Almost half of American kids get their first cell phone by the age of 12, and that age continues to decrease. On top of that, two thirds of parents allow their 4 to 7-year-olds to use the parents’ mobile devices for apps targeting children.

The American Academy of Pediatrics (AAP) recommends certain behaviors and strategies to prevent pediatric obesity. Behaviors are things that children should do (e.g. eat breakfast daily or get 1 hour of physical activity daily). Strategies are methods that help encourage the behaviors (e.g. positive reinforcement). Recent research assessed 62 kids’ nutrition and fitness iPhone apps for inclusion of these behaviors and strategies.

Each app was given a score for each of 10 behaviors from 0 to 3. The numbers (0 to 3) corresponded to no recommendation, weak, moderate, and strong respectively. For example, an app would receive a “1” if they showed fruits and vegetables, a “2” if it encouraged eating them, and a “3” if it recommended 5 servings of fruits and vegetables per day. The scores of all of the behaviors were summed to give an overall “behavioral index score” (between 0 to 30).

The 4 recommended strategies were only rated based on their presence or absence. If the strategy was employed by the app, it was given 1 point. Otherwise, it was given 0. The points were summed in a similar manner to the behavior resulting in a “strategy index score” ranging from 0 to 4.

Half of the apps were free. Those that were not cost up to $9.99. The app that performed the best in both indices (Iron Kids by American Academy of Pediatrics) cost $3.99. This app had a behavioral index score of 26/30 and a strategy index score of 3/4. WakeMyMojo, the second best app based on the indices, was free. It’s worth noting that the most expensive app received terrible scores (behavioral: 1/30; strategy: 0/4).

When looking at the apps’ user ratings in the iTunes store (0 to 5 stars), only half had ratings available. Of those that had them, there was a moderate, statistically significant correlation between the user ratings and the researchers’ score indices (r=0.31, p=0.043).

The mean behavioral score was 3.5 (out of 30) which seems to imply that the apps did a terrible job for the most part. A closer look shows that more than half of the apps received a 2 or 3 (moderate or strong recommendation) in at least 1 behavior. This tells us that many apps focused on less of the behaviors, but strongly recommended the behaviors that they did address.

Of the recommended behaviors, some were much more heavily represented than others. For example, exposure to fruits and vegetables were in nearly half of the apps whereas eating meals together with family or limiting screen time were barely used.

The mean strategy score was similarly low at 0.48 with 1 in 5 apps using at least one recommended strategy.

The researchers went back later to look at readability. Of the 48 apps they were able to assess at that time, nearly 4 out of 5 apps were useable without reading at all (there was either no writing, writing that was also narrated, or short words like “Go” or “Stop” that could be inferred from using the app). The remaining apps required a fifth or sixth grade reading level on average.

The general takeaway from this study is that there are apps for kids that encourage recommended behaviors and strategies for preventing pediatric obesity. Most of them can be used by kids of almost any age. Finally, many apps focus on a small number of recommended behaviors and strategies, and some of the recommendations are poorly represented. Therefore, an iPhone app could help in preventing pediatric obesity, but areas not addressed by the apps should be addressed using other methods.

Wearing JR, Nollen N, Befort C, Davis AM, Agemy CK. iPhone app adherence to expert-recommended guidelines for pediatric obesity prevention. Child Obes. 2014 Apr;10(2):132-44.