User Beware: Quantify Your Health at Your Own Risk

When it comes to healthcare, “there’s an app for that.”

Tracking and quantifying our habits and physical responses, or health tracking, is everywhere. Fitness tracker apps come preinstalled on our phones. If you want a calorie-counting app, there’s roughly a zillion to choose from. Even continuous glucose monitoring is available to people without diabetes. It’s made tracking our health easier and more accessible to more people. But what might be the unintended consequences of that?  

A recent article about the personalized nutrition service app Zoe discussed how otherwise healthy people without previous patterns or struggles with disordered eating or disruptive thoughts about food can become obsessed with food, nutrition, and diet. Continuous blood glucose monitoring for people without diabetes is becoming quite popular, with limited evidence for its positive impact on health. Finally, fitness tracker/calorie counting apps may be associated with initiating disordered eating and eating disorders (EDs). Strava has made physical activity into a competition and social media platform where friends and acquaintances can follow each other and compare activities, times, heart rates, etc. While we’re far from definitive conclusions in these areas, it’s also important to consider the potential side effects of the constant quantification of health data.

Unintended Consequences of Health Tracking

The association between nutrition service apps, physical activity trackers, and calorie counters with disordered eating and eating disorders seems obvious. So, if that’s the case, then perhaps those with a history of disordered eating or eating disorders (ED) [1] shouldn’t participate in those activities and apps, right? Problem solved!

But what about those who have no history of disordered eating or EDs but are beginning to obsess over their diet, calories, and physical activity? Again, limited preliminary evidence suggests it’s possible, and if so, that’s a problem. Bombarding ourselves with so much data readily available and at our fingertips may inspire us to walk after being at a desk all day (good!) or find us checking our phone after every step taken and mouthful of food swallowed (bad!).

Health tracking that creates health problems (e.g., EDs, obsessive thoughts, etc.) is counterproductive. Beyond the potential obsession with health numbers, these movements can occasionally work their way into the general public. Think about social media. It has significantly changed the way we interact. Sure, social media has good sides—staying connected to our loved ones who are spread far and wide is the biggest advantage. Posts on Instagram, Facebook, TikTok, etc., are conversation pieces in everyday life. The downside is the damage that social media can, has, and continues to do to young people and society in general. This is especially true for self-image, self-esteem, anxiety, and depression. For example, a randomized controlled trial examined the effects of reducing social media use and its impact on participants’ appearance and weight esteem. Among the 220 participants aged 17 to 25, those in the intervention group (i.e., the arm with reduced social media use) saw improvements in their appearance and weight esteem compared with the control group just by reducing their social media use!

People often internalize what is shared on social media regardless of the quality or accuracy of content and may make decisions, value judgments, and base their actions on it. We are aware of these dangers and have seen their consequences firsthand, yet despite all of this, everyone still uses it. This seems like a cautionary tale directly applicable to health tracking.

I mentioned Strava earlier, which is social media for physical activity. I also discussed the harm social media can and has had on self-image, self-esteem, anxiety, and depression. Those concepts are also heavily involved in health and health tracking. No, I cannot say that a social media platform geared towards fitness junkies directly causes harm to self-image, self-esteem, and increased anxiety and depression. But it does beg the question: should that be on our radar? People share their workouts, diets, and meals through social media. It’s not a stretch to assume that people will also continue to share personal health information from their fitness trackers, specialized nutrition programs, continuous glucose monitors, and more. What will that do to our body image, self-esteem, diets, and eating habits, especially considering how social media impacts what people represent (i.e., carefully curated versions of ourselves)?

Is Knowledge the Right Kind of Power?

We should plan for when the use of these applications becomes ubiquitous. Becoming obsessed with the numbers and allowing them to drive our choices may have other unintended consequences above and beyond personal health. When people become obsessed with a particular topic, they often integrate it into their identity and values system. It’s not a stretch to imagine people equating moral judgments of others with their health numbers. “Oh, she ONLY averages 9,000 steps a day. I just don’t think she’s trying hard enough.” “He averages 3,000 calories per day and eats a lot of carbs. He would look better if he cut back.” These biases already exist, but tying numbers to them may increase discrimination and may equate these health numbers to morals, moralizing, and people’s perceived value. That’s a scary thought.

I don’t mean to seem like Chicken Little, as I certainly don’t think the sky is falling because of health tracking. But I do think it’s important to consider both the good and the potential bad. Scientists are trained to consider how their work may be misused or abused. Same idea here. Anticipating potential problems is vital for all new research, lines of inquiry, and products. What if we’d discussed the potential drawbacks of social media upon Facebook’s debut? Again, I can’t say for sure, but I think it’s worth having the conversation now.

While the general adage, “knowledge is power,” is true in healthcare, there may be limits, especially as we continue to outrun ourselves technologically before we understand the impacts of these new technologies. In the meantime, I say go for it if you want to track your health information. Just maybe don’t share it on socials. And definitely don’t judge your friends (or others) by their numbers. Oh, and don’t become obsessed. Proceed with caution for the sake of everyone’s health and good time.

[1] According to the Academy of Nutrition and Dietetics, “Disordered eating is used to describe a range of irregular eating behaviors that may or may not warrant a diagnosis of a specific eating disorder. Eating disorders, such as anorexia nervosa or bulimia nervosa, are diagnosed according to specific and narrow criteria. This excludes a majority of people suffering with disordered eating.”