The Pros and Cons of Fitness Tracking

I have an Apple watch now. This may be surprising to those of you who know me and know how tech-reluctant I am, but my daughter got a new one so I got her hand-me-down. My children impressed on me that, due to the fact that I have had knee surgery and I am 68, I am officially a “fall risk” and they would feel better if they knew I could call for help from the ground. So here we are.

I must admit that I am enjoying being able to know the time, date, and weather with just a glance at my wrist. The fitness tracker, however, has been an interesting experience. It initially set goals for me based on previous data about how active my phone had been while in my purse (since most clothes designed for women don’t have pockets.) This meant I was way overachieving on movement and exercise. I have to admit, it was a bit heady to get messages like “You’ve passed you move goal! That’s how it’s done,” or “Off to a great start. Keep crushing it. Your move and exercise rings are way ahead for this time of day,” or “Longest Move streak, your move streak now stands at 9 days in a row, keep it going.” I wasn’t doing anything differently; I’m usually pretty active but positive reinforcement is always nice. After about a month, I turned off the notifications but I still look at activity levels.

It did make me wonder how many people actually improve their physical movement in response to the prompts. We know from research that being sedentary is associated with poorer health measures. I’ve had several conversations about this and apparently there are people who benefit from being reminded to stand up and move around each hour, especially if they work at computers or play video games. I guess that a lot of folks are better at sitting still than I am.

When I work with individuals in therapy, especially when they have any history with disordered eating or body image concerns, I encourage them to find some kind of movement that is pleasurable and gives them joy. Too often, the term “exercise” has come to be associated with weight loss, with expiation for the “sin” of eating, or with punishment for being too large. Joyful movement may be a totally new concept.

How do fitness trackers fit into this notion? I took a look at the literature, especially as it concerns eating disorder symptoms. Hahn, et. al., (2021) used the term “quantified self” when talking about wearable technology. In their study with first year college students, they found a strong enough association between ED behaviors and the use of multiple tech-based weight related self-monitoring, including fitness trackers, that they suggest that assessing the use of such tech might be a simple way to screen for ED risk.

Simpson and Mazzeo (2017) found an association between fitness tracking and eating disorders. They expressed concern that the emphasis on numbers could reinforce the inflexible thinking that is often seen in individuals with ED and that tracking technology could equate exercise as a way to atone for transgressive intake.

In another study, Plateau et. al., (2018) pointed out that self-monitoring can be helpful in behavior change but that tracking intake and exercise may not be advantageous for everyone. The study found a relationship between self-monitoring and both disordered eating and compulsive exercise but cautions that it is not clear which came first.

Scheid and Lupien (2021) point out that it is possible for health tracking tech to worsen symptoms in those with preexisting eating psychopathology and that an inability to meet goals can have a negative impact on self-esteem.

Much of the literature about fitness trackers focuses on the role it can play in “successful” weight loss, although the studies cited rarely followed participants for more than six months when we know from other studies that weight regain happens for the majority of participants in any weight loss intervention by year three. Focusing on weight loss as a goal not only reinforces weight stigma, is also leads to people abandoning their health goals when the number on the scale does not drop. 

One of my concerns about fitness trackers is the possibility of reinforcing reliance on an external locus of control, much like dieting. In my book Thrive at Any Weight (p. 43-44) I describe it this way:

In the field of personality psychology, internal and external locus of con­trol refers to our beliefs about what we have control over and what is beyond our control. Do we attribute outcomes in our lives to our own behaviors or to outside influences? The concept is applied to many different circumstances and variables, but I am interested in how it applies to decisions about eating. 

Dieting is based on an external locus of control; essentially, it is the idea that I cannot make good decisions about what or how much to eat, so I have to have someone else tell me… Why am I not competent to make that choice? 

An external locus of control requires the belief that I am not capable of making those decisions—someone else will do a better job… 

An internal locus of control honors the body’s appetites and needs. It involves listening to the body’s signals. It requires asking questions: “Am I hungry? How hungry am I? What am I hungry for? Am I full yet? Does this food satisfy me? How do I feel after I eat it? When will I be ready to eat again?” Eating according to an internal locus of control involves asking these questions several times a day and deciding the best way to respond.

        Ideally, we would all make decisions about movement and activity based on how we feel and what we want. I find myself wondering what happens when folks start to depend on fitness trackers instead of their own judgement. In particular, I wonder about those with eating disorder symptoms who already don’t trust their own bodies or choices. Another concern is the way fitness trackers estimate the “calories burned” during activity, which is a measurement that is widespread in the fitness field, but equating exercise with food is a risky step on the slippery slope of diet culture. We need food and we need movement and they don’t cancel out each other.

        Having said all that, I must say that I am excited about the future of wearable technology. Wouldn’t it be wonderful if your watch could tell you if your chest pain is caused by heartburn (“Take an antiacid!”) or anxiety (Take some deep breaths!”) or a heart attack (“Call 911! Now!”) I hope that someone, somewhere, is working on wearable technology that will be considered Durable Medical Equipment, so that health insurance companies, Medicare, and Medicaid will cover it. It would be such a benefit for those with medical conditions, or are elderly or fall risks, or simply live alone and worry about slipping in the shower. Already, my Apple watch not only tells me my pulse, but also estimates my cardiorespiratory fitness, and can alert me if my heart rate is irregular or if my gait is uneven. What else is possible, especially if developers focus on well-being rather than weight loss?

Hahn SL, Sonneville KR, Kaciroti N, Eisenberg D, Bauer KW. Relationships between patterns of technology-based weight-related self-monitoring and eating disorder behaviors among first year university students. Eat Behav. 2021 Aug;42:101520. doi: 10.1016/j.eatbeh.2021.101520. Epub 2021 May 8. PMID: 33991833; PMCID: PMC8462031.

Plateau CR, Bone S, Lanning E, Meyer C. Monitoring eating and activity: Links with disordered eating, compulsive exercise, and general wellbeing among young adults. Int J Eat Disord. 2018 Nov;51(11):1270-1276. doi: 10.1002/eat.22966. Epub 2018 Dec 3. PMID: 30508261.

Scheid, Jennifer L. Ph.D., CSCS; Lupien, Shannon P. Ph.D. Fitness Watches and Nutrition Apps: Behavioral Benefits and Emerging Concerns, ACSM’s Health & Fitness Journal: 3/4 2021 – Volume 25 – Issue 2 – p 21-25

doi: 10.1249/FIT.0000000000000644

Simpson CC, Mazzeo SE. Calorie counting and fitness tracking technology: Associations with eating disorder symptomatology. Eat Behav. 2017 Aug;26:89-92. doi: 10.1016/j.eatbeh.2017.02.002. Epub 2017 Feb 9. PMID: 28214452.