Water
A hydration counter the patient taps themselves, against a daily goal you set. The clinically interesting reading is usually the high one, not the low one.
The patient's food log carries a small water bar at the top: minus, a row of droplets that fill in as they drink, plus, and the count. They tap it themselves. You set the goal the droplets fill toward, and you see the result on their Water card on the patient overview.
It defaults to 8 cups, and unlike most of Pippa's numeric features it is on for everyone rather than off by default.
Here is the bar as the patient sees it, part-way through a day on the default eight-cup goal:
It sits in the food log's header next to the close button, so it is reachable from the camera, the write pane and the check-in without navigating anywhere. Long-pressing the count explains the unit ("cups of water today, out of the 8 your care team suggests"), since 7/8 on its own is a riddle.
Clients can change the app's color scheme, so screenshots here may not match what is on the phone in front of you. See Colors.
Why water is allowed to be a plain number
Pippa hides almost every number from the patient. Water is the exception, deliberately: cups of water carry no calorie or weight meaning, so counting them doesn't do what counting food does. A patient can see "6/8" without it becoming a verdict on their day.
The risk with hydration runs the other way, and it is the thing this card is really for.
Drinking to excess to blunt hunger, to feel full instead of eating, or to move the number at a weigh-in is a recognised behavior in eating disorders, and it carries real medical risk of its own (hyponatremia). A hydration tracker that celebrated "more" would be cheering it on. Pippa's does not, and the dashboard treats a sustained high count as something to ask about rather than something to praise.
What the patient's side never does
Worth knowing precisely, because it shapes how you raise this in session:
- Going over the goal doesn't escalate. The bar stops at full, no further droplets fill, and nothing congratulates them. The count keeps climbing; the celebration does not.
- Being under the goal is never a failure state. No red, no "behind," no streak to break. The unfilled part of the bar is just the part of the day that hasn't happened yet.
- The app never tells the patient their intake looks high. This is the important one. Flagging it in-app would teach them to log less rather than drink less, and you would lose the signal entirely. It surfaces to you, and only to you.
The card
The Water card on the patient overview shows the last 14 days as a bar strip, plus their average on the days they logged. Filled bars reached the goal. Bars past the loading threshold render in the warning color rather than simply taller, so "more" never reads as "better" at a glance.
Set the daily goal here, anywhere from 4 to 14 cups. It syncs to the app immediately; the droplet row redraws to match, one droplet per cup, so the row itself shows the target without the patient reading a number.
The two concerns
Hydration feeds the concern model in both directions, and they are ranked differently on purpose.
| Signal | Tier | Reads as |
|---|---|---|
| Any single day at or above 20 cups (~4.7 L) | High, Critical alongside purging or a high skip rate | Acute water loading |
| 3+ days at or above 15 cups (~3.5 L) | Medium, rising to High past 5 days or alongside restriction | Water loading |
| 3+ days at or under 2 cups (~0.5 L) | Medium, rising to High alongside meal restriction | Fluid restriction |
| 5+ days at or under 4 cups (~1 L) | Low (informational) | Intake drifting down |
| Both directions in the same window | High | Swinging, often around weigh-ins |
The thresholds are absolute volumes, not multiples of the goal. A goal-relative rule silently disabled itself: at a 14-cup goal it needed 28 cups before flagging, which is nearly the app's own 30-cup daily clamp, so loading became undetectable exactly where the goal was highest.
Fluid restriction is not a lesser signal than loading. It is an ED behaviour in its own right — often to avoid perceived calories or fullness — and it also masks findings, since dehydration can normalise haemoglobin, urea and creatinine and hide anemia or renal impairment. It sits on the MEED risk ladder in its own right. Earlier versions of this page described low intake as merely "self-care dropping off"; that was wrong.
The high signal outranks the low one because it is a behavior, not a lapse. The low signal is worth noticing next to restriction, since under-hydration compounds its medical risk and often tracks with self-care generally falling away, but it is not an alarm.
Raising it in session
Because the app stays silent about high intake, this is a conversation you have to start. It usually lands better as curiosity about fullness than as a challenge about water: "I noticed you've been drinking a lot of water this week. How has hunger been feeling around meals?" gets further than naming the behavior, which tends to produce a defence rather than an answer.
Family supporters do not see hydration at all. The loading signal needs clinical framing, and a parent reading it raw is more likely to police than to help.