At Oral Roberts University in Oklahoma, freshmen and new students are required to wear Fitbits to monitor their level of daily activity. The university is digitizing health and fitness requirements the school already had in place, but the reliance on fitness trackers has some advocates raising questions about whether they're truly healthy for everyone.
For people with or at risk of disordered eating, fitness trackers can trigger or exacerbate problems with compulsive exercise, rigorous calorie counting, and other manifestations of eating disorders. In response to ORU's fitness requirement, Kaitlin Irwin of Proud2BMe, the youth arm of the National Eating Disorders Association (NEDA), launched a petition calling on the university to stop making its students wear Fitbits. The petition is part of a broader conversation aimed at raising awareness of the potential downsides to fitness trackers.
Not everyone exhibits harmful behaviors when using fitness trackers. Some doctors use them with patients to monitor sleep patterns, activity, heart rate, or even as a diagnostic tool in emergency rooms.
However, the compulsion to hit certain step counts or restrict calorie intake if goals aren't met can make some people become so reliant on fitness trackers that the tech may augment unhealthy behavior instead of encourage fitness and a healthy lifestyle.
"What we’re hearing about more and more in our community and people who work with us, either they themselves are in recovery or they are supporting someone, a lot of these initiatives or technology associated with fitness and health, while it might be well-intentioned, it’s actually backfiring for a lot of people who are in a space where that level of tracking and counting can either trigger disordered thoughts and behaviors or further entrench a disorder," Claire Mysko, CEO of NEDA, said in an interview with the Daily Dot.
Mysko said that one of the major problems with fitness trackers is that these devices put an enormous emphasis on numbers and counting, which can trigger an obsessive focus, a behavior that is consistent with disordered eating. According to the Anxiety and Depression Association of America, obsessive-compulsive disorder (OCD) is the most common anxiety disorder to occur alongside an eating disorder.
Advocates use the hashtag #DontTrackMe across social media to educate people on the potential negative effects of devices that monitor things like calories, activity, and heart rate. NEDA recently hosted a Twitter chat to coincide with the launch of the ORU petition, and the organization highlighted some troubling information and personal accounts of fitness trackers aggravating unhealthy behaviors.
Dr. Jennifer Kreatsoulas, a yoga therapist who specializes in eating disorders and has recovered from one herself, said that while data can be useful in recovery, relying on numbers to dictate your success isn't a holistic measure of health.
"Data serves a purpose, but I think it does remove us from our own experience in our body. Just like in the same way being tied to our digital devices all the time takes us out of being present and in community with everyone around us, this hyper-focus on data turns us into machines," Kreatsoulas said in an interview with the Daily Dot. "It takes us away from our humanity in some way. Then we’re always trying to beat a number versus just enjoy our lives."
In a recent study of 200 women who wear Fitbits, researchers found that reaching daily goals made people happy, self-satisfied, and motivated, but digging deeper into behaviors revealed more negative feelings: 79 percent of women felt pressure to reach their daily targets, and 59 percent felt that their daily routines were controlled by the wearable device.
"ORU’s Fitbit requirement has the potential to trigger students who are already struggling."
Kaila Prins, health and wellness coach and founder of Performing Woman, conducted an informal survey of over 1,000 people called the Body Image Report, and found a similar relationship with fitness trackers and the compulsion to meet certain goals. Almost 50 percent of all respondents felt pressured to meet daily activity goals. That number increased to 67 percent for respondents with eating disorders.
The National Institute of Mental Health reports that eating disorders can frequently begin during young adult (or collegiate) years. The average age of onset for anorexia, bulimia, and binge eating disorder is 19, 20, and 25, respectively. In her petition to the university, Irwin wrote, "ORU’s Fitbit requirement has the potential to trigger students who are already struggling."
ORU declined to provide a response to the petition, but earlier this year, university provost Kathaleen Reid-Martinez told the Daily Dot the 10,000-step requirement and Fitbit monitoring has made students more aware of daily physical activity, and they have formed social groups to hold each other accountable and gamify the requirements.
Fitness tracking can have tremendous benefits for people who want to lose weight or be more conscious of how they're treating their bodies. The "quantified self" movement has spread from paper-and-pencil worksheets documenting daily calorie intake to automated systems that collect data from our wrists or pockets with limited effort. But the system is not for everyone, and it should be an individual decision whether or not people participate.
Fitness tracking in high schools
ORU isn't the only educational institution requiring students to wear activity trackers to monitor their physical fitness. A growing trend in schools from elementary to the high school level is bringing the tech into PE classes.
In the U.S., almost 14 percent of high school students are obese, and 16.6 are overweight, according to 2013 data from the Centers for Disease Control and Prevention. Programs that bring tech into PE classes are meant to address this health issue by monitoring children's activity throughout their school careers.
Interactive Health Technologies (IHT) recently launched a partnership with Adidas to bring the ZONE heart rate and activity tracker to PE classes across the country. In addition to a comprehensive program that includes worksheets, goal-setting, and journaling, the fitness trackers monitor kids' heart rates and activity levels throughout their PE class sessions, and report to parents and teachers whether kids were achieving optimal activity.
Jen Ohlson, founder and president of IHT, said that the company's tech collects data about students' height, weight, and fitness level, and creates individualized fitness goals for each student. The algorithm is based on gender, genetics, and other personal data that culminates in "personal zones" for achieving ultimate physical success. Ohlson said the company worked with exercise scientists and health and fitness entrepreneur Sally Edwards to develop the program.
The fitness tracker is only worn in PE class, and once the class is completed, students automatically get an email with their heart rate data, calories burned, activity level, and whether or not their goals were achieved.
"If they’re not talking to kids in their formative years with technology, there’s a pretty good chance you’re not getting through to them all the way," Ohlson said in an interview. "Their first language might be English or Spanish, but really their first language is technology."
IHT's fitness tracking goes in tandem with curriculum called PE3, or "PE for the Mind, Body, Spirit," that teaches students about things like healthy eating, how feelings impact our food or exercise, and how and why to measure your pulse rate. The Texas Education Agency awarded the program as an official PE course for every high school, and it also received honors from the Texas Department of State Health Services as the most effective curriculum in 2011.
Worksheets and journaling exercises accompany the program, including vision boards, weekend family activities, and mood recognition. The curriculum was developed for high school and middle school students, but IHT is expanding the program in the fall to include elementary school. Below is an example of one worksheet exercise.
Kreatsoulas said that approaching fitness by learning how exercise makes you feel rather than how successful your wearable says you are is a healthier strategy.
"My fear about having trackers in school is that it’s going to strip children of their right to be children, to just play. And to not be so hyper-vigilant about their performance," she said. "I think, for people with that setup for an eating disorder, becoming so in-tune to performance at such a young age, I think it will just kick in as an eating disorder much sooner than maybe if there wasn’t such a hyper-vigilance about performance."
Almost one in 60 kids between ages 13 and 18 would qualify for an eating disorder, according to a study from researchers from National Institute of Mental Health (NIMH), the Universities of Chicago and Minnesota, and the National Center for Scientific Research in Bordeaux, France.
Ohlson said that PE teachers can use the heart rate and activity data to recognize over-exercising and talk to kids about healthy behavior, and help teachers keep track of classes with upwards of 100 students. However, a lot of behaviors that signal disordered eating happen outside the classroom.
"What is much more dangerous than being overweight and underfit is being underweight and overfit."
Clinical psychologist Dr. Lynn Tracy equates in-school fitness tracking with programs like weigh-ins or BMI report cards called "Fitnessgrams." In 2014, these Fitnessgrams were distributed to schoolchildren in New York, despite BMI being an unreliable indicator of children's health. Critics decried the report cards as "fat-shaming," and the Academy for Eating Disorders called upon the New York Department of Education to stop the practice.
The affects of fitness tracking on both physical and mental health of students is not well-known, and it's unclear what sort of impact long term health tracking has on childhood development.
"I don't know what the data [says] about how [fitness trackers] are helpful. But I do know that there’s data that indicates that says some of these fitness trackers can be triggers for disordered eating. What is much more dangerous than being overweight and underfit is being underweight and overfit," Tracy said in an interview. "Why would we be giving kids something to use when we know they’re potentially problematic?"
What to do with data
Since 2001, math and reading have received more time and attention than PE classes. The NIH reports that 44 percent of school administrators have cut "significant time" from physical education and recess after the No Child Left Behind Act was passed.
So it makes sense educators would turn to alternative, modern methods for teaching large classes in a limited amount of time, and search for ways to engage students with technology and apps that are native to their everyday life.
By requiring students to use fitness trackers to monitor activity, teachers can passively track their behavior—and because these programs are school-wide, that data can follow them through their formative years, collecting health information until the student is ready to graduate. This data can show patterns like whether exercise impacts educational success or why students tend to get headaches in the middle of the day. It also makes privacy advocates wary.
Already fitness trackers have run into privacy issues. As the Washington Post reports, many fitness trackers and personal health apps fall outside the purview of the Health Insurance Portability and Accountability Act, a privacy law that's meant to protect your health data.
Ohlson said that student data is hosted securely on IHT servers, and that the districts own the data. Students, teachers, and parents have direct access to health information, and districts can look at it in aggregate to compare fitness trends across different demographics.
Michelle De Mooy, deputy director of the Privacy & Data Project at the Center for Democracy & Technology, said that while there are health benefits to tracking student fitness, what ends up happening is privacy aspects get left behind or overlooked.
"There’s a rush to really invest in technology, especially when schools are concerned," De Mooy said in an interview. "There’s a big push in a lot of schools in the U.S. to embrace technology and STEM, and sometimes what I’ve seen is a rush to do this without really making sure the companies being used to do this kind of thing are really protecting data and privacy."
With schools, she said, there's more of a coercive element to fitness tracking, because it corresponds to grades. Data collected by fitness trackers is much more invasive than pen and paper readings—it includes granular location and biometric data that can be viewed by administrators and used in different ways.
De Mooy said there are a number of questions to ask when determining whether schools should implement fitness tracking technology: How are you deploying this kind of technology? Is there a real choice for people? What kinds of settings are on the tracker, and what data do people see?
Perhaps the most important question is: What are companies and schools doing with the biometric pictures of people they're creating?
At times IHT may make certain personal information available to strategic partners that work with IHT to provide products and services, or that help IHT market to customers. For example, if you purchase an IHT product or service from an IHT reseller, you authorize IHT and its reseller to exchange the information you provide during the process of configuring and deploying the product or service. Personal information will only be shared by IHT to provide or improve our products, services and advertising; it will not be shared with third parties for their marketing purposes.
De Mooy said that encouraging students to be more engaged with their health is a positive thing, but the component of collecting and compiling data seems outside the scope of educating and improving health.
"It speaks to this blurring line that has occurred with a lot of technology. A great example is the workplace and schools. You no longer have separate personas in one place or another," she said. "I guess if you think about what would they possibly want to do with this information, you think it’s probably to save money. That’s usually the rationale. What I would question at this point is: How does this help the person?"
One size does not fit all
Programs like those at ORU and Texas high schools are meant to motivate the student body, but they may not be ideal for everyone.
"A lot of this technology is created with good intentions, but it can be very problematic for people who are at risk or in recovery," Mysko said. "The idea of the constant counting, the shift away from thinking about health and fitness in a holistic way and what works for one person and one body is not necessarily the right fit for another is a message that’s really important. That level of individuality and nuance is not reflected in an app."
Mysko said that app developers and wearable creators should be aware of how people can use their technology in detrimental ways, and consider building in preventative measures that could help someone recognize unhealthy behaviors, and potentially change the way they use the product or even ditch it altogether.
One option, Mysko said, to build in screening that recognizes disordered eating or compulsive exercise and prompt questions or direct people to help through the app in a way that's not judgmental. Pattern recognition could point people to more information about eating disorders or exercise.
The majority of students who use fitness tracking apps will likely not develop an eating disorder or profound body-image issues, but there are individuals through all levels of education that experience fitness tracking differently, and the requirements may do more harm than good.
"Whoever is saying 'Yeah we need to use fitness trackers,' would have to have the awareness that there are small subsection of kids who are going to abuse them. And then there are a bunch of kids in the middle who will never have a clinical-level eating disorder that might feel fat-shaming or body-shaming because their BMI is naturally higher, or they are people who are more naturally sedentary or active," Tracy said. "Some folks are going abuse it, and that’s dangerous, and some folks are going to have a blast with it and be more active and challenge themselves in a good and healthy way. Then there will be folks that won’t get sick with it, but have unintended consequences of feeling bad about themselves because they’re not as fit as X, Y, or Z."