other hand, foods where daily consumption should be limited, such as desserts and high fat foods, are designated as red light. Yellow light foods are described as foods you should be eating, while keeping portion size and daily quantity in mind; their website lists proteins and pasta as examples. The app will set limits (depending on the user's profile) regarding how many red light foods that user can consume each day or week.
Spoiler alert: I hate this app and would never recommend it to anyone. However, to be thorough, I do want to discuss some positive aspects of it.
I like that the program is an app. Children and adults use apps all the time- it's become a daily part of life. I never want to make someone, especially a child, feel different or strange when coming up with health goals. Again, everyone uses apps, and no one even needs to know what you’re doing on your phone, so this isn’t an isolating or strange behavior. Awesome!
The traffic light system that the app uses was created by Stanford University and is based on research. I personally don’t agree with the traffic light system (more on that later), but to remove my bias, it is evidenced-based and is used by a lot of health professionals (including dietitians and doctors) and multidisciplinary programs.
Finally, tracking your foods has been shown to be effective. In my practice, I always tell my patients – you don’t HAVE to track what you’re eating, but people who do tend to be more successful. Tracking intake can help quantify certain things and can help show trends.
Oh my, where to begin. I’ll start off by reiterating some points that have been made by other dietitians, psychologists, eating disorder experts and physicians online already. Diets are not appropriate for children. As much as Kurbo doesn’t use the word diet, this app is exactly that. It categorizes foods and gives a limit on how much of certain foods should be consumed - this is a diet. Both obesity and eating disorders are on the rise in the U.S. Dieting and categorizing foods as good (green) or bad (red) can potentially foster an unhealthy relationship with food, and in certain circumstances, perhaps even lead to eating disorders. For children specifically, not only is dieting potentially dangerous for these reasons, it also simply is not effective. Studies have shown that adolescents that diet are more likely to become overweight than adolescents that do not diet.
There are still many things about the app I find problematic that I’m not sure people are talking about. As I mentioned before, I am not a fan of the traffic light system. I am definitely not speaking for all healthcare professionals when I say that, and not even all dietitians. I personally feel that sorting all foods into red, yellow or green categories is an extremely simplified way of thinking that creates more problems than it solves. I wrote a previous blog post about the problems with categorizing foods as “good” or “bad”. While the traffic light system introduces a middle "yellow" classification, it still sorts food into oversimplified categories. I worry about this creating a dangerous mindset regarding food, particularly in children, as their abstract thinking abilities are not as developed as that of adults. Kurbo's methodology in regards to how each food is categorized as green/yellow/red is not 100% transparent, however the primary factor is caloric density. In other words, the more Calories a food has, the more likely it is to be classified as a red light food. This leads to many foods containing fat, even healthy fats, to be labeled as red light foods. I played around with the app quite a bit and found all of these to be red light foods: applesauce, ice cream, a half bagel, chocolate, protein bars, lasagna, meatballs, candy, 2% milk, rice milk, soy milk, cheese and peanut butter. I think categorizing peanut butter and candy as the same thing is a problem. If I’m only allowed to have 6 red foods (that’s how much they allotted my adult profile) a day, I’m certainly going to choose candy over something like applesauce. Think about it from a child's point of view – maybe a caregiver such as a parent or grandparent told them that peanut butter is nutritious (which it is), but now the app is telling them it's "bad". This false equivalence creates distrust and confusion.
The FAQ section of the app goes out of its way to say that app users are “still eating their favorite foods” and “doing so without sacrificing important nutrients”. I don’t have hard data to dispute this, but I don’t think everything adds up. I felt that the 6 red foods I was allotted per day was VERY restrictive, considering so many foods I consider healthy were red. I went WAY over my goal the first day I logged all my foods. I then created a profile for my fictional 10 year old son, and he was only allotted 3 red foods! Considering how long the red foods list is, I feel this is entirely too restrictive and just unnecessary. I question whether a child, when restricted to 3 red foods a day, would be getting all the Calories and other nutrients that they require. For example, it seems difficult to eat an appropriate amount of dietary fat while still restricting the amount of red foods.
Another large concern I have is that most calcium-containing foods are yellow and red. Adolescent girls have higher calcium needs than anyone, and I would hate for them to not meet those needs due to how this app categorizes dairy. Some example of red light foods include 2% and whole milk, chocolate milk, flavored yogurts and cottage cheese. Yellow calcium-containing foods include string cheese, 1% cottage cheese, non-fat yogurt and 1% milk. The green options which include calcium are quite limited, and generally not foods that young people would be consuming regularly.
On a different note, the health coach’s credentials are less than impressive. They complete “a thorough training program”, but it’s unclear exactly what this means. These coaches are not dietitians, psychologists or doctors. Based on the website, the coaches have degrees in communications, political economy, tourism management and other bachelor degrees that have nothing to do with nutrition, health or child development.
I did not pay for the coaching aspect of the app, so I can’t say a whole lot about that part. However, I was very concerned when I saw a few examples of conversations with the health coaches. I saw a screen shot someone posted online of a health coach suggesting to save red light foods for the upcoming weekend. This is a very typical approach from adult Weight Watchers users: skip breakfast and lunch so you can order anything off the menu at dinner or eat light all week so you have lots of points to use over the weekend. This is not a good strategy to fuel our bodies. Some may argue that this is considered "planned binging" and promotes eating disorder behaviors. Encouraging someone to starve themselves in preparation to overeat later is not advice I would expect from a “team of experts”.
What to Do Instead
Ideally, you would meet with a Registered Dietitian Nutritionist to help you and your child with weight or nutrition issues. An individualized approach is the best approach! A complete assessment will be completed before coming up with a plan of action. A lot of family dynamics are involved in childhood obesity- it’s generally not as simple as eat less red foods and more green foods. With Kurbo, even when paying for the health coaching, I’m not sure that many fine details are discussed. I like to know the who, what, where, when, why and how regarding a child's nutrition. Also, while the Kurbo plan is “personalized”, it doesn't seem to take into account the child's medical history, or even current physical activity levels when determining how many red light foods can be consumed per day.
Using a family approach, rather than forcing a child to track what they’re eating in an app, is a much safer, less-isolating way to go about things. Read more about that here.
If you must track or count something, there are some other options. I like the 5-2-1-0 program. It encourages eating fruits and vegetables, increasing activity and decreasing screen time. I’m not sure other dietitians would agree, but I would feel more comfortable having an older teen track their intake using something like MyFitnessPal compared to Kurbo. An app like MyFitnessPal does count calories (gasp!), but it also looks at nutrients like fat, carbs, calcium and sodium. I like how it shows the bigger picture, and provides a more accurate representation of how a specific food will affect your daily nutrition. Ideally, an app like this would only be used with the supervision of a dietitian or well-educated parent.