P31 Management of Disordered Eating Behavior Risk in Clients Varies Among Outpatient Dietitians: A Qualitative Thematic Analysis


      Sixty-two percent of dietitians recommend nutrition apps to patients, with calorie-tracking apps the most popular. While previous research has indicated common characteristics of nutrition app users, little is understood about how client characteristics impact dietitians’ decisions about recommending apps. Addressing this relationship would provide guidance for dietitians to make evidence-based practice decisions regarding which clients would benefit.


      To explore the role of client characteristics in outpatient dietitians’ decisions to recommend apps.

      Study Design, Setting, Participants

      Twenty- to 60-minute semi-structured interviews conducted by phone, videoconferencing, or in-person from November 2019 to July 2020 with U.S. outpatient dietitians (n = 20).

      Measurable Outcome/Analysis

      Interviews investigated dietitian experiences surrounding their app decision-making process, including the client-, app-, and practice-related factors involved. Two coders conducted a qualitative thematic analysis of the client-related factors.


      Dietitians years in practice ranged from 2 to 42 year and they identified weight management and diabetes as top counseling topics. We identified 3 client-related themes: motivation, tech/health literacy, and disordered eating behaviors. While clients’ motivation and literacy level may impact the dietitian's decision, the presence of disordered eating behaviors more consistently impacted these decisions, leading dietitians to avoid or carefully select apps for clients, especially calorie-tracking apps. Many participants perceived that apps would benefit or harm clients based on a nuanced set of characteristics, such as being numbers-oriented vs obsessive. Several participants reported they avoided the use of calorie-tracking apps for all clients, including those without concerning characteristics or behaviors, due to worries that their use would increase risk of developing disordered eating behaviors.


      While several client features influenced dietitians’ app decisions, disordered eating behaviors appeared to be the most consistent characteristic leading to avoidance or adjusted use. Despite this consistency, dietitians differed regarding whether apps promote these behaviors in all clients. Further research to understand this relationship is needed to guide dietitians and app design.
      Funding None.

      Appendix. Supplementary data