Weighing the pros and cons of pediatric fitness tracking devices

Issue: May 2018

Obesity is a prevalent condition experienced by Americans, with the CDC reporting obesity in 36.5% of adults and 12.7 million children and adolescents between the ages of 2 and 19 years.

Those with obesity are prone to developing later conditions that are a detriment to health, including heart disease, stroke, type 2 diabetes and certain cancers. One way in which some adults have combated obesity is using fitness and calorie counting devices. This May, one company is expanding its target demographic to include children as young as 8 years of age.

According to Fitbit’s website, the Fitbit Ace can be used by children to track their activity levels in the form of steps taken and time spent actively. Additionally, children can also record their sleep duration and sleep schedule. These data can be viewed by both children in a “secure Kid View” or through a family account, where parents can also assess their child’s activity levels.

Sarah Hornack, PhD, pediatric psychologist at Children’s National Health System and assistant professor of psychiatry and behavioral sciences at The George Washington University School of Medicine and Health Sciences, told Infectious Diseases in Children that some children and adults may benefit from the use of these movement tracking devices.

“One of our primary recommendations for both adults and children is to engage in a behavioral strategy called self-monitoring in which they keep track of different types of healthy behaviors in an effort to improve the behaviors, track progress and move toward a healthier lifestyle,” she said. “I have seen that these fitness trackers have helped adults in that way and that some adults have become more aware of their own behavior.”

Several other fitness and movement trackers are available for children. The Garmin Vivofit Jr 2 tracks similar data and includes chore and behavior management tasks that can be created by parents through an app. Certain products, such as the Nabi Band Complete, provide children with a visual record as to how much activity they complete in 1 day, such as walking the length of the Eiffel Tower or burning off a certain amount of food.

According to a blog post from Fitbit, the Fitbit Ace is restricted in its features and does not collect information on calories burned and body fat percentages. The company also notes that the app changes as children age, and at age 13 years, the Fitbit becomes fully functional and collects data on calories and body fat measurements. Hornack has expressed her concerns about the association that some children and teenagers may have between fitness and thinness.

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“I think that the presentation of a tool like this needs to be embedded in a larger conversation about healthy living and the purpose of these tools,” Hornack said. “Emphasis should not be made on weight and body shape but moreso on having a healthy lifestyle and promoting healthy behaviors.”

One feature of the Fitbit Ace that Gary Miller, PhD, professor in the department of health and exercise science at Wake Forest University, finds questionable is the push notification setting. This optional feature allows children to receive reminders on their phones to move, which the company claims to encourage “kids to stay active all day.“ The feature, according to Miller, may not provide enough of an explanation regarding the type of movement necessary for children or the proper motivation behind it.

“A lot of people do not understand the importance of activity for children,” he said. “I know many adults that think that since they get recess at school, they get enough. When you look at the playground, many kids may be sitting down and not being active.”

“Children need to have fun when they are active,” he added. “One of my biggest gripes is when adults try to increase physical activity for children. They think they will want to do what adults want to do. They place them on a treadmill or have them walk around a track instead of promoting play.”

Although not all children and adults may have negative experiences with fitness and calorie trackers, research published by researchers from Virginia Commonwealth University demonstrated that college students who used fitness trackers were more likely to additionally count calories, which contributed to eating disorder symptoms.

Study authors Courtney C. Simpson, MS, and Suzanne E. Mazzeo, PhD, noted that these devices could be used for reasons other than health and may promote excessive exercise to change the person’s appearance. Furthermore, the authors stressed the need for rest days and time limits, which tracking devices generally do not track. Although a relationship was found between fitness trackers and eating disorders, they note that some adults may find benefit from behavioral monitoring, and it has demonstrated efficacy in weight loss in those with obesity and overweight.

Ultimately, both Miller and Hornack both suggest that a thorough discussion should be had with parents who are concerned about their child’s activity levels. Also, they should be aware of suggestions made by the AAP and the CDC, in addition to the options available for their children.

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“Pediatricians need to speak with parents about the different types of activities that can be done by children,” Miller said. “Children could get involved in different after-school programs or programs at community centers. I think it is important for parents and children to understand the importance of being physically active. A child’s activity levels are a good predictor of their activity level as an adult.”

Miller and Hornack also suggest that a candid conversation with the child is needed if they are the ones inquiring about the use of these products. Body image, health promotion and physical activity should be discussed in a greater context with children interested in the Fitbit Ace.

“Generally, in our society, kids receive all kinds of messages about weight and shape, and we know that there are many school-aged boys and girls that have certain preconceptions about what their weight should be, and they feel that their ideal weight should be less than what it currently is,” Hornack said. “We need to be really mindful of focusing on healthy living, healthy behavior and ensuring that this is their purpose, not to feed into obsessive thoughts or concerns.”

The National Association of Anorexia Nervosa and Associated Disorders claims that eating disorders affect at least 30 million Americans regardless of age and gender and note that the mortality rate associated with eating disorders is higher than that with any other mental illness. With the prevalence and potential severity of these conditions, Miller suggests that these discussions may uncover potential body image or weight concerns.

“I believe that trying to find the underlying reason for their concern [about their weight or activity level] is very important,” Miller said. “It may indicate a body image issue or that they are looking at their peers’ health and trying to fit in with them.”

According to Hornack, the development of unhealthy eating behaviors and eating disorders often begins in school-aged children and young adolescents. Furthermore, she mentions that those who have a history of obesity are at greater risk of developing these eating habits or an eating disorder.

“It is something that as a clinician, I am always cautious about, aware of and monitoring when they bring me these kinds of concerns,” she added.

Miller stresses that although these technologies are not inherently harmful or beneficial, the effect of these devices depends on the child or adolescent’s motivation behind using the devices. Consulting pediatric patients about exercise and weight management should be approached in a thoughtful way.

“As a public health message, it is important to promote physical activity but with a caveat,” Miller said. “There are some individuals who will lean towards this technology who have body image concerns. I think these individuals need to be identified and make sure that the pediatrician is not promoting these issues that could arise.” – by Katherine Bortz

References:
ANAD: Eating disorder statistics. http://www.anad.org/get-information/about-eating-disorders/eating-disorders-statistics/. Accessed April 9, 2018.
CDC: Adult obesity facts. Accessed April 9, 2018.
CDC: Childhood obesity facts. Accessed April 9, 2018.
Fitbit Ace kids wristband. https://www.fitbit.com/ace. Accessed April 9, 2018.
Fitbit: Buck the Trend: Help get your kids moving with Fitbit Ace—Fitbit’s first tracker for kids! https://blog.fitbit.com/fitbit-for-kids/. Accessed April 9, 2018.
Simpson CS, Mazzeo SE. Eat Behav. 2017;doi:10.1016/j.eatbeh.2017.02.002.

For more information:
Gary Miller, PhD, can be reached at Wake Forest University, 1834 Wake Forest Rd. Winston-Salem, NC 27109; Contact: Cheryl Walker (walkercv@wfu.edu)
Sarah Hornack, PhD, can be reached at Children’s National Health System, 2916, 111 Michigan Ave. NW, Washington, DC 20010; Contact: Simone Hunter (shunter@childrensnational.org)

Disclosures: Miller and Hornack report no relevant financial disclosures.