JMIR Publications

ABSTRACT

Background:

With the number of young people presenting with early-stage eating disorders on the rise, and current support services unable to meet increasing demand, digital tools offer a promising alternative. They have the potential to reduce waiting lists, enable early intervention, and help prevent the worsening of symptoms - minimising the psychological, physical and economic burden of prolonged illness.

Objective:

This paper presents a case study of five individuals aged 19 to 25 who used the Worth Warrior app over a 7-week period. The app is based on Cognitive Behavioural Therapy principles for eating disorders and was designed to help young people manage negative body image, low self-worth, and related early-stage eating difficulties. This report explores both participants’ experiences and changes in clinical symptoms and self-esteem over the course of using the app.

Methods:

An uncontrolled pre- and post-follow-up design was used over three study phases: baseline, post-app familiarisation, and follow-up. Eligible participants were aged 17–25, with low self-esteem and early-stage eating disorder symptoms, and not receiving treatment or using other mental health interventions. A community sample was recruited through online advertisements, social media, and relevant websites. Standardised self-report tools were completed at each stage, including the Eating Disorder Examination Questionnaire (EDE-Q) and Rosenberg Self-Esteem Scale. Feedback on usability, accessibility, and safety of the app was also gathered. Case reports were written for the five participants who completed all phases.

Results:

Participants’ individual experiences with the intervention are discussed. At baseline, four participants scored above the clinical threshold for eating disorders; the fifth scored above the non-clinical population mean. All five reported moderately- to extremely-low self-esteem. By follow-up, three participants scored below the clinical threshold for eating disorders, two of whom scored above-threshold at baseline, and four participants showed improved self-esteem. Eating and weight concerns declined in four participants, while restraint, shape concern, and eating-disorder-related behaviours decreased in three. The app was positively rated for usability, acceptability, and safety. Interactive features aimed at changing self-perceptions and the journal function were particularly valued. Reported dislikes included a lack of reminders or incentives to encourage regular use and discomfort in practising self-compliments; one participant reported no dislikes. By follow-up, three participants had ceased engaging in at least one previously-reported eating-disorder-related behaviour, and two said the app had prompted them to seek support.

Conclusions:

These cases highlight the Worth Warrior app’s potential to support young people with early-stage eating disorders and suggest that the app has the potential to be an effective, safe, acceptable, and scalable digital intervention. While findings cannot be generalised, they provide an encouraging foundation for future research and broader implementation.