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Why health tracking apps all blow, and a perfect pivot

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Superb work by one of my favorite tech journos, Wade Roush, on one of my favorite web peeps, Adam Bosworth.

Many props for this! I started with this...

“Most software people don’t start by thinking about psychology,” Bosworth says. “Most software people think about features first, because they are concrete and they know how to implement them. They think, ‘I would want this, therefore my users would want this.’” But sometimes—perhaps most of the time, Bosworth argues — they’re dead wrong.

...but here's my aha moment: Negative feedback does not work in web apps, but positive reinforcement does.

“It became clear we were not going to affect most people’s habits in a good way,” Bosworth says. “That brings us up to April 2010, at which point we stopped and we asked ourselves the basic question that we should have asked in the first place. Why are people unhealthy, and what could possibly motivate them to change their behavior?”

Data wasn’t the answer. The Mint-like approach, Bosworth had realized, was working more like a stick than a carrot. “All these people would enter their height and weight and lab data, and immediately we would tell them, ‘You suck. You’re overweight, your blood pressure is too high, your cholesterol is too high, you must change.’ They were gone in 60 seconds,” says Bosworth. “They know what it’s doing to their life expectancy, and they still are not doing the right thing.”


In York’s scheme, every Mint-like element had been removed; every piece of negative feedback was replaced with some kind of positive reinforcement. It was, in essence, a game.

Data isn't always the answer. It takes a social scientist to appreciate that.

To be fair, I think it's entirely possible that the engineers who work on these apps, and the VCs who fund them, are both in the tiny minority of people for whom "more data" is a very motivating idea. But you know... not to be unkind... but let's just say that if being rational and data-driven were all it took, every engineer and VC would be super-fit and buff right? :)

I know the VP of Marketing at Keas and he once told me something very interesting. He said that most health apps are made for people who are already healthy (eg: people who want to measure every calorie they burn) but people who actually need to live a healthier lifestyle. As a corollary, for people who are already in shape, numbers are motivating, but for people who aren't, they are depressing/de-motivating.

I think that what Keas is doing right is that they're making an app that's actually fun to play for people who aren't health nuts, which differentiates it from all those crazy calorie counters etc. with billions of dashboards measuring a person's physical output. Great article, thanks for pointing it out, Joyce!

Weight loss in particular is a REALLY complicated, emotionally-loaded, disinformation-filled domain in our society. I remember reading (I think via NYT science writer Gina Kolata?) that one of the non-obvious points is that people get a lot of positive social reinforcement for LOSING weight but they do not get any for the much harder job of MAINTAINING weight loss... which tends to lead to repeated bouts of yo-yo dieting (see: Oprah, Kirstie Alley, etc.), which is actually terrible for your health. That seems like the kind of thing an app like KEAS might actually help with... not that it's fun to play, but that you could build in social rewards for the actual desired behaviors.

Weight loss is actually incredibly simple -- and I am choosing my words carefully. I did not say "easy", I said "simple", as in "non-complex."

The problem is, we hate the simple answer: create a consistent negative energy balance for an extended period of time (translation: burn more calories than you take in, consistently.)

We all know in our heart of hearts this is true and real scientists (not bestseller writers) are in agreement and have proven it time and time again.

The problem is that maintaining negative energy balance goes against our most fundamental drives. In a society where food is plentiful and we work and play by sitting, it requires MASSIVE amounts of willpower to stick with. So most, understandably, fail.

Ill-informed journalists frequently say "diets don't work" or "exercise doesn't work" which abuses the definition of the term "work." An equivalent would be saying "saving money doesn't work." Saving money works just fine but most people lack the willpower to do it consistently for an extended period. Same thing.

The system is fine, the failure is in compliance. So how do we increase compliance?

We must accept that we are more emotional more than we are rational. We must accept we are often slaves to our context.

Rational systems rely on numbers and willpower. If you like tracking what you eat, have boundless willpower and enjoy the gym, weight loss is simple.

For most, rational systems will eventually result in failure.

We must manipulate our surroundings, our habits and our self-definitions. We must take willpower out of the equation. Games may help us set goals but more advance work is necessary to remove the willpower issue.

Not to digress (but haven't we already?), food is a "playing field" - that is it is a place for most people to act out. Typically there are underlying reasons for obesity. They fall under two categories by enlarge: 1) "comfort food" and 2) a terrible food environment which we've created over the past 100 years. 98% of the population has no idea what they are eating or how the body functions (to #2) and we all know what #1 looks like on some basis. Making those changes is a life long journey, both psychologically and intellectually. Diets as part of that journey can help address both, but fundamentally when one understands that those to places are the growth areas in one's life that can help to get on that road and make a lasting impact. (I said I was going to digress!)

So for content to the actual thread, software is no better off that weight loss and nutritionist folks - plenty of people addressing the effect ("features" in software, "diets and calorie counting" in nutrition), with few people understanding the root cause (and hence, root value).

Looks like funding "health platforms" -- including the "health graph" of Runkeeper is hot right now:

One of the most popular health and fitness apps on the iPhone, RunKeeper, is started tackling by making it easy for people to measure their exercise, but now it is busy building out an entire “Health Graph” so that all sorts of health data can plug into its service.


RunKeeper CEO Jason Jacobs wants you to “imagine a system that can identify correlations between a user’s eating habits, workout schedule, social interactions and more”, that has the sole purpose of delivering an “ecosystem of health and fitness apps, websites, and sensor devices that really work, based on a user’s own historical health and fitness data”.

I remain skeptical of this unemotional, data-driven approach to health.

I think Keas's positive reinforcement has a much greater chance of long-term success.

I also think that Bakadesuyo's point that weight loss is simple is right on: "Games may help us set goals but more advance work is necessary to remove the willpower issue."

I agree that Keas model at the high level sounds like it will have much greater impact on people's health. Staying healthy for guilt reasons is potentially a way to get started, but over time it must turn into habit and positive reinforcement to be sustainable. RunKeeper has a chance of starting with helping make people's health more transparent, but they are a far way from having a product that can help people truly live better.

Runkeeper has failed twice today to send me a change-password mail. Odds I can trust them with all my health info?

Odds that you can trust them with all your health info is very low.

But then again, odds that you can trust any piece of software is low.

Removing the need for willpower is the best way. Do things like using a treadmill desk at work, and something similar when gaming at home. If you have no chair and a treadmill you must stand on to do your work or gaming you you only have to start the treadmill to get some gentle cardio. Find ways to make choosing not to exercise or eat healthy require more willpower. I have my doubts an app can do that. An app can help track, remind, organize and possibly entertain. Positive reinforcement is best when the activity itself is rewarding, so not the muscles you gain by lifting weights, but the actual weight lifting. The best health apps will be the ones that require the least attention. Their primary focus should be automation of all tracking, and using that information to let people know when they are pushing themselves too hard. 

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