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Despite the hundreds of diet apps available for use on smartphones (mobile phones), no studies have examined their use as tools for dietary assessment and tracking in sports nutrition.
The aim is to examine the prevalence and perceptions of using smartphone diet apps for dietary assessment and tracking among sports dietitians.
A cross-sectional online survey to examine the use and perception of diet apps was developed and distributed to sports dietitians in Australia, Canada, New Zealand, the United Kingdom, and the United States (US).
The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). diet apps were used by 32.4% (57/176) of sports dietitians to assess and track the dietary intake of athletes. Sports dietitians from the US were more likely to use smartphone diet apps than sports dietitians from other countries (OR=5.61, 95% CI 1.84-17.08,
Nearly one-third of sports dietitians used mobile phone diet apps in sports nutrition practice, and viewed them as useful in helping to assess and track the dietary intake of athletes.
Dietitians are experts in nutrition and work in all sectors of health [
A core practice of sports dietitians is to assess dietary intake by examining the composition and adequacy of food and nutrients usually consumed by an athlete. However, accurate dietary assessment using traditional methods (such as a diet record recorded with pen and paper) is challenging as people tend to misreport the type and amount of food consumed, either because of memory lapse, social desirability bias, incorrect estimation of portion size, or lack of knowledge of the content of meals. Additionally, people may alter their usual food and fluid intake to ease recording [
Sports dietitians also ask athletes to track or monitor their dietary intake after implementing nutrition advice, in order to evaluate the effect and adherence to prescribed dietary recommendations [
The emergence of smartphone (mobile phone) technology and diet apps has expanded the tools available to sports dietitians to assess and track dietary intake. Diet apps on smartphones allow recording of food intake, which is instantly converted to nutrient intake and compared with calculated nutrition goals. Nutrition goals are calculated based on a diet app user’s sex, weight, weight goals, and activity level. Food entries and weight progress can be shared with a dietitian in real time [
Studies examining the validity of diet apps on personal digital assistants (PDAs) have shown them to be as valid as traditional dietary assessment methods [
Regardless of their uncertain validity, smartphone diet apps have become prolific in app stores [
A cross-sectional online survey to assess smartphone diet app use in sports dietetics was developed and distributed electronically between June 22 and November 11, 2012, to sports dietitians in Australia, Canada, New Zealand, the United Kingdom (UK), and the United States (US). We selected English-speaking countries that had known sports dietetic associations. An administrator from each dietetic association sent a series of emails to their members to invite them to participate in our survey. We chose to survey registered sports dietitians, as their registration guarantees academic and professional qualification in nutrition [
Survey questions were initially developed by reviewing the literature on technological advancements in dietary assessment and tracking, and by pilot interviews of two registered sports dietitians, conducted in March 2012. Semi-structured interviews lasted one hour each and included the following topics: methods of dietary assessment and tracking in sports dietetics, barriers in assessing and tracking dietary intake of athletes, and benefits and limitations of using smartphone diet apps. The interviews were recorded (with Philips Voice Tracer digital recorder lfh0622), transcribed, and analyzed.
The resulting questionnaire (
Skip logic, which is also known as “adaptive questioning”, was employed to direct respondents through different paths in the questionnaire based on their answers. The questionnaire included a total of 27 questions. Depending on the respondent’s answers, the number of questions presented ranged from 13 to 26. Of the questions, 9 required an answer before the respondent could proceed to the next page. The questionnaire was 11 pages, with 1 to 8 questions per page. Question order was not randomized because of the use of skip logic. However, answer choices for multiple-choice questions were randomized or flipped [
The questionnaire took 5-15 minutes to complete, depending on the paths taken through the questionnaire. A progress bar appeared on every page, which displayed the percentage of the questionnaire that was complete. A ‘thank you’ page was automatically displayed upon completion of the questionnaire. A separate collector was set up for each dietetic association that consisted of customized weblinks, identifying the dietetic membership of respondents. Administrators of each dietetic association sent their members an invitation email with a link to the questionnaire. Reminder emails were sent to all respondents one and two weeks after the initial email was distributed, following the Dillman’s Tailored Design Method [
Respondents who completed the questionnaire could submit their email addresses to receive a factsheet about using smartphone diet apps in sports dietetics practice, a background paper on dietary tracking with smartphones, and results from the study. Email addresses were collected with a second questionnaire, which was hyperlinked to the end of the primary questionnaire (
Results from both complete and incomplete questionnaires were included in the final analysis. Response rate was calculated as the number of first question respondents, divided by the number of invited respondents. Completion rate was calculated as the number of last page respondents, divided by the number of first page respondents. Data was analyzed using Stata version 12 (StataCorp LP, College Station, TX, USA). Descriptive statistics were used to describe attitudes and current practices of sports dietitians (including frequency counts and cross-tabulations). Associations were examined using Fisher’s exact test, as cell counts were frequently less than five. All statistical comparisons were 2-tailed, and
The overall response rate from the 1709 sports dietitians invited to participate was 10.3% (n=180). Of the 180 respondents who began the questionnaire, 90.0% (n=162) completed it. Four respondents were excluded from analysis because they were dietetic students and were not yet working. The results presented include both complete and incomplete questionnaires, yielding 176 responses.
The plurality of respondents were Australian or Canadian, in the age range of 30-39 years, and had been practicing sports nutrition for 6 to 10 years (
Demographics of survey respondents.
Characteristic (N)a | N | % | |
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Australia | 54 | 30.7 |
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Canada | 54 | 30.7 |
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United States | 39 | 22.2 |
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United Kingdom | 17 | 9.7 |
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New Zealand | 10 | 5.7 |
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21-29 | 40 | 24.7 |
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30-39 | 55 | 34.0 |
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40-49 | 36 | 22.2 |
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50-59 | 22 | 13.6 |
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60 or older | 9 | 5.6 |
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|
|
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0-1 | 14 | 8.7 |
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1-5 | 22 | 13.7 |
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6-10 | 54 | 33.5 |
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11-15 | 36 | 22.4 |
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16-20 | 16 | 9.9 |
|
More than 20 | 16 | 9.9 |
Other (part-time) | 3 | 1.9 |
a Results reflect the proportion of respondents who answered each question.
For this section all results refer to the subset of participating sports dietitians who use diet apps in their clinical practice (n=57) and are referred to as
Smartphone diet apps were used by 32.4% (57/176) of sports dietitians to help them assess and track the dietary intake of athletes. The age of the sports dietitian was not associated with diet app use (logistic regression
Overall, diet app users utilized 28 different smartphone diet apps when counseling clients. MyFitnessPal was overwhelmingly the most popular diet app, used by 56% (32/57) of diet app users (
Diet app use by sports dietitian’s country of residence.
“Which smartphone diet application(s) do you use?” N=57.
Respondents rated the effectiveness of diet apps in assisting with dietary assessment (
Of the diet app users, 95% (54/57) reported limitations and benefits of using diet apps in clinical practice. The most commonly perceived limitations of diet apps were problems with the nutrient database, incorrect portion size selection by the client, and incorrect food selection by the client (
“What are the limitations of using smartphone diet apps?” (N=54)a.
Theme | n | % | Example of Comments |
Nutrient database is inaccurate, missing foods, not country-specific | 22 | 41 | “Poor, incomplete databases with no monitoring of foods that are added by users for accuracy” |
Incorrect portion size selection | 12 | 22 | “Inaccuracies in reporting portions of foods” |
Incorrect food selection | 10 | 19 | “The clients must know the differences between foods and how they were prepared” |
Client does not own smartphone | 7 | 13 | “Not all clients have smartphones” |
Requires client to be tech savvy | 7 | 13 | “Difficult to use for those that are not tech savvy” |
Difficulty transferring data from app to dietitian’s reports | 7 | 13 | “Getting the information off the app onto a record system that the dietitian can keep” |
aQuestions were open-ended.
“What are the benefits of using smartphone diet apps?” (N=54)b.
Theme | n | % | Example of comments |
Ubiquitous | 27 | 50 | “Most people have a smartphone and use it constantly” |
Convenient | 14 | 26 | “More convenient than pen and paper record” |
Easy to use | 12 | 22 | “They are extremely fast and easy to use encouraging adherence” |
Enter foods as they are eaten | 11 | 20 | “Clients can record food as they go. Less risk of forgetting” |
Instant feedback | 10 | 19 | “Immediate feedback” |
Increases awareness of nutrition | 8 | 15 | “Creates awareness of calories in and out” |
Accurate | 7 | 13 | “Possibly more accurate as they can record as they go and not embarrassing to be seen to be writing down food intake as everyone is on phones these days” |
bQuestions were open-ended.
Perceived effectiveness of smartphone diet apps in assessing dietary intake (N=53).
The present study is, to our knowledge, the first to survey sports dietitians about their use and perceptions of smartphone diet apps in sports nutrition practice. We found that one in three sports dietitians used smartphone diet apps to assess and track the dietary intake of athletes. This prevalence is comparable to a recent study by Lieffers et al [
In our study, MyFitnessPal was the most popular diet app, which is consistent with finding from Lieffers et al [
Sports dietitians in our survey believed that the ubiquity of diet apps may increase the accuracy of dietary assessment/tracking. The immediate entry of records after eating would reduce reliance on memory, which is notoriously problematic in traditional dietary assessment methods [
In the present survey, sports dietitians had a positive perception of diet apps in helping them to assess/track dietary intake, which was in agreement with Lieffers et al [
Our survey was disseminated in English-speaking, developed countries, which may limit the generalizability of our findings. The survey was sent out on different dates to the five participating countries, due to factors outside of our control. For instance, dietetic associations emailed their members at varying frequencies (eg, weekly, fortnightly, or monthly), which influenced when the survey invitation was distributed. Future studies should explore alternative ways of distributing surveys that are independent of administrators - perhaps using social media to disseminate the survey [
The overall response rate is lower than we desired, however it is similar or greater to electronic surveys of dietitians in participating countries [
We were unable to distinguish whether respondents used diet apps for dietary assessment or dietary tracking. Future surveys should differentiate between these two possible roles of diet apps, as certain apps may be better suited to one of these two tasks. In this study, all of the most commonly used diet apps compare actual nutrient intake to goal recommendations, which may make them prone to social desirability bias as overt nutrition recommendations can encourage people to report that they consume foods inline with known recommendations [
We found that one-third of sports dietitians used smartphone diet apps with athletes. Sports dietitians who used diet apps had a positive perception of them, and viewed diet apps as useful in helping to assess and track the dietary intake of athletes. We expect that more sports dietitians will use diet apps as smartphone adoption continues to increase and diet app software is refined. Software developers have an opportunity to address the limitations of currently available diet apps and enhance the benefits cited by the sports dietitians in this study. Future research should continue to survey dietitians from all disciplines on their use of smartphone diet apps to examine usage and best practice in dietary assessment and tracking. Finally, there is clearly a need to validate commercially available diet apps, so that dietitians can be confident in recommending their use for dietary assessment and tracking.
Study questionnaire.
personal digital assistant
None declared.