Can technology improve people’s eating habits? This is the multibillion-dollar question challenging developers. Consumer applications and integrated digital solutions for food tracking, menu planning, grocery shopping, eating out, and nutrition and lifestyle coaching are proliferating. Innovations include scanners that identify nutrients, wearables that gauge real-time calorie intake and breathalyzers that measure metabolism.

“Food tech is the final frontier to be explored by using apps, sensors and wearables,” said Ted Vickey, PhD, founder and CEO of FitWell in San Diego.

Consumer interest has spurred development. As of March 2017, 26% of people aged 18–29 reported regularly using apps to track diet and nutrition, as did 17% of people aged 30–45, and 9% of those 45–60, according to Statista survey (Statista 2018a). The Super­Tracker website for recipe or menu analysis, food intake and physical activity tracking served 27 million users before the federal government terminated it in June (USDA 2018). The more popular food-tracking apps include MyFitnessPal (myfitnesspal.com), with 11 million active users per month (Statista 2018b), and Lose It!, with over 3 million active monthly members, according to its website (loseit.com).

With so much acceptance, fitness pros need to know what technologies are available and how to assess their potential for health and performance improvement.

Types of Dietary Apps

Mobile phone-based apps are the most popular technologies—some singly focused, for calorie and nutrient tracking, for instance, and others with integrated digital solutions that include live coaching and detailed biometric data. More complex digital solutions integrate tracking with other wearables and smart devices, like scales and water bottles. Here’s a sampling of what users select for tracking and advice on healthful dietary choices:

• Calorie tracking. MyFitnessPal and Lose It! combine food and water consumption self-reporting with physical activity tracking and social support. Both products offer extensive validated databases—with millions of grocery and restaurant items—and barcode scanning. Lose It! also has a photo feature. You snap a picture of food for quick nutrition information then manually enter portion size (although the app cannot analyze multiple ingredients in foods like a cheeseburger). Calorie Mama (caloriemama.ai) has a more sophisticated photo tracker that pro­vides detailed nutritional analysis.
• Meal planning and recipes. MyPlate Calorie Counter (livestrong.com/myplate), has a food tracker with a smaller database than either MyFitnessPal or Lose It!, but it adds personalized meal planning and healthy recipes and includes shopping lists. San Francisco-based Suggestic Precision Eating™ (suggestic.com) takes meal planning one step further by using artificial intelligence (AI) and augmented reality (AR) to offer real-time, location-based eating suggestions.Shai Rozen, CMO and co-founder of Suggestic, says, “We believe the biggest obstacle in people changing behavior around food is choice. We remove part of the decision-making effort by providing contextual, highly relevant tips in real time. With most food trackers, users log items after eating. Suggestic takes your goals and recommends what to eat before you eat it. Users can follow preferences like vegan or paleo.” With Suggestic, a user can hold a smartphone camera over a restaurant menu; the app uses AR to highlight and rank menu items, providing real-time suggestions. The app also uses AI to find behavior patterns over time and learn to make “smarter” recommendations.
• Recipe and nutrient analysis. Nutrients (pomegranateapps.com/nutrients), a detailed database of 200,000 items with nutrition information for individual foods and meals, offers recipe analysis and is particularly valuable for people with specific food intolerances. Registered dietitians like that it takes emphasis away from calories and focuses on foods’ nutritional value. “People should be food-group oriented instead of counting calories,” advises Felicia D. Stoler, DCN, MS, RDN, a clinical nutritionist in Red Bank, New Jersey, and author of Living Skinny in Fat Genes: The Healthy Way to Lose Weight and Feel Great (Pegasus 2011).

  Another app, Fooducate (fooducate.com), provides an analysis of calories, macronutrients and percentage of minimally processed foods. To increase awareness of calorie quality, the app provides color-coded food grades. It breaks down calories consumed from solids or liquids and offers suggestions for healthier choices in place of highly processed foods. As Meagan Moyer, MPH, RDN, LD, clinical nutritionist at Emory Healthcare in Atlanta and author of Bits and Bytes: A Guide to Digitally Tracking Your Food, Fitness, and Health (Academy of Nutrition and Dietetics 2017), says, “You need to know not only what you shouldn’t eat, but also what you should.”

• Grocery shopping. Shopwell™ (shopwell.com), created by registered dietitians, enables grocery shoppers to scan barcodes and nutrition labels for immediate nutrition information, personalized food scores and recommendations. It can analyze affiliated supermarket shopping receipts to show how well purchases align with nutritional goals and dietary restrictions, such as food allergies or diabetes. Fooducate also gives advice on healthier alternatives.
• Eating out. Several apps help people find healthy options when dining out, but many are regional, so check out which ones cover your neighborhood. Examples include Food Tripping (jacapps.com/case-studies/food-tripping), Clean Plates (cleanplates.com), and HappyCow for vegans (happycow.net). Suggestic’s menu assessment feature includes scoring for over a half-million restaurants nationwide.
• Nutrition coaching. More sites are integrating opportunities for live or distance fee-based coaching with registered dietitians. Rise (rise.us) allows people to describe their goals to a registered dietitian. Participants submit photos of what they eat to their coach, who checks in daily with suggestions for how to modify dietary choices. Users can sign up on a monthly or quarterly basis. Moyer thinks this trend will grow, as most apps are not personalized, food logs are often inaccurate and people need individualized counseling.
• Coaching interface. Some apps integrate a coaching interface to enable an authorized personal trainer, health coach or dietitian to log in and see client data. MyNetDiary (mynetdiary.com/food-diary-and-calorie-counter-for-trainers.html) and Healthie (gethealthie.com) provide these platforms. Other web-based solutions are designed only for health professionals, like Diet ID™ (dqpn.io), which enables a coach to use food photographs to identify client eating patterns that need improvement.

Emerging Technologies

New technologies are emerging for more personalized data on specific foods, rather than a generic database. Products that are still being perfected include lasers, wearables and an array of smart devices.

• Lasers. New handheld laser devices like Tellspec® (tellspec.com/en) and SCiO™ (consumerphysics.com/scio-for-consumers) potentially enable users to scan food to analyze what’s inside it, including pesticides, gluten, or proportions of carbohydrates, fats and proteins. Cloud-based technology sends data to a user’s smartphone. This spectrometer technology is being installed into a smartphone that will be available in China in 2019 (phone.consumerphysics.com).
• Wearables. Wearables are still in development. For example, “Healbe’s GoBe 2 (healbe.com/gobe2) claims to automatically measure calorie intake through a wearer’s skin,” says Bryan O’Rourke, CEO at the Fitness Industry Technology Council in Mandeville, Lousiana. “The product was met with mixed reviews . . . including skepticism about whether it does what it says. If the calorie-counting technology works, it would be groundbreaking.”
• Smart devices. As tech tools become smaller and more affordable and cloud-based computing becomes more powerful, smart devices that connect with one another, aka the Internet of Things, can potentially monitor every aspect of our lives. For example, Lumen (lumen.me), a device scheduled for 2019 release, looks like a handheld breathalyzer with data that shows what energy pathway—carbohydrates or fats—is currently being used for fuel to optimize training, time nutrient consumption or achieve weight goals. Hidrate Inc. offers Hidrate Spark 2.0 (hidratespark.com), a smart water bottle that recommends daily water intake based not only on biometric data but also on weather from GPS information; it tracks water consumption, glows for drink reminders, and syncs with other fitness programs like Fitbit or Apple Health.

Addressing Behavioral Change

While we may learn what’s inside specific foods and what’s going on inside an individual’s body, the apps’ tracking, goal-setting, meal-planning and even nutrition coaching don’t address emotions and habitual behaviors that drive unhealthy eating habits.

“Integrating behavioral science is the holy grail of disruptive health technologies,” said Vickey. “Trainers need to use [tech] tools to educate clients on the behavioral change aspect of what they’re doing. Sometimes apps and wearables give too much information.” Vickey advises us to “follow the KISS principle.”

• Mindful-eating programs. Some developers are tackling these issues with mindful-eating apps that provide suggestions and exercises, such as Mindful Eating Tracker (tracknshareapp.com/mindful-eating-tracker) and “In the Moment” Mindful Eating app (lmwellness.com/in-the-moment-mindful-­eating-phone-app).

  Mindfulness and addiction expert Judson Brewer, MD, PhD, director of research at the Center for Mindfulness and associate professor at the University of Massachusetts Medical School in Worcester, Massachusetts, created Eat Right Now® (ERN) (goeatrightnow.com), an app-based program with craving-specific tools, expert coaching and a supportive community to help people who struggle with weight loss, binge eating and cravings. ERN has a “flipped classroom” model, so professionals like personal trainers can teach, assign homework and interact digitally with clients in the community. Brewer also developed a program that targets anxiety since that can be part of the issue (see Resources below for more information).

  “We’re offering behavior change facilitator trainings, so coaches can combine their skills with the program,” said Brewer. “The combination of a facilitator with the course is effective. Clinical studies show a 40% reduction in craving-related eating (Mason et al. 2018) and close to 50% reduction in anxiety symptoms in 28 modules with 1–2 months of daily use.”

  “Food-recording apps like MyFitnessPal can be useful behavior management tools to supplement professional advice and teach autonomy to clients,” says Neal Pire, MA, national director of wellness services at Castle Connolly Private Health Partners in New York. “Apps are useful tools to increase clients’ awareness and empower them to change and adopt better eating behaviors [when they’re not with their trainer].”

Choose Tech Wisely

Both fitness and nutrition experts agree that technology is only a tool, and it’s not for everyone. “Clients should be learning more how to eat by themselves and make informed choices,” says Wesley Delbridge, RDN, spokesperson for the Academy of Nutrition and Dietetics in Phoenix.

Stoler notes that people should not become so dependent on their phones that they can no longer make eating decisions without them or feel stressed that they can’t log every bite. “It’s like training wheels—to give a course of action and knowledge base that they hopefully find useful—but at a certain point, people need to graduate.”

Experts emphasize that solutions need to fit individualized needs. “There are many tools, but they’re not necessarily stand-alone,” says Moyer. “Often people need help to stick with dietary changes. Support groups built within apps are a great source. Pay-to-play apps [where people bet on weight loss] can work for some people, but not all. Every person is different.”

Fitness professionals need to stay within scope of practice when using these apps and must refer to a registered dietitian when appropriate. Ken Baldwin, director of education and training for Perform Better Australia, in Brisbane, says, “Personal trainers need to be able to address issues like sleep, water, recovery, mood changes, hormones, age and gender differences . . . but they should not think about giving advice beyond their scope of practice. They should create a great professional network.”

Apps Support the Human Touch

The tech market for tracking eating patterns is bursting with tools that support the quantified self; the future seems limited only by the imagination. At the same time, eating healthier foods is dependent on a person’s financial resources and personal initiative. No program can control what a person eats. Behavioral change is complex.

Data alone does not improve health or performance. What makes a difference is how data is interpreted and applied. People are not machines; food is not simply a nutrient source. Fitness professionals have an opportunity to help clients understand these tools and to optimize training, but at the end of the day, people need to find joy and satisfaction in what they eat and drink and find happiness with their bodies and their lives. Fitness professionals can be the wise proponents of these truths.

Have you ever made a recommendation to a client, then discovered the client heard something completely different? Or she took part of what you suggested and ignored the rest? Like the time I advised my client about the healthfulness of berries and later found out he had given up all other fruit. That was a nutrition misfire. Maybe it was the client’s all-or-nothing thinking, or maybe I hadn’t been clear enough. After all, there is subtlety in food and nutrition, and getting the message right is a challenge. Stamp out misunderstandings by learning how top nutrition professionals set their clients straight on six all-too-common nutrition misfires.

Misfire #1

Sugar is bad; therefore, all carbs are bad.

“All carbs are not created equal,” advises Kathy McManus, MS, RDN, director of the Department of Nutrition at Brigham and Women’s Hospital in Boston. “There are some unhealthy sources, like white bread, white rice, white potatoes, and foods containing added sugar (cake, cookies, candy and sugar-sweetened beverages). These foods raise blood sugar and can lead to diabetes and weight gain.” But don’t throw the baby out with the bathwater. As McManus points out, “The right types of carbohydrate foods, such as intact whole grains, fruits, vegetables, beans and other legumes, are the foundation for a healthy diet.” (Intact whole grains include all layers of the original kernel: bran, germ and endosperm.)

Because added sugar is “empty-calorie,” providing calories but no additional nutrients, focus clients on reducing added sugar, not on reducing sugar that occurs naturally, as in fruit or all carbohydrates. Help clients navigate this terrain by thinking about the carbohydrate’s context: If it is added sugar or refined grain, limit intake. If it’s in whole foods, dig in, though be mindful of portion control even with healthy foods.

Misfire #2

Vegetarian diets are healthy, so I should avoid all animal foods.

Vegetarians have lower rates of overweight and obesity, diabetes, heart disease, and some cancers compared with those on a typical American diet (Appleby & Key 2016). That sounds pretty compelling, but it doesn’t necessarily mean animal foods (meat, poultry, fish, dairy products) have no place in a healthy diet. In addition to protein, meats are sources of well-absorbed minerals, including iron and zinc, while milk and other dairy products are great sources of calcium.

McManus says that avoiding all animal foods “can be overly restrictive and limit options, especially when eating with friends and family and away from home.” It can be difficult to find enough variety to eat well in restaurants and may be socially isolating. She explains that “plant-based eating” means eating mostly foods from plants (legumes, healthy oils like olive oil, nuts, seeds, whole grains, fruits and vegetables), but it allows for greater flexibility than a vegetarian diet and can include fish, eggs, dairy and some meats. Plant-based eating “supports many of the same health benefits as vegetarianism, such as lower weight, less heart disease and less diabetes, but for many people is a less severe, more sustainable food pattern to support health.” Some call this pattern a “flexitarian” diet.

Misfire #3

Gluten is bad for some people; therefore, everyone should avoid gluten.

Gluten is a protein found in wheat, barley and rye. “The fact that gluten is a protein surprises people, since today’s food conversation is very positive about protein,” says Kim Kirchherr, MS, RDN, a nutrition consultant in Chicago who has worked extensively in supermarket nutrition. “Gluten is the reason bread has that wonderful, chewy texture.”

People with celiac disease react to gluten in a way that damages the lining of their small intestine, leading to digestive symptoms like bloating, diarrhea and malabsorption of nutrients.

Wheat sensitivities are not always related to gluten. “Some people with irritable bowel syndrome are intolerant to the carbohydrate portions of wheat called oligosaccharides. But the majority of us are totally okay to consume wheat and gluten,” says Denise Barratt, MS, RDN, a nutrition consultant and blogger in Asheville, North Carolina, and the author of Farm Fresh Nutrition (vineripenutrition.com). Barratt says gluten-free products may have less iron, fiber and B vitamins, so reconsider switching unless you need to avoid gluten for health reasons.

On the other hand, do we tend to overeat white bread, pizza, cakes, cookies and other less healthy sources of gluten? Yes, we certainly do. Is it the gluten that makes these foods unhealthy? Not for most people! The message shouldn’t be to avoid gluten; it should be to choose more nutrient-dense breads made with whole-grain flours and, especially, more intact whole grains like barley and quinoa, which don’t raise blood sugar as much.

Misfire #4

Juicing is the best way to get your fruit and veggies.

There’s a juice for every day of the week, and your clients have probably tried them all: green juice, detox juice, and juices infused with ginger and turmeric. Recent research has shown that juices are an effective way to increase vitamins, minerals and phytonutrients in the diet (Zheng 2017). In the U.S., most people don’t eat enough fruit or vegetables and may miss out on the nutrients they provide: vitamins A and C, potassium, fiber, phytonutrients, and more.

But is drinking juice better than eating the fruits and vegetables they were squeezed from? No one is arguing that we should drink juice instead of eating whole produce. Juicers usually remove fiber, but fiber is important for digestive health and cholesterol reduction, and it helps keep blood sugar under control. “You may be tossing out some of the great things we eat fruits and veggies for in the first place,” says Kirchherr.

Calories are another consideration. “How many whole oranges are you using for that glass of orange juice? Five? Six? Would you ever sit down and eat that many whole oranges?” asks Kirchherr. You are probably consuming a lot more calories from juice than you would if you were eating the whole fruit. Barratt tells her clients, “It is much more economical and nutritious to eat whole fruits and vegetables in smoothies, salads, soups and stir-fries.”

Misfire #5

Nutrition Facts labels on foods tell me all I need to know about the foods.

“Most of us want a super-simple way to manage the information about things we eat and drink,” says Kirchherr. She recommends using 5% (low in a nutrient) and 20% (high in a nutrient) of the Daily Value as a quick guide. (The Daily Value indicates how much of a nutrient a single serving of the food contributes to an average daily diet of 2,000 calories.) Trying to reduce sodium? Look for 5% or less of the Daily Value. Trying to increase fiber? Go for 20% or more.

However, Kirchherr cautions, “The Nutrition Facts label provides context in terms of calories and nutrition, but the ingredient list gives us more detail about the product. Focusing on one or the other doesn’t give the full nutrition picture.” McManus explains that, for example, fiber is often added to white bread, which boosts the number of grams of fiber on the Nutrition Facts label but doesn’t make white bread as nutritious as whole-wheat bread. Whole-wheat bread lists whole-wheat flour as the first ingredient and contains more vitamins, minerals and phytonutrients, which don’t all appear on the Nutrition Facts label. In addition, says McManus, “Research is limited on the health benefits of some of these added fibers, and they may not be equivalent to naturally occurring fiber in whole grains.”

Also, as McManus reminds clients, “Many of the healthiest foods (fresh fruit, vegetables, fish, poultry, whole grains, nuts and seeds bought in bulk) do not have Nutrition Facts labels.”

Key changes to nutritional labels. By the way, Nutrition Facts labels are changing to be clearer about the number of calories per serving and to reflect current scientific knowledge about nutrients of concern for Americans. There is an overview of the changes at fda.gov/downloads/food/labelingnutrition/ucm511646.pdf.

Misfire #6

Vitamins and minerals are essential for health, so I should take a lot of them.

If you get less than enough iron, you become anemic; too little vitamin C, and you get scurvy. Vitamins and minerals are critical for good health, but the message for clients, says Kirchherr, is “bigger isn’t always better. This is true for things that are good for us, too.” We can’t easily get rid of excess vitamins stored in fat, such as fat-soluble vitamins A, D, E and K. The B vitamins and vitamin C, on the other hand, are water-soluble, and we excrete what we can’t absorb, so taking an excess of those may mean you are essentially flushing the money you paid for them down the toilet.

While a multivitamin and mineral supplement containing around 100% of the Daily Values may be low risk and could make up for nutrients missing in the diet (Ward 2014), we have little research on the long-term effects of large doses of vitamins, minerals and other dietary supplements. In the U.S., laws do not require the Food and Drug Administration to verify safety or effectiveness before dietary supplements are marketed to consumers (NIH 2011). And don’t assume that because a supplement is popular, it is also effective. Many people believe that taking large doses of vitamin C will prevent them from getting colds, but the scientific evidence doesn’t support that belief (PubMed Health 2017).

To avoid nutrition misfires, we need to help clients scratch the surface and see there is more to every nutrition topic than just a sound bite. Kirchherr wisely reminds us, “Extremes, like ‘always’ and ‘never,’ don’t work in food and nutrition.” Perhaps that should be our first message to clients.

Learn how a lack of breakfast can impact exercise and what kinds of foods will give you the energy you need for the day from Martica Heaner, PhD, MA, MEd, NASM-certified trainer, award-winning group fitness instructor, and adjunct assistant professor of nutrition at Hunter College in New York City.

Exercise and Skipping Breakfast

Some people believe that by exercising on an empty stomach in the morning, they’ll burn more body fat. However, if the body burns a higher percentage of fat while exercising on no breakfast in the morning (and study results are mixed), that doesn’t mean metabolism—or total calorie burn—is speeding up. “If you’re going to do a long or strenuous workout on an empty stomach, you may not have adequate carbs to power your workout and so you won’t be able to work out as long or as hard,” says Enette Larson-Meyer, PhD, RD, FACSM, nutrition professor at the University of Wyoming and author of Vegetarian Sports Nutrition (Human Kinetics 2007). “Even if you are burning a slightly higher ratio of fat, with impaired performance you may not be burning as many total calories or total calories of fat as you could if you were well-fueled.”

What Counts as Breakfast?

“Usually we aim for breakfast providing 25%–30% of the calories for the day, so the amount will depend on a person’s daily energy expenditure,” says Larson-Meyer. Ideally, the morning meal should provide carbohydrates and fiber from fruits, vegetables and/or beans, as well as protein from dairy or, better, from plant-based varieties of milk or yogurt, as well as eggs or plant foods like beans and whole grains. While fruit is generally recommended over juice because fruit contains more fiber and fewer calories, a lean exerciser need not fear juice. “Most people should avoid drinking their calories, but if juice is an easy energy source before your workout in the morning, go ahead and drink it,” Larson-Meyer says.

What about doughnuts or pastries? “Something is better than nothing, and if you’re in the woods starving, a doughnut is okay,” says Melinda Manore, PhD, RD, nutrition professor at Oregon State University, Corvallis, and author of several textbooks, including Nutrition for Life (Benjamin Cummings 2006). But keeping a stash of easy breakfast backups, like breakfast bars, nuts or even cold leftovers, can give you more nutritious choices so that you’re not just filling up on empty calories. Don’t be afraid to get creative: Some cultures eat soups for breakfast, others eat beans (on toast or in bean burritos). Aim for a breakfast that provides energy and nutrients and that helps you feel satiated.