I’m a pediatrician and pretended I was a 16 year old
trying to lose weight on WW’s Kurbo.
Dr. Maria Rivera MD MPH
Here is what happened.
I am a pediatrician and a mom of a two year old. I also have done extra training in Preventive
Medicine and Public Health and I am the co-founder Foublie, a platform that helps parents raise happy eaters with a focus on early childhood. I am passionate about nutrition and child feeding. Therefore, when I saw the news that Kurbo had been relaunched under WW, I decided to check it out myself. Today as people are delivering a petition with more than 100,000 signatures on it to Weight Watchers Headquarters, I would love to share my own experience and thoughts on the app.
What did I find?
If you are 13 and older you do not need parental permission to create an account. The app itself is free. I created an account and entered my date of birth as October 27, 2003. I will be turning 16 in 2 months. Awesome.
I then have to enter my height, my weight and my gender. Ok I am a female, 5’6 and 140lbs. The app does not tell me my BMI, but it is 23.3 which is considered a normal healthy weight.
I continue and I am then asked to pick a goal. I can choose from phrases like eat healthier, or make parents happy or lose weight. I choose to lose weight. I shouldn’t be losing weight, as I am actually a 16 year old teen at a healthy weight. That doesn’t matter. It lets me proceed with my goal. I then get asked how motivated I am to reach that goal and how successful I think I’ll be. I am determined, 9/10 for both of those! I am an eager and motivated 16 year old.
I get to pick an avatar, and I pick an avocado because my teenage brain thinks it’s cute and my mom brain thinks it’s the best food ever. I don’t realize that avocados would be my downfall later on. But we haven’t gotten there yet. The app lets me know that the best way to reach my goals is to hold myself accountable and to track what I am eating. I want to know what would happen if I pretend I am a 16 year old with restrictive behaviors. So that is what I do.
Here is what I log
Breakfast: 1 portion of sugar free cereal (no milk) and 3/5ths of an avocado (unclear why the app divides avocado portions in 5ths)
Lunch: 4/5ths of an avocado (I live in California I love avocado!)
Snack: 1 portion of full fat plain unflavored yogurt
Dinner: 1 piece of whole wheat toast with 1 portion of sugar free peanut butter
As I logged, my red light food counter continued to drop. Uh oh. 5/3. “Over budget on reds today! Try some green foods!” I ate too many red foods.
Before I continue, this program uses the Traffic Light Diet, which was developed almost 50 years ago, by Leonard Epstein, PhD. Red foods are the foods high in calories and I am only allotted 3 of them per day. Green foods are “healthy foods”, the ones I can eat as much as I want. Yellow foods are those where I should watch my portions, but these are not tracked by the app, so I am not sure how many I can eat in a day.
So back to teenage me. I start feeling like I was failing the day. Which foods were the ones that put me over the edge? Eating 3/5 of an avocado counts as one red food. 4/5 of an avocado- oh boy, that counts for 2 red foods right there. My quota for the day is done. But then I added in plain yogurt that was full fat (1 red food) and sugar free peanut butter (1 red food), and I went up to 5. So my red/bad foods for the day included: avocado, plain yogurt, and sugar free peanut butter.
I feel bad about myself and all my avocado eating (even knowing this is not a real log I’m creating). On the bottom I have the option to upgrade to a coach to help me set goals and explain the meal tracking. But I am a 16 year old teen and $69/month is a lot of money, so I pass.
As a pediatrician I am very worried about this app in the hands of teens and tweens without supervision.
If you tally up everything I logged for the day, it was less than 1000 calories, which is not enough for most 16 year old girls. I made up that log, but it is a realistic scenario that a teenager with an eating disorder or restrictive behaviors could aim for and log. The worst part- with an already restricted diet that day, it still made me feel like I had to cut out more because I had eaten too many red foods. All the foods that were red, I would actually consider healthy fats for kids.
Kurbo is based on research out of Stanford’s Pediatric Weight Program. The difference is that in order to enroll into the weight program at Stanford, patients have to meet certain BMI criteria and usually have health problems that may be associated with their weight such as diabetes or high blood pressure. It is also a family-based program, they must attend in person sessions and always be accompanied by a legal guardian. They are carefully monitored by a whole team of physicians, nurses, health coaches, and dietitians to make sure they are building healthy habits and not developing an eating disorder. Taking out the accountability, making the focus of the entire program be on tracking your own foods, and not requiring parents or a health coach to be involved is a recipe for disaster.
I believe the solution is not as easy as asking Weight Watchers to remove the app.
Pediatric obesity is a complex multifactorial public health problem. As a pediatrician I am concerned about the number of young kids I take care of that already have prediabetes, high blood pressure, or fatty liver. We are limited by a health care system that has few options for them. It is possible that with some more safeguards and changes, Kurbo could be an option for these families. In fact, before it was acquired by Weight Watchers, many families actually did use and liked the program. In its current form, and under different leadership, I am concerned about the potential of abuse and it leading to disordered eating and unhealthy relationships with food. I also disagree with its focus on weight instead of lifestyle change, the lack of family involvement and oversight, and the inclusion of healthy fats into red light foods.
If you are a parent to an 8 to 17 year old, I urge you to talk to your kids before they use an app like this. If they are interested in using it try to understand why. Try to take on healthy lifestyle changes as a family. The AAP recommends family meals, minimizing screen time, and talking about healthy meals and exercise instead of talking about weight.
If you are a parent to an overweight or obese child and you have been told by your pediatrician they are concerned about their weight because it is impacting their health- I see you. You may feel like you have exhausted your options and the system is failing you. I encourage you to look for healthy lifestyle programs in your area, but acknowledge those are not always available. If you decide to use Kurbo, know that the Traffic Light Diet was never intended to be used on its own, it works best when the whole family is involved, so jump in together. Also, when WW comments that their approach is science-backed, the studies always include the coaching option, so make sure you sign up for a coach and maintain close contact with your child’s pediatrician. If you can, I also urge you to not harp on the food labels of red, yellow, and green.
So Weight Watchers, please consider adding more safeguards so that normal and underweight kids do not use this as an app to further their restrictive behaviors. Fine tune and refine the lists of red, yellow, and green food so they more accurately represent fats that a developing child may need. Ensure that your health coaches are adequately trained and consider using Registered Dietitians as coaches. Lastly, please remove before and after pictures of children that have lost weight from your advertising campaign.
As a society we need to do better about how we feed and nourish our children. This conversation is an important one. Let’s keep it going.
Dr. Maria Rivera is a general pediatrician, preventive medicine physician and Co-Founder of Foublie. She is raising a happy 2 year old eater. Her opinions are her own and not those of any of the institutions she is affiliated with. Sign our pledge to our children here.
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