Diving into other people’s data:
The evolving relationship between bodies, data, and public health
This month’s issue of the European Journal of Cultural Studies has an article exploring individual agency and self-tracking devices, starting with exploring our relationship to our bathroom scales and moving forward in time to the fitness bands that are so popular today. Authors Kate Crawford, Jessa Lingel, and Tero Karppi then place the challenges faced by owners of these devices within the context of control, access, and interpretation of personal data.
The idea that self-tracking leads to self-knowledge started in the 1920s, when the weight scale was popularized and mass-marketed for individual use. Actually, the original scales (called ‘penny scales’) were designed to be used in public places, where people would pay a penny to be weighed. In order to make a profit, scale owners had to convince people to return and weigh themselves often, so marketing strategies centered on self-knowledge through frequent weighing. The number on the scale started to represent the self, an association that continues to this day. Value and self-worth are twisted together with that number; fat-shaming and stigma occur as a result.
Since I research self-weighing as a possible intervention for controlling weight, and am also a strongly invested on decreasing the fat-stigma included in our current intervention models for reducing obesity, I read the article by Crawford and colleagues with some interest. Here I focus on the following points:
Self-worth and the number on the scale
The social and economic forces that drive global weight gain are extremely powerful and difficult to counteract. If it were easy, we wouldn’t be in a situation where there is no country in the world where average adult BMI isn’t increasing. That’s right. Everywhere, BMIs are going up.
My mission is to make a contribution to the nutrition field by changing the way that we think about –and treat—obesity. The way I do this is by studying interventions that enable people’s agency, particularly those groups where power is so fragile to begin with, like in children. And frequent self-weighing, as paradoxical as it sounds, is one promising strategy that might work in this way.
When I was in school I was taught never, ever focus on the ‘number’. The ‘number’ constrains a person’s agency by causing needless psychological distress. Seeing natural weight fluctuations discourages people; they lose sight of the bigger picture and give up. I was taught that telling children to weigh themselves every day is out of the question; you would be setting them up for an eating disorder. The number on the scale is that powerful.
Yet research on people who self-weigh daily or weekly shows the opposite; people who frequently self-weigh tend to feel better about themselves. We don’t definitively know why this is; the studies that have been published are small, the weight was self-reported, and in many studies the people actually lost weight (which may have been the real reason for their self-confidence increase, not the frequent weighing).
But I’m very interested in pursuing this further. Because we place WAY too much value on a number that is affected by too many hidden factors out of our control right now. And if self-weighing increases the power a person holds over that number, then as clinicians we should tell it like it is.
So we have two issues here:
The idea of frequent weighing originated from companies trying to earn bigger profits; in this way people were taught that they could control their weight through various methods, of which they could then observe on the scale over time. Since we value control and personal responsibility in the US, this morphed into the phenomenon where our weight equals our value.
Now 100 years later, overweight and obesity rates are increasing. Overweight adults tend to have lower self-esteem, which is further weakened through stigma and fat-shaming. Yet frequent weighing may be the way to counteract this stigma and shame on the individual level.
In order to more fully understand how the very number that wrongly defines our worth can be used to counteract this phenomenon, we need to explore how our current public health paradigm constrains and enables the agency of individuals.
Health, vanity, and stigma
At this point, nutrition and public health strategies to stabilize the prevalence in obesity rates have centered almost entirely on education and awareness. Yet while the proliferation of nutrition education has certainly increased awareness of the health problems associated with having a BMI over 30, it has done very, very little to stop us from collectively gaining weight. Instead, the ubiquity of nutrition education has merely helped spread the message that weight gain is preventable; here’s how you prevent weight gain; now that you know that, if you gain weight it’s probably your fault.
In other words, nutrition education increases the stigma and shame overweight people experience everyday.
Well, when you read through gobs of nutrition research all day every day like I do, each article starts off with the exact same mantra: “Over 2/3 of Americans are overweight or obese. Obesity increases the risk of chronic diseases like heart disease and type 2 diabetes. It also costs billions each year in health care.”
However – young people typically want to lose weight to look better or to feel better. Weight loss ads for companies don’t focus on health risks or costs; they focus on how their product benefits the consumer. The consumer wants to LOOK better, wants to FIT INTO that pair of jeans. The values placed on a slender frame are front and center of every weight loss ad; not chronic disease prevention.
Fitness trackers target the younger demographic by appealing to personal behaviors that lead to weight loss and better health. By using the same ‘self-knowledge’ model as the penny-scales used back in the day, fitness trackers can appeal to a much larger market. They also aim at the cultural need for defining our worth with a number.
Self-monitoring is the cornerstone of any behavioral weight loss program because people tend to do better over time if they can independently regulate their weight without the help of an assisted intervention. So they are taught to self - monitor. Fitness trackers are great for this because they allow for automatic self-monitoring, making it easier to adhere to. As Crawford and colleagues explain, “technologies of measurement rely on rhetorics of agency, where the act of purchasing a device promises a kind of empowerment and control” (489).
But by integrating the quantification of self-monitoring with weight loss strategies, are we simply strengthening the culturally created ‘weight is worth’ values?
I research self-weighing because I want to know 1) does it work in helping people maintain their weight? and 2) does it enhance an individual’s agency and power they feel over their own body? In order to do this, I need data. Which is problematic.
This morning I googled “Fitbit court cases” and got 292,000 results. This is pretty amazing considering that the Fitbit has only really gained popularity in the last 3 or 4 years, yet already has garnered enough cultural authority to have 300,000 Google lawsuit hits.
The top hit is from engadget.com, where they report a story of a woman who called 911 and told the dispatcher that she was woken up in the middle of the night with a stranger on top of her. She explained that she lost her tracker in the shuffle (look, why the woman would mention her Fitbit during the investigation is beyond me), and when the authorities later found her Fitbit in the hallway and downloaded the data, it showed her awake and moving around all night. They submitted the Fitbit to the court and the woman now faces misdemeanor charges.
So this is where we are now. We buy fitness trackers to give us better insights into our health, but in the meantime, the data they collect may be up for grabs.
In order to explore the effects of daily, weekly, or monthly self-weighing, we need to access weight data – a lot of data. Looking at a large amount of data allows patterns to emerge that might not be seen in smaller experimental data that has happened up to this point. For example, in a recent systematic review on self-weighing, the largest study was on 3,768 people, who were given 2 telephone calls and asked to self-weigh weekly and record their weight on a note card.
But it’s tough to get people to sign up for a study where all they do is weigh themselves (or not), and see what happens. There’s no incentive, and recruiting people to these kinds of studies is tough. So one way to get enough data is by working with organizations or companies that have access to this data*.
Crawford and colleagues are concerned with the emergence of people using data collected by the device in court cases. They recognize the encroachment of data not only on our self-worth (by turning the number on the scale into how we value ourselves), but now we risk having this data (that may not even be accurate) used against us in structural ways as well.
For all of us working in this field, these are incredibly important discussions for us to have. Qualitative research on self-weighing is rarely undertaken, but knowing the lived experiences of people who frequently self-weigh (or people who stop weighing themselves) is the only way to get to the bottom of some of these questions. Certainly it won’t help with the ownership issue. But it may shed some light onto whether or not self-knowledge does cause a shift in individual agency, for better or for worse.
*To be clear, oftentimes not even the organizations or companies can tell who YOU are. Your data gets de-identified as soon as it gets shot into the cloud automatically for most companies.
