For three months, Kristin would lie in the dark, powerless to fall asleep. “All I could think about was how I was already so tired, how losing sleep could damage my health, and then my mind just spiralled,” she says.
The 31-year-old started using a health app - which included a sleep monitor - to try and improve her ZZZs, especially as she had to be up at 5am for her demanding teaching job. But it didn’t work, and one night, her obsessive thoughts led to a full-blown anxiety attack that ended with a visit to A&E.
“I thought I was having a heart attack,” she recalls. That was just a few months ago, and since then, Kristin has been seeing a therapist to help her anxiety. One of the things her therapist suggested, in addition to medication, meditation, and mindfulness? Ditch the sleep app.
While her story is dramatic, it’s not unusual to hear about people turning to apps for self-improvement, and digital health is set to become an even larger part of our lives. In the US, digital wearable medical device sales are expected to top $55 billion in 2022, increasing from $10.5 billion last year. Here in the UK, there are approximately 40 apps that the NHS are happy to flag on their website.
But there are over 165,000 health-related apps available worldwide that aim to help with everything from better orgasms to brushing our teeth more effectively. Alongside diet, fitness, and mindfulness apps, the overall message seems to be that a better, healthier you is only a few data points away.
What’s wrong with that? Well, for some, the data-logging may backfire, as it did with Kristin. And some research suggests these apps may not be helping our health, they may be making things worse.
One recent study found that fitness or calorie-counting apps are linked to "eating disorder attitudes and behaviours". On top of that, research has shown a disconnect between app developers and the scientific community, making it harder to trust the effectiveness of these products – and yet they continue to play a huge part in our daily lives.
Fitness trackers: friend or foe?
Chances are you know someone who wouldn't think of leaving the house without their fitness tracker. And, according to a 2015 study, people who use exercise apps are more likely to work out in their spare time, compared to those who don’t use them. But last year, research found that while heart rate analysis in wrist-worn trackers was fairly accurate, the calorie expenditure data wasn't, causing many users to think they were burning more or fewer calories than they actually were.
Another study found that young adults who used fitness monitors actually lost less weight than those who didn’t use them during the same period of time. One theory was that people who wore the trackers may have given up (and become less active) when it was clear that they weren’t going to reach their goal.
In other words, perhaps fitness apps can create an ‘all or nothing’ mentality that can make it difficult to set realistic, achievable targets. Take Lara, a 29-year-old who works in ad sales, who was given a fitness tracker as part of a health-based initiative from her employer. Her colleagues committed to increasing their activity levels for health reasons, and they were all split into teams. She started running late at night, and walking around her flat to raise her step count. But it became stressful, especially when she started shrugging off nights out with friends for increasing her steps instead.
“I always wanted to do better than the day before,” says Lara. “At first it motivated me, but after a few weeks, it felt like I wasn’t running to feel good; I was doing it to log onto the app. It made me lose sight of how to take a rest day and relax.”
After two months of logging on to the app every day, Lara took a week off, and found that she lost more weight that week, and felt more energised. Now, she tries to focus more on how her body feels, rather than just ticking boxes.
More than just a number
Many people use health apps to feel in control of their bodies and minds. Of course, wanting that control isn’t new, but the amount of data we now have at our fingertips is new, says psychotherapist Amy Morin. She has seen a number of clients who didn’t think they had health issues until they began using apps that made them worry about, say, getting enough exercise or sleep. Like with Kristin, the problem came from repeatedly seeing their data.
“You shouldn’t need a tracker to know if you’re tired,” says Amy. “Some days, we might feel fine on five hours of sleep, and some nights, we might need nine: that’s normal. I think some people (who use these apps) can lose touch with the human connection they have to their bodies.”
Amy also urges people not to rely on the apps and trust their own judgement instead. “The danger is when we reduce our self-worth down to a number instead of doing things because they make us feel good and healthy.”
The dark side of diet data
“I know myself well enough that I can’t even download a fitness app on my phone,” says Emily, 32, a product manager, who has struggled with disordered eating for half her life. She also finds it hard when people who use tracking apps upload their results onto social media. “As someone who probably will always have issues surrounding food, I cringe when someone posts their stats. I wonder why they need to share it," Emily says.
Even well-intentioned apps and trackers have unintended consequences. “People can become overly focused on numbers, which may exacerbate unhealthy behaviours, like food restriction or compulsively exercising,” says Deborah Glasofer, assistant professor of clinical psychiatry at Columbia University in New York.
On the flip side, apps can be a great way to initiate healthy change. “They can help make some people more mindful of improving their eating behaviours,” adds Deborah. People including Natalie, 32, a researcher who has struggled with making healthy eating choices when under pressure at work. "I often don’t have time to take a full lunch break, so I used to make rash decisions in the office canteen – or when a colleague was passing around biscuits," she says. "But I recently started using a food tracker that’s made it easier for me to pick out a healthy choice and I’m already seeing a change in my habits."
Is there hope for happy apps?
In recent years, there’s been a new wave of mental health apps – and they’re more popular than ever, with global revenue reportedly up by 40% in the first quarter of 2018.
The appeal is obvious: in our busy lives, an easily accessibly app that promises to help us get a hold of our mental health seems like the perfect solution. But Sarah Allen, a clinical psychologist, worries these apps may overpromise and under-deliver.
“I'm not sure apps really give people the control over health they promise,” she says. Instead she thinks they offer the illusion of control, where people become overly fixated on the data (such as minutes logged meditating) that they miss out on the real world.
Author Ruth Whippman downloaded several such apps as research for a book she was writing on happiness. At first she loved them, but then she realised they were stopping her from spending more time with friends and family – things that really improved her sense of well-being.
“An app can tell us to read a certain book or go to a mindfulness class or meditate, but what we really might need is to just get a coffee with a friend,” Ruth says. Part of the problem, notes Whippman, may be that apps encourage insular behavior by suggesting happiness is just a tap away on our screens. Instead of reaching out to others, people may end up isolating themselves instead.
Sarah Allen also thinks these apps are dangerous for people with mental health issues. “I sometimes wonder if people with low self-esteem are more vulnerable to falling prey to the latest gadget that promises unrealistic dreams,” she says.
Some apps claim to improve depression and anxiety, but one study found that 85% of NHS-accredited apps promoted to relieve those conditions provided no data within the app store as to their effectiveness. Sure, they may have reviews, but many of these apps do not have scientifically reviewed data to back up the claims that they can help improve our mental health.
Of course, it isn’t all doom and gloom. There is research that shows that using apps can help people reach goals and improve happiness. And one popular app of this kind was proven to increase resiliency through a series of game-like challenges. And, of course, your friend who swears by their Fitbit will tell you that their app changed their life for the better: anecdotal evidence that apps can be helpful, too.
But apps should not be a one-size-fits-all recommendation. While there are plenty of people who couldn’t live without a health app, it’s clear that no one is destined to a life of ill health if they choose to skip using one. And for some, choosing to skip the health app in favour of a few body and mind check-ins throughout the day may be the far healthier choice.
As for Kristin, even though she won’t go near a sleep app, she has recently downloaded a meditation app. “This one doesn’t track, it just gives meditation suggestions and provides music," she says. "It’s simple, easy, and exactly what I need.”
If you chose the latter above and have an unhealthy relationship with your app, talking to a GP or psychologist can help you sort out these feelings and find healthier ways of coping.
If you have been affected by the issues raised in this article, help and support is available.