Brands have overlooked the link between eating disorders and smartwatches

By Anula Wiwatowska

Last updated 15 November 2022

With every new technology comes the opportunity to use it for good or for evil. While smartwatches and fitness trackers give people the chance to better their health, they also provide tools that perpetuate disordered eating and exercise habits. So far, manufacturers haven’t taken a stand on these issues.

This July, Apple released a comprehensive Health Report detailing the use of Apple technology in supporting personal health, research and care. The 59 page report goes into extensive detail about a range of health and fitness features, and studies done in collaboration with the medical community. These range from digital mental health through to heart health and the Covid-19 response. There is no mention of eating or exercise disorders, however.

When asked about whether Suunto made considerations for eating disorder suffers, Australia and New Zealand Lead Damian Commone told WhistleOut, “we do consider risks of using our solutions during development and how to protect end users from misusing or misunderstanding our solution, but we do not take a clear stand here.”

“I’ve had patients in sessions getting notifications and saying ‘I need to close my rings,’ and physically getting up from a session..."

We reached out to Samsung and Fitbit, but did not hear back.

According to research by the Butterfly Foundation, up to 17% of the Australian population either have a diagnosed eating disorder, or multiple symptoms of one. Those dealing with eating disorders could simply avoid smartwatches and fitness trackers, but that wouldn’t make fiscal sense for manufacturers. Encouraging sufferers to forgo these devices isolates one in five Australians. It isn’t a good business decision.

Despite being relatively new technology, smartwatches and fitness trackers still employ numbers that have been around since the 1930s. Just like smart watches now, the Fitbit I got back in the early 2010s asked a few questions to get you started; age, height, weight, and how active you are. Once the tracker binged on my information it would spew out a number of calories that I should consume per day, simply to exist. My baseline calories. This calculation is your basal metabolic rate (BMR) and is still the same one used today across a range of watch brands.

Although the BMR is a widely used metric, it isn’t necessarily an accurate one. In 2005, a controlled study found a 26% unknown variance in BMR between people of the same height and weight. Variables such as muscle mass, weather, and hormonal changes also affect BMR, meaning that with the data a watch can get at setup, this number ends up being nothing more than a rough estimate. One that people with eating disorders might just cling to.

Anecdotally, the BMR I receive across fitness trackers is usually on the lower end, regardless as to what level of physical activity I say that I'm doing. Consider these low-end estimates, the known, and the unknown variances, and the tendency for eating disorder sufferers to drastically restrict their calorie intake, and we’re on dangerous ground.

I’ve struggled with a foray of disordered eating, and while I've mostly recovered from my eating disorder, innocuous reminders from smartwatches still send me spiraling. These notifications and the accompanying on-wrist functionality mirror the signals of an eating disorder. Where a watch has persistent and insistent tracking of calories, obsession with calories is a symptom of anorexia nervosa. While your watch might let you know that your exercise minutes are down, body dysmorphia sees this as guilt and shame about missing a workout.

According to registered psychologist and eating disorder expert Vicki Boler, “When it comes to people who struggle in that space, having a reminder on their hand to walk more and burn more calories, fuels that part of them that is problematic and potentially life threatening”.

“I’ve had patients in sessions getting notifications and saying ‘I need to close my rings,’ and physically getting up from a session because that triggers the eating disorder part of them.”

While I'm jealous of the people who can look at a calorie count without knowing how many bananas that equals, I and the 55.5 million other people affected by eating disorders every year, shouldn’t have to opt out of using a smartwatch entirely just to avoid these triggers. Manufacturers have the opportunity to cater for a more holistic approach to health, and some are taking steps in the right direction, but for now the rigidity of tracking is cause for concern.

“...having a reminder on their hand to walk more and burn more calories, fuels that part of them that is problematic and potentially life threatening”

Of course the issues with BMR, and wellness culture in general are systemic, and don’t wholly rest on the shoulders of smartwatch manufacturers. Plus eating disorder sufferers don’t need an external source to tell them to restrict, we’ve all gotten along with it before technology had anything to do with it. But in the same way that technology brings positive change, it also surfaces the negative. You can’t start a workout without a smartwatch giving you the number of calories or kilojoules you have supposedly burned according to each manufacturers’ proprietary algorithm. You’re given calorie, step, and stand goals - rules that are dictated by a computer on your wrist.

“With eating disorder recovery, a lot of it is trying to get away from ‘the rules’” says Boler.

“People’s bodies are different, some need more [steps], some need less. Are you recovering from an illness? Are you physically vulnerable? And is that realistic for you? These arbitrary goals don't allow enough flexibility to account for the complexities of us humans and what we actually need.”

For those in recovery or wary about how a calorie-count can affect them, a simple solution is to offer the option to hide these numbers. Concealing these numbers from view won’t adversely affect how the watch itself works or make workouts any less effective, but it could have a worthwhile effect on users.

One such manufacturer leaning away from the usual smartwatch tracking is Whoop. Whoop is the antithesis of these fitness trackers, instead focusing on two metrics - strain and recovery. Rather than tracking numbers like calories or steps, Whoop bands look at your daily cardiovascular exertion and your recovery data such as sleep and heart rate, to help you make informed choices about what your body can take on for the day. Nar a single caloric measurement is found within Whoop tracking, and yet it has been widely reviewed as the tracker of choice for athletes.

That is because fitness and holistic health can’t be measured in weight, or height, or muscle mass, and it is certainly more complex than simply calories in and calories out. For the most part however, smartwatches and fitness trackers use these as benchmarks. You’ll be celebrated for burning a certain amount of calories multiple days in a row, and encouraged to “push harder” than you did the day before.

“In the eating disorder and mental health space we promote more intuitive ways of listening to our bodies which is sometimes incompatible with tech because it is not human,” says Boler.

“It can’t know exactly what we need from day to day. It is a program. And although it is smart and it is amazing technology, it is never going to be as flexible and as mindful as we ourselves need to be.”

We see this reflected in the tracking structure of most consumer level fitness trackers. There is little room for things like rest days or injury recovery from the key smartwatch manufacturers in the market, or if there are you’ll have to pay a premium for the luxury.

Fitbit has made the switch over to weekly movement goals, and can make rest recommendations through its Daily Readiness Score, but that feature is stuck behind a paywall. You’ll need to pay $14.99 per month or $129.99 per year in order to get access to a more balanced approach to fitness.

My colleague previously pleaded with his Apple Watch to let him take a rest day without sacrificing his workout streak. Despite having a monumental market share, and comprehensive tracking across the spectrum of health, the Apple Watch still takes your goals on a day-to-day basis. It can tell how hard you worked out, and how well you slept, but hasn’t taken that next step to use that data to make recommendations on the kind of rest or recovery your body needs.

Apple provides accessibility features on iPhone and Apple Watch for a range of conditions including hearing and vision impairments, and for those who are wheelchair bound. Eating disorders are serious mental health issues that affect 55.5 million people globally every year, and yet there are almost no accessibility features in tech for those affected. By contrast, around 10 million people in developed countries need a wheelchair every year.

It is clear that manufacturers have the ability to provide additional features for those with eating disorders, but their inaction leaves the responsibility on the individual. Instead, the onus should be on the brands to make these devices as inclusive as possible. Shifting tracking focus from a binary to a holistic approach could help people develop healthier relationships with food and exercise in the long term, while in the short term we can protect those already suffering by giving the option to remove the triggers.

Smartwatch manufacturers are perpetuating the systemic failures of the wellness industry, and it is time to recognise and recover from these failures.