Living the quantified self: the realities of self-tracking for health

The end of 2012 and the dawning of a new year brought with it a multitude of news reports and blogs on the phenomenon of the quantified self or using self-tracking tools for health promoting purposes. Much hype has been generated around ‘digital health’ or ‘mHealth’ technologies, or mobile digital devices such as smartphones and wearable materials with embedded sensors that are able to connect to device apps or websites and download the data collected. These technologies include thousands of health-related apps for smartphones, tablet computers and iPods that can keep track of the user’s food and alcohol consumption, physical activity, body weight, ovulation cycle, stress levels, mood, sexual activity and many other physical functions and habits. It has been argued that by using such apps the smartphone can become a ‘”soulmate device” that knows your body better than you know it yourself’.

There are also an increasing number of specifically designed devices such as the Fitbit, Jawbone’s Up, Nike Fuelband and Zeo headband and various brands of adhesive patches that are available for self-tracking. All of these are designed to be worn upon the body to automatically collect data on bodily functions such as physical activity, pulse, heart rate, body temperature, calories burned and sleep patterns. Some can be worn 24 hours a day to provide constant readings of biometrics. Digital body weight scales, blood oxygen saturation monitors and blood pressure monitors that link to smartphones are also on the market. To motivate users, some devices include ‘gamification’ strategies. These use built-in reward or docking systems so that points or real money can be collected or paid if various commitments (to regular exercise or weight loss goals, for example) are either met or unmet, as well as websites where one’s metrics can be compared competitively against those uploaded by other users.

Nike+ FuelBand (Photo credit: LoKan Sardari)

The combination of New Year resolutions season, predictions for digital innovation in 2013 and the reporting of the new technologies that were showcased at the 2013 Consumer Electronics Show in Las Vegas has contributed to the recent intensified focus on self-tracking for health reasons. Self-tracking mobile devices, apps and gadgets were reported as the new way of ensuring resolutions to lose weight or engage in more exercise would be accomplished (see here and here). They were frequently mentioned in lists of trends to watch in digital health technologies in 2013 (see here and here). Weird and wonderful devices such as self-tracking devices for dogs to wear to monitor their exercise levels, smartphones that could detect bad breath and other odours and a ‘smart fork’ embedded with sensors that could warn people they were eating too fast all received media attention in the early days of 2013.

I have written elsewhere about the ways in which self-tracking for health and the quantified self movement may be theorised sociologically, drawing attention to some of the ethical, moral and political issues (see here and here for previous blog posts on the topic and here for a lengthy academic article). Little academic research has yet been published on how people are taking up this approach to health promotion as part of their everyday lives. But accounts are beginning to appear in news stories and blog posts that have begun to explore the lived experience of self-tracking.

On the positive side, several self-trackers have reported that they feel more in control of their health using digital devices and have argued that there are many benefits to quantifying the self. Many people have discovered that tracking of their food intake and body weight has allowed them to achieve weight-loss goals. One success story is that of Dan Hon, who has type 2 diabetes and uses the Nike Fuelband and the Fitbit to monitor his physical activity levels as well as a digital blood glucose meter and weight scales. He reported that the combination of these technologies had allowed him to reduce his blood sugar levels to normal and that he had ‘healed myself through data’ (see here for his story). Another user experiencing problems with sleep used a Zeo headband to track his sleep patterns and experimented with taking magnesium supplements, giving up caffeine and changing the lighting in his room to see which of these factors affected his sleep. Using the data downloaded from the headband he eventually worked out how to best achieve a good night’s sleep. Other people with a diverse range of health problems have used self-tracking devices to monitor medical treatments for acute diseases or chronic conditions, evaluate the moods created by eating certain foods, track their alcohol consumption  and many more aspects of their bodily functions, health and illness states. Patients have also been able to ‘crowdsource’ the data they have collected on websites such as PatientsLikeMe and CureTogether, allowing the massing of data for a better understanding of what treatments are effective (see here and here for overviews).

Image via CrunchBase

Also beginning to emerge are accounts by people who have tried self-tracking for health reasons but have become disenchanted with the practice. As these stories demonstrate, the realities of quantifying the self do not always meet expectations. The devices do not share data with each other, so it is impossible to track different activities using more than one device and then produce statistics that combine the data collected. Some users find them inconvenient or uncomfortable to wear. Some people quickly become bored with the effort involved in self-tracking. It has been reported that the devices are often not compatible with some types of smartphones.

Other users who have tried self-tracking for health have suggested that the intense focus on the body that these devices encourage may place too much pressure on oneself, leading to feelings of failure and self-hatred. It has been argued that intense self-tracking may cause ‘cyberchondria’, leading to people becoming unduly anxious about their health state based on the data they collect. Devices may be used by people such as anorexics to facilitate health-destructive behaviours by engaging in too much obsessive self-tracking. Activities such as walking may become viewed through the lens of the self-tracking device rather than for the other pleasures they may bring, as one commentator wrote of his experiences using a Fitbit while visiting Paris. As he noted, ‘the data mind is hard to shake’, even while immersed in the sights and sounds of one of the most celebrated cities in the world.

Privacy issues are a concern as more and more data are collected by self-trackers. The manufacturers of self-tracking devices are beginning to approach workplaces as a site for encouraging people to use them and compete against each other. There are concerns that people may feel pressured into using them to meet employers’ expectations and that employers may use the data. Other critics have questioned what may happen if health insurance companies begin to expect their clients to use the devices if they wish to avoid higher premiums (see here for an account of these issues). The quality and efficacy of health apps and their potential for harming rather than promoting users’ health have also been questioned, given that they are currently not regulated (see here).

Using digital devices to self-track for health reasons is a very new phenomenon. While stories such as those referred to above are beginning to identify both positive and negative dimensions, it is a practice that still requires much more investigation and analysis in the face of all the hype.