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How accurate are dietary intake apps and what improvements need to be made?

By Emma Partridge

Dietary tracking applications (apps) have become quite sophisticated over the years, moving from manual entering of a food and portion to using barcode scanners to identify brand name products and return nutritional content information based on an entered portion. However refined these apps have become, their most poignant issue may not lie in the accuracy of the nutritional content information returned, but in the accuracy of the user’s portion estimation. An analysis of misreporting on National Health and Nutrition Examination Surveys (NHANES) between 2003 and 2012 published in the British Journal of Nutrition found that under-reporting of energy intake was most prevalent in US adults 20 years or older. Specifically likely to under-report were women and overweight or obese subjects.1 The reality that under-reporting, conscious or subconscious, can happen in any subjective food recording process leads to questioning whether these types of apps are actually successful in their dietary tracking abilities, especially for overweight or obese people tracking their diets in attempts to lose weight. In a randomized control trial conducted at the Duke University Medical Center and published in Obesity, researchers found that overweight and obese young adults (18-35 years) were no more likely to lose weight using a smartphone app than the control group, who did not undergo any weight loss or health intervention.2 If we can reasonably determine that smartphone apps where one enters their food intake or receives social support don’t help the majority of overweight or obese people lose the weight they’re aiming to, how can this be improved? The latest technologies coming into play are image-assisted apps that allow users to submit photos of their meals then receive nutritional content based on the food and the portion size. Apps such as MealLogger allow the user to submit a photo of their meal, choose their portion size, and post the photo for others to view. While this form of social photo-sharing may skew users to acceptable portioning by social pressure, the user’s ability to choose their portion size still introduces under-reporting bias. Other apps rely on objective, but far broader, methods of extrapolating nutritional content from a food photo. Apps like MealSnap allow users to submit photos of their meal to have the MealSnap system “auto-magically detect the nutritional breakdown” of the meal, according to their Microsoft.com page. While this calorie estimate is likely rougher than one where users choose their portion, it is also objective and prevents under-reporting bias. Apps with more user input may fall victim to inaccuracies from under-reporting, while apps that avoid biased reporting may sacrifice accuracy for objectivity.  To correct this, future technologies must undoubtedly continue to move toward a goal of improved accuracy and usability. Likely, these technologies will move toward advanced imaging, as imaging, finding ways to take in the real food, rather than relying on the user’s input.  The future of image-assisted food technology will determine how close inventors and researchers can get to exact measurement of food and portion while maintaining accurate extraction of nutritional content. I, for one, am excited to see where it leads.

1.Murakami K, Livingstone MBE. Prevalence and characteristics of misreporting of energy intake in US adults: NHANES 2003-2012. British Journal of Nutrition. 2015;114(8):1294-1303.
2.Svetkey LP, Batch BC, Lin PH, et al. Cell phone intervention for you (CITY): A randomized, controlled trial of behavioral weight loss intervention for young adults using mobile technology. Obesity. 2015;23(11):2133-2141.
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Is There a Best Calorie Counter?

By Brett Loman

Americans are more aware of what we are eating than ever before, but how we choose to track this information varies quite a lot. Some simply choose to eat more or less of a specific type of food while others record every single thing that they consume. In light of this, I decided to give a few programs a test run. I’ve rated them with 3 stars being the highest.

SuperTracker **½ overall
(free online tool, part of the MyPlate website published by the USDA)
At first impression I was overwhelmed by the multitude of –initially- empty tables and graphs. Once I got into the swing of things, however, my concerns transformed into amusement.
Ease of Use – **
While only be accessed through a web browser, the mobile site is an apt adaptation of the desktop version. Searching for each food is simple enough, but things get cumbersome when selecting the number of units. There is a multitude of units to choose from (e.g. fluid ounces, grams, slices, etc) but the number of those units is limited to a select few choices in a drop down menu.
Foods Available – **
Only some name brands and restaurants are available as choices. However, I could build the majority of complex foods using the basic selections that were available.
Nutrient Information ***
I was surprised by how much detailed information this program offers. Nearly every macronutrient, vitamin, and mineral was addressed in the “Nutrients Report”. This report offers target and average intake side-by-side plus expandable menus that explain which foods contributed (and by what percentage) to that nutrient’s intake.
Recommendation Information – ***
This is where the graphics are exceptionally helpful. They compare my intake to recommendations on the basis of food groups (broken down into things such as refined versus whole grains), empty calories, and individual nutrients.

MyDietAnalysis **overall
(subscription-based website provided by Pearson)
It happens to be the tracker utilized by my university’s introductory nutrition course, so naturally I had to give it a try.
Ease of Use – *
It is only available through a web browser, and the mobile site was not very user-friendly. Commonly chosen foods were under a completely separate menu unhelpfully named “Fast Entry” and only 7 days of intake could be store at one time.
Foods Available – ***
This program has the most specific food items I have seen in a tracker program. Most of the major chain restaurant and grocery brands are represented, cutting out the guesswork involved when building an item from scratch.
Nutrient Information – **
They come awfully close to matching SuperTracker in this respect, but MyDietAnalysis falls short since nearly the same information is presented… on several different pages.
Recommendation Information – **
The “Actual Intakes –vs- Recommended Intakes” report shows you just that for all of the nutrients side-by-side. The bar graph is a nice touch, but the scale for percent of goal met could use a little help, given that I didn’t even realize that it was there at first.

MyFitnessPal *½ overall
(free website and mobile application)
Definitely the app most-mentioned by patients and friends who claim to track their eating habits, tempting me to give it a go.
Ease of Use – ***
By far the greatest strength of this program is its availability as a mobile app. Eating lunch out? Just whip out your phone and track it on the spot. Another handy feature puts the foods you eat most often in a checklist immediately under the search box.
Foods Available – *
What I see as both a major weakness and strength of this app is the ability of any user to create foods, which can then be shared community wide. Sure, it’s great for the company, but the problem lies in the room for inaccuracies and errors.
Nutrient Information – *
Disappointingly, only nutrients routinely found on the nutrition facts panel were available. Again accuracy depends upon who actually entered the food into the database.
Recommendations Information – *
Only 6 of the nutrients could be displayed on my homepage at a time, and the printable report doesn’t even include all nutrients available, nor any averages of my intake compared to recommendations.

Final Thoughts
So are any of these inaccuracies, shortcomings, or lack of information harmful? I’d say probably not. The important thing here is that any of these tools can get people aware of what they are eating so that healthy changes can be made. With that I say happy tracking and please discuss in the comment section below.