Joanna Strober's 11-year-old son had a weight problem. Looking for advice and specific weight-loss tools, she took her son to see his pediatrician, who didn't offer much besides "exercise more, eat less," Strober said.
"It's really hard to know what to do when the doctor tells you that," the Los Altos Hills mother said.
She looked into other options to help her son be healthier. There was the Stanford Pediatric Weight Control Program, a six-month-long behavioral and educational program that Strober referred to as the gold standard for children's weight loss. But it comes with a $3,500 price tag (though financial assistance is available) and its success -- since 1999, more than 80 percent of the children have achieved "age-appropriate weight reduction" -- is based on active, in-person participation. Groups of children ages 8 to 18 and their families are required to be on campus weekly for two-hour meetings, which is logistically challenging for many parents, including Strober.
But talking to Stanford staff and doing some research on weight-loss apps, Strober realized that the program's gold-standard practices could be translated into a more accessible platform that reaches kids and parents where they are. With a background in venture capital, she did what any other Silicon Valley mother would do: She founded an app company she named Kurbo.
The company, made up of a 10-member team that works out of a downtown Palo Alto house, licensed Stanford's program and turned it into a mobile version offered to 8- to 18-year-olds and their parents at no charge. The main feature of the app is a meal-tracking system: Users log what they're eating throughout the day, and the app lets them know how they're doing using a "traffic light" system. Red foods are deep-fried items, fats, sugars and carbs. Greens are fruits and vegetables; yellow is everything else, to be eaten in moderation.
When Kurbo users log what they had for breakfast -- perhaps two eggs and whole-wheat toast with butter -- the app will let them know how many red foods they can eat the rest of the day. Kid-friendly games teach about what foods fall into which traffic-light category and why; videos offer information on topics like portion size, exercise and budgeting.
"The best thing you can do for weight loss, period, is to track what you eat," Strober said. "If you pay more attention to what you eat, you're more likely to lose weight."
This doesn't mean counting calories so much as learning about what is in the food in order to establish a healthier, long-term lifestyle.
It's also about choice. Kurbo doesn't tell users what red foods they can or can't eat; that's up to them.
The app's second defining feature is a coach who serves as a third-party (read: non-parent) support system for the kids. Instead of weekly in-person meetings, the Kurbo coaches -- all of whom have established experience in children's health -- are available to both the children and parents via Skype, FaceTime, text or email at all times. Scheduled sessions usually take about 10 minutes and generally don't occur more than once a week. The coaches can view the foods and exercise time children have logged and help them to set personal goals around eating and exercise.
Esther Levy, a former elementary school teacher who worked at the Stanford pediatric program for four years before joining Kurbo as a coach, talks to kids when they get home after school, before they go to bed -- even while they're on vacation.
"It really reaches kids wherever they are and makes it as easy as possible to support them in losing weight or just being healthier," she said.
"We know that the third-party accountability is really important and taking the role of the food police away from the parents," said Strober, who said she struggled with that with her son.
"I was telling him what to eat, and I was creating a lot of problems," she said. "You're really scared (as a parent). It's not just the weight issue; it's the health issues; it's the emotional issues. There are a lot of things that happen for kids who are overweight."
Coaches aren't, however, free; consultations costs $75 per month. Strober said they plan to roll out a text-only coaching model soon that will cost less.
Kurbo coaches often serve as parents' support system, too. (One parent recently emailed Levy pictures of food labels while grocery shopping, unsure what was the most healthy choice.) But it's up to the child whether or not to allow parents to be able see the app. And after an initial session with the coach, children also choose if they want their parents to be present for future sessions.
Jordan Greene, a freshman at Carlmont High School in Belmont, said her coach helped motivate her to meet goals they set together and was someone with whom she could talk. She likes that the app is on her cell phone, and she has her coach's phone number so she can text her if she has a question or a need. (Greene's mother joked that she listens to her coach more than she does her own mother.)
And it's actually worked. Since starting with Kurbo in April, 14-year-old Greene has lost 30 pounds. She's learned about portion size for the first time with a helpful comparison: One serving is about the size of one's fist. Fond of dance, she wants to try out for her high school dance team and says she now feels less self-conscious.
Greene's mother, Michele Brenner, said her daughter's doctor suggested she try Weight Watchers a few years ago, but it wasn't the right model for someone that young. They knew about the Stanford program, but it just wasn't accessible, Brenner said, and there weren't any other programs out there for someone of her daughter's age.
But, Brenner said, it's not just that Kurbo is easy, free and accessible. The feature that sets the app apart, said Brenner and other users, is the fact that it puts the entire process -- the tracking, the education, the goal-setting, the accountability -- in the hands of the child.
"It put her in the driver's seat," Brenner said. "She was doing it because she was self-motivated to do it, not because it came from me."
Putting kids in charge of their weight loss is an approach Kurbo replicated from the Stanford program. Sam Feldman, a sophomore at Kehillah Jewish High School in Palo Alto, participated in Stanford's program when he was 9 years old and 50 pounds overweight. He joined the Kurbo team this summer as an intern, testing out the app and advising on what worked or what didn't work for him at Stanford. (Along with a youth advisory board, a group of Lucile Packard Children's Hospital pediatricians, psychologists and well-known tech experts helped develop the app and continue to provide guidance.)
Feldman -- now a slim, healthful, confident young man who plays three sports -- clearly found success through Stanford's program, and it went beyond just losing weight.
"It really changed who I was in all aspects. I didn't just lose weight," he said. "I feel like I can really accomplish anything because I saw who I was before and who I am now, and it really gives me the confidence to do anything."
Feldman was at first skeptical that a mobile app with nowhere near the same level of in-person instruction could produce such results. (Plus, it ran counter to the idea that kids who need to lose weight should be spending less time on their screens and more time outside exercising.)
But, he said, the more he thought about it, the convenience and affordability of a mobile version of Stanford's approach made sense. Instead of carrying around a journal to log what you're eating, you can pull your phone out and take a picture or make a note on the app. Kurbo coaches are available through numerous mediums at all times. He saw beta users testing the app lose 15 pounds and more.
Since launching to the public in August, thousands of people across the country have downloaded Kurbo, and coaches currently work with about 100 users, Strober said. More than 80 percent of users have reduced their Body Mass Index (BMI), a standard measure of body fat based on height and weight.
"When the kids start feeling like they're empowered to make changes, it's really cool," Strober said. "When they have a tool that helps them and then they have someone else who cares about them talking to them -- that combination, we found, is really powerful."