Recently I bought a modern weight scale that is able to measure body fluids, muscle- and fat percentages and share it with my phone to track these metrics. I have always felt confident about my body and I was curious about what my data would be. The next day I weighed myself. The scale first indicated my weight, the same as it always indicated, and then the fluid, muscle and fat balance. The data was directly visible on my phone. The app indicated that I had too much fat mass and too little muscle. I realised that this may be true since I never really exercise, but because of this insight, I started to feel unsure about myself. The app even gave me the recommendation to walk 10 000 steps a day to become more healthy. Suddenly, I was not as happy and confident about my body as I used to be. Shortly afterwards I realised how bizarre this is: before I weighed myself, I felt good and after seeing my data I felt negative about my body, when in fact nothing physically changed.
In this personal experience, I found out that data provided by apps can influence how we feel about our bodies. Maybe, you as a reader have had a similar experience, for example with a smartwatch or an activity/sleep tracker on your phone. If you would not have seen the data, your feelings would not have been negatively impacted. However, with the rise and use of health and tracking apps, these metrics are constantly collected and visualised. This makes it hard to prevent getting confronted with data about your body. Although these data and health apps strive to make us physically healthier, they could have the reverse effect on our mental wellbeing. Currently, there is a record-breaking increase in people dealing with mental problems, which is partly fueled by the corona pandemic. This is reinforced by the growing use of AI (e.g. social media usage). These are two factors that will not disappear for some time.
Do the numbers tell the tale?
With the rise of artificial intelligence (AI) in our society, more and more apps are being developed, including health and tracking apps. In the USA 64% of adults use a health or activity tracking app to measure the number of steps, blood pressure, sleep analytics and heartbeat metrics, to name a few. These apps promise to increase physical activity, personalise (medical) advice and prevent diseases. AI makes it possible to generate personalised strategies by monitoring all kinds of metrics of the user. This in turn leads to personalised recommendations intended to change the behaviour of the users. The goal of such an app is to make users aware of their health and lifestyle. This allows the user to map, evaluate and compare different facets of their lifestyle with others.
The effects of health and activity tracking apps are effective. They have proven to increase the physical health of their users. In general, most people exercise too little and fail to reach the guidelines for exercising. A wearable fitness tracker motivates by providing insights into how much we exercise and in which patterns. Besides activity tracking apps, there are apps available to register nutrition intake to increase awareness of a healthier lifestyle. The intention of health and tracking apps are substantially grounded, however, what are the unintended side effects? What does constantly measuring your physical activity and notifying health parameters do to your mental wellbeing? By making everything measurable it becomes very clear whether or not we reach our goals. Being constantly aware of these metrics can result in unnecessary feelings of stress and frustration. Research from the University of California shows that keeping track of exercises and daily activities does not necessarily contribute to reaching the goals. Two hundred women participated in a research where they wore a Fitbit activity tracker. Of these women, 68% indicated that the activity tracker contributed to reaching their goals of a healthier lifestyle. However, when the researchers asked how they felt, 79% shared that they felt pressure to reach their daily targets and 59% felt that their daily routines were controlled by Fitbit. Moreover, 30% felt that Fitbit was an enemy and made them feel guilty when they didn’t reach their targets. So the health apps are proven to be physically effective for the majority, nonetheless, they come with negative psychological side effects for most.
The benefit of personalised advice is breaking down the user’s targets into achievable subgoals. This creates motivation to achieve these goals. However, people can go overboard with the use of a health app and activity trackers. Being successful in reaching goals can have the feedback loop of constantly setting higher goals that require more and more commitment to obtain. This can result in going beyond limits. Such apps can push someone to train harder and, for example, restrict their food intake. This could lead to a reverse effect on one’s health. Evidence shows that activity trackers trigger, maintain or exacerbate eating disorder symptomatology. In such situations, these wearable devices might do more harm than good.
Most health and tracking apps lack any scientific backing
Over the last decade, the usage of health and activity tracking apps has grown exponentially and is expected to continue on this growth path. This is shown by the number of users and the revenues the global mobile health market makes. The revenue generated by health apps is expected to multiply three-fold from the year 2021 to 2025 to a total value of over 300 billion USD.
Hence, developing health and tracking apps is a huge business, resulting in different app stores filled with ten-thousand health and tracking apps. However, a large proportion of these apps lack a scientific background. Rathenau Institute investigates that there are large differences in the quality of the current offer of these health apps. One problem is that the line between health apps and medical apps (for which certification is required) is blurring, which leads to the development of health damage. Most users of these apps are not aware of the fact that many health apps behave like medical apps, but without a licence. Since May 2020 there are stricter standards that these apps have to meet, to provide safer and more reliable usage. However, the apps that already have been developed before this date do not yet have this proof and are still being used. Therefore it is important to be aware and not fully rely on the health app that is developed before May 2020.
The grass is always greener on the other side of the fence
Let’s have a closer look into a health/tracking app and the way it works, for example, Strava. Strava is a workout app that has seen enormous growth over the past decade, now reaching a total of 3 billion tracked activities.
“Turn any workout into a virtual race, whether it’s against yourself, your friends or the world’s best athletes.”Quote Strava
Strava aims to build a worldwide community of athletes, by sharing their physical activities. They bring this virtual race as a positive trait. However, how does constantly competing with others affect your mental wellbeing in the long run?
My roommate started using this app as she is quite competitive in everything she does. She tracks her weekly run to see how she is performing. She can see her split times, total time, total distance covered, calories burned and even compare between different runs. After her last run, she told me: “I had the feeling that my run went well, but when I looked at my split times I realised that I did not reach the times I did in the last few weeks.” She went home feeling unsatisfied with her run and with herself. After our conversation, I realised that we are constantly comparing our previous results with the desire to improve every workout. On the one hand, this has a positive effect because you will strive to improve yourself. On the other hand, it could cause feelings of sadness and dissatisfaction when we were not able to improve on last time, despite the positive effort of working out.
Besides the comparison with yourself, activity tracking apps like Strava or Runkeeper highly encourage sharing your workouts and interacting with the workouts of others. Whether it is your friends, family, colleagues, or professional athletes. Later that day my roommate came back to me with the following story: “So when I arrived at my field hockey practice afterwards, a teammate asked if I had been doing my weekly run because she did not see my post. I saw that my teammate just improved her personal best split times. I didn’t post my run because I was not satisfied with my results. So I decided to tell my teammate that I wasn’t able to run because I was too busy.”. She had created a mixed feeling of guilt, jealousy, and an increased stress level as she certainly needed to perform next week to make up for this “failure”.
It turns out that tracking apps have a particularly positive experience for users with a low risk of negative psychological effects. People who use self-tracking apps can experience negative feelings of dependency, pressure and guilt. If you have a low risk for negative psychological effects this could result in better performance. However, if you have a high risk of negative psychological effects the usage of self-tracking apps could lead to experiencing negative feelings and cause anxiety or frustration. It is important that we are aware of individual differences in how people act on these devices. The trick is to protect the high-risk group of these treats.
While these activity tracking apps started with the intention to track and analyse data about the activity itself, their influence has grown as it has been fully integrated into social media now. They encourage you to post your workout on social media and generate positive affirmative interaction (i.e. praise and public approval) in your social circle. Sometimes this leads to behaviour where people only post successful workouts, ones where they improved themselves compared to last time. This results in an unfair comparison, where you can get the feeling that you are lacking, compared to the people you follow. On the other hand, the effect of social pressure plays a role as well. Some even have the feeling that a workout only counts if you post a picture or the results of an activity tracking app. What’s the point of working out if no one knows you’re doing it?
While the original intention is to motivate people to do their workouts, there is evidence that these apps often do not reach this promised effect. The negative psychological outcomes can manifest in two different kinds of behaviour. In the first place, feelings of guilt can motivate to do the activity more often, which is positive. However, one should be aware that the motivation does not become an obsession or addiction. A second effect of the negative feelings is a feedback loop of demotivation. Where demotivation and procrastination could lead to self-doubt. Someone unable to reach the recommended goals could be demotivated to even try again the next time.
Nevertheless, the intention of the app is good, the side effects might be harmful. The damaging behaviour that such apps stimulate has not been the intention of the creators of the app, but the fact that it draws people back to the app over and over surely benefits them in terms of revenue. As most apps have a revenue model based on ads, the more people click, the better their business runs. Researchers found that apps like Strava, Nike+, MyFitnessPal, RunKeeper, and Fitocracy, are ‘gamified’ to provide rewards and encourage users to keep tracking their exercise. This is the whole idea behind their business model. Therefore it is not necessarily in the interest of the shareholders to change the effect their apps have, which is certainly worrisome.
The trick for a dose of dopamine
People seem to be very sensitive to these kinds of apps. But what is the underlying reason for this? The answer is that it is caused by dopamine. Dopamine is a neurotransmitter in the central nervous system and is considered the main pleasure centre of our brain. Dopamine is released when we experience a feeling of pleasure. This causes our body to repeat the behaviour that led to this pleasant feeling, increasing motivation and the desire for this feeling. Dopamine, therefore, ensures that we get a good feeling when performing a certain physical effort or taking certain foods as prescribed by the apps. And we all want to have a good feeling right? However, the danger of dopamine is that the level of dopamine you need to experience the same happy feeling keeps increasing. Too much dopamine can cause problems and is closely linked to addiction. This mechanism is the driving force of the game and application industries. They take advantage of the dopamine addiction. Nir Eyal explains that apps aim for users to reopen an app in their minds: you get a trigger inside, a tickle to open the app, caused by dopamine. Getting a Kudo on Strava, for example, or hitting 10 000 steps in a day creates a sense of reward and makes you feel good.
Besides that, Eyal points out that these apps and health trackers make clever use of notifications. These notifications inform you that there is a reward waiting for you. Receiving and cleaning up notifications results in a dopamine boost. This is exactly the goal of the app makers: to make it a habit for the users to open and use their apps every day. As dopamine triggers a feeling of happiness, people pursue things that give them this happiness, even when opening this app doesn’t benefit or value them anymore.
It is quite ironic that an app to improve one’s health gets developed based on the effects dopamine has on our behaviour since an excess of dopamine leads to addiction. Hence, apps to improve physical health could have the reverse effect on mental health. The fact that developers use dopamine as a motive is quite logical, as they simply try to generate revenue with their app. However, this has consequences for the mental health of its users. Therefore we must be aware of this gamification and use of notifications as a trick to lure us back to the app.
How to improve the negative effects?
I believe that the popularity and desire for health and tracking apps are largely driven by a lack of self-confidence and the desire to improve ourselves. We are constantly looking for evidence to make ourselves feel good. We validate this approval by the usage of data. For example, if I have accomplished my 10 000 steps, I can feel good about myself. If the app indicates that I did not eat too many carbohydrates, I am feeling well. If I have had enough hours of deep sleep, I can say that I had a good night’s sleep. As a result, we are training ourselves to learn to trust the data instead of trusting our feelings and intuition.
How do we remedy this continued search for external approval for our internal feelings? Let’s start with ourselves and focus on raising awareness of what data can do to our feelings. Every time before we open an app such as Runkeeper, Strava or a different health/activity app, let’s ask ourselves: how do I feel now? Then look at the data and ask the same question again, to see how our perspective has changed after observing the data. It would help to pause a moment to reflect on this. If we do so, we consciously work on improving self-confidence and allow our feelings to be relevant instead of only allowing us to feel positive after the data confirms we hit our targets. Besides that, learning to value our feelings more than the comparison with another individual could improve the feeling of self-worthiness.
More evidently, action needs to be taken on a larger scale. Awareness of the side effects these health and trackings apps could have and learning how to behave is an important point. There should be education lessons for children about the effects of AI on mental health. Attention must be paid to trusting yourself and learning to make your own choices. Besides that, there should be more guidelines on application development. It should not be possible for someone to publish an uncertified app that thousands of people download to monitor and maintain their health based upon that app.
I work in the field of AI and I think AI can offer potential in health improvements, for example, medical apps that track metrics for people with diabetes or heart problems. However, in the area of health and tracking apps, there is a huge side effect that has an impact on our mental being. We need to be more aware of this. Therefore, I have stopped using the majority of these kinds of health and tracking apps. The tickle to see how many steps I have taken in a day remains present, but I no longer base my choices on it. From my own experience, I know how sensitive I am to health and tracking apps. While being driven by apps, data has kept me busy for a long time but it did not bring much value. I had lost myself mentally. I learned to trust my feelings and not depend on my data or compare my data to the data of others. My motto is, therefore: “What I do not see, does not exist”. If I don’t know that the neighbour might run more often and is better than I am, it doesn’t exist for me either. As a result, I remain more positive about myself and I dare to rely more on my own choices.