Apps ad nauseam

This is some sort of a Sunday-evening rant. Be warned.

I’ve spent several hours browsing all sorts of apps and devices for health-related goals, and right now I don’t want to see or try out any of them. I guess I reached the saturation point. Who are the intended users of these thingamabobs? Surely not the ones whose need for intervention would be the highest.

Mothers who struggle with budget and time constraints, trying to do their best to keep themselves sane while preparing food for their families and working two jobs. Businessmen and -women whose days are filled with one meeting after another, sitting in cars and airplanes, grabbing food where it’s available and entertaining clients over one drink too many. And lonely, depressed teenagers and adults who try to fill their emotional voids with food and end up feeling even worse, triggering another binge to relieve their self-disgust.

It is difficult to understand the worlds that other people live in, let alone design fancy gadgets that could help them change their behaviors (if they could afford them or be bothered to try them out). Unhealthy diet and lack of exercise are often just symptoms of deeper-lying issues. Somehow, the simple idea of eating food has become incredibly complicated.

Let’s say that the (obese or at-risk) population can be split into three groups: first group lacks awareness of healthy habits, the second lacks the abilities, and the third one just isn’t motivated. All groups can to some extent be nudged with upstream interventions that make healthy options more available, appealing, and affordable than unhealthy ones. However, downstream interventions that target individuals need to be tailored to their personal needs. And those needs can be really complex. (For instance, the need for cognition. Mine is pretty high, which works against me sometimes – I usually want explanations, it’s not so easy for me to just go with the flow and intuitively follow suggestions or hunches.)

I’m looking for solutions that could work in the real world and actually reach people in need. I think that one channel really can be social media – probably not Facebook, but other online communities which provide a tight social group with similar goals, intimate understanding of problems, and emotional support. We are herd animals and like to flock together. Now, lot of people just lurk on online forums, taking information in but not posting anything themselves. If we would advertise suitable applications among these communities, perhaps we could reach a part of the lurker population. These suitable applications should obviously be effortless to use, somewhat entertaining, and emotionally engaging. Stories are powerful persuaders, and social support is something almost everyone craves.

Not saying that trackers and self-monitoring apps don’t have their place. Of course, a part of the population benefits from habit trackers that serve to increase their awareness of their nutritional intake, activity level, sleep quality and so on. However, most applications assume that people are rational and can change their behavior based on this new self-awareness. For some people, calorie counting and tracking may just feed their obsessions about their diet and weight, when they would in reality need to become more aware of what’s going on in their mind.

I’m not a mental health expert. I’m just someone who’s experienced her share of stress, loneliness and anxiety, and also struggled with sensible eating at some point. And I would like to understand why human beings make their lives so difficult sometimes.

Advertisement

School Meals and Freedom of Choice

Having learned so much about school lunchrooms in the US, I started wondering how things are in Finland nowadays. A quick search in Google Scholar resulted in a couple of articles. One of them was about free school meals and food choices, based on empirical data collected in 2003. They only did questionnaires, not measuring plate waste – waste measurement would probably be quite difficult, since food is self-served. Anyways, they found that a large portion of students weren’t following the plate model and weren’t eating a balanced meal.

School meals have been free in Finland on all school levels since the late 1970s. This could be one cause of Finland’s excellence in the PISA survey. However, the problem is the same as in other countries: students don’t eat everything they should be eating. Another challenge is producing a healthy, balanced meal with very little cost (on average, a bit more than 2 euros). This challenges ties into the first problem, since students’ favorite foods are usually not the ones that would be recommended by health promoters. (As this Finnish news article shows.)

It’s interesting how kids – and adults – develop the simple heuristics based on which they select food. Parents and other adults are obviously important role models, but it can also be those simple things like the color or the shape of the package (“I hate blue, not gonna drink from a blue carton!”) that makes the difference. Understanding of nutritional needs and health effects doesn’t come into picture until later, if ever. In any case, force-feeding kids something that they don’t want to eat and taking away their freedom to choose is not going to work. It doesn’t work for adults, either. Psychological reactance. Nudging towards healthier options and making them more appealing is the better route to go, even if it seems slower.

Role models could also tell how you should *not* act. Just be careful that they don't backfire. (Poster from the great Demotivators collection.)

On a not food-related note, I stumbled upon LEGO Learning Institute’s paper about optimal learning in school. They say that Finland and Denmark could combine the best of both systems – Finland knows how to teach kids to read and do math (regardless their socioeconomic background), but Denmark is better in fostering collaboration and well-being at school. It’s true that the emphasis in school curriculum has been more on the learning and less on the doing together, although I hope that today’s teaching methods are starting to emphasize the latter. That seems to be at least partially the case based on what I’ve heard from my sister (she’s studying to become a teacher, and a great one she’ll be!)

Finally, in the words of Michael Pollan: Eat food. Not too much. Mostly plants. It’s sort of the quote from Arvo Ylppö, “Everything within reason”. The problem with this advice is that people are not that reasonable.

Plate Wasting

My first field trip was last Wednesday to a local elementary school, where we went to measure plate waste after school lunch. We waited in the area where kids usually come to leave their trays, intercepted them and marked down the amount of leftover food/liquid for each item on a tray (none, 1/4, half, 3/4, all). This method of measuring plate waste is called visual estimation, and it’s been shown to correlate closely with waste measured by weighing. It’s also much quicker, more convenient, and so easy that even I could do it.

It was sad to see such an awful amount of food going to waste. I didn’t really mourn that much about things that weren’t proper food such as chocolate milk, rainbow-colored sugary yogurt, or hamburger buns, but I hated throwing away apples that were left untouched, dumping vegetables into the bin, or pouring away unflavored milk. The small comfort is that most of the things went into the compost bin – at least they will be recycled somehow.

Lunch was quite different from what I recall in my hazy memories about elementary school: here, almost everything was pre-packaged and there was no water, just juice and milk. In my school, we had a lunch lady who served us food on our plates, and we could regulate the amount of serving by saying “just a little” or “a lot”, depending on how hungry we were that day. Of course, that’s probably something that varies from school to school both here and in Finland.

It’s been a long time since I’ve been around so many kids at the same time. They were pretty cute (although noisy) and most of them looked healthy and normal-weight. Some of them seemed quite smart and inquisitive, too. One girl was especially interested in what we were doing. She told us that she had eaten everything on her tray, and said that her mother instructs her to only take what she can eat. She also had critical comments about high sugar content in food and unnecessary wasting by throwing away unopened cartons.

There was also some gender-questioning, since my male workmate had a ponytail. We had to answer tricky questions such as “If you’re a girl, why do you have short hair, and if he’s a boy, why does he have long hair?” and “Are you both girls?” I hope we managed to challenge some of the stereotypies they’ve already developed.

Tale of stubbornness

There’s this girl who’s extremely pig-headed and has a tendency to push herself too hard, ignoring the warning signs of her mind and body. Who wants to be strong for others rather than admit that she might need help too.

But then there comes a time when even half a mile feels like crossing a desert, and a friendly workmate who happens to be driving past and offers a ride for the last few hundred yards feels like a life-savior. Perhaps the girl will learn that it’s okay to accept sincere offers for help, and ask for it too.

She is really grateful for all the friendliness, generosity and caring people have given her – not just during the past few weeks, but throughout her life. And she needs to tell that to them, face-to-face, in more words than just a “thank you”. She’s afraid that some people may have taken her stubbornness as ungratefulness, when she’s just wanted to not be a bother.

***

“I don’t want you to do anything that hurts.”

After two and a half weeks of limping on a hurting foot and generally not giving it enough rest, I finally had to hear it from a doctor to understand that pain is a signal that something’s not right. Good news: no plantar fascitis anymore. Bad news: stress fracture in the heel. At least that’s the current diagnosis, since stress fractures don’t show clearly in x-rays until they start healing. My bone had a certain unhealthy fluffiness in it.

No weight-bearing for the next 2-4 weeks, depending on how eagerly the bone starts to heal once I’m not stomping on it constantly. I’m on crutches the first time in my life. Well, I did want new experiences, right?

I worried about not being able to exercise, but hobbling with crutches is actually quite good upper-body training. I felt pretty exhausted after lugging myself around campus. Just hoping the weather stays pleasant.

***

My  experience is not at all unique, although stress fractures usually happen to real athletes and runners. The pattern is the same: too much exercise, not enough time to rest and adjust. Injury develops gradually and healing takes a long time; pain is the last thing to come and the first thing to go. If exercise continues despite the fracture, the bone may break so badly that it never fully recovers.

Come to think of it, the effects of physical and mental stress are pretty similar. Some amount of stress is good, but chronic stress and insufficient recovery from it lead to trouble. Stubborn overachievers who don’t let themselves rest and take it easy every once in a while may end up in the work disability statistics.

Bits and pieces

Some pickings from other blogs:

• Dan Ariely’s new paper says that asking people if they want to downsize their portions is much more effective than calorie labeling in helping people not to overeat. In general, making people stop and think before they make a decision is better in changing behavior than merely providing information. (I think that calorie labeling might be ineffective also because the information is too difficult to interpret. You need to put your brain to process it and make calculations in order to understand what it really means. And even then, it’s still a big step to actual behavior change.)
• Stories are persuasive because they are easy to understand and empathize with. Engaging stories sweep you away and you forget to pay attention to the fact that the narrator is subtly trying to make you shift your attitude. I wish I could learn to write like that – with good intentions, of course. There’s a book called “Made to Stick” in which they presented an acronym that stuck with me. SUCCES: Simple, Unexpected, Concrete, Credible, Emotional, Stories. The more you have of those in your message, the more likely it is to penetrate in your audience.
• Educate parents to prevent children’s obesity. Parents and schools, they’re the main gatekeepers and habit establishers, and therefore the primary targets.

And an opinion piece in LA Times written by two wise men in the Lab. Don’t take all choice away, or you’ll invoke reactance.

January’s crops

The first three weeks have flown by really quickly, so time to pause for a moment and see what I’ve done and planning to do at the Lab. Believe it or not, I’ve been trying to get work done too, not just running around applying for social security numbers, fixing myself a bike, and chasing squirrels!

Mindless Eating Challenge data. I’m currently analyzing what kinds of eating tips are effective for people who want to lose weight. For instance, is it better to ask people to change their physical environment or eating habits, or rely on their willpower? (I personally think that in the long run, all are needed – it’s good to eliminate some of the temptations, but being mindful of what and how one eats is also necessary.)

The dataset consists of about 2000 people who participated in the online National Mindless Eating Challenge a few years ago. Each participant got three eating suggestions that were based on the research done over the years in Food & Brand Lab, and was advised to follow these suggestions for a month. Basically, like this.

The tips are meant to be easy and simple, since small sustainable changes are better than large ones that cannot be sustained, both on individual and population level. Adding 20 minutes of walking to a day, changing one unhealthy snack to a fruit, eating salad first during meals – they don’t require a lot of sacrifice or effort from a person, but they can work as first steps to a lasting habit change. And throwing in some environmental changes, such as using smaller plates, makes it easier not to stuff oneself.

Now if I can just figure out which tips are the best, and perhaps even find some clues for profiling people who benefit the most from certain types of tips…

Habit change interventions. These are still on the drawing board; I’d love to develop some easy, simple, and low-cost interventions that tackle stress management and healthy eating. Could be something similar to Mindless Eating Challenge, but with the added flavor of relaxation/mindfulness, values clarification, and problem-solving strategies. Improving people’s abilities and self-efficacy as well as helping them make concrete changes. All this on web or mobile platform, of course – not for the sake of technology, but because that’s how it would be possible to reach almost anyone.

Lab experiments. I’m quite interested in emotional eating and eating behaviors under stress, and studying these things in a laboratory setting could provide insight in developing interventions for them. Something like making the participants try to complete impossible tasks to increase their stress level, then giving part of the group relaxation or mindfulness exercise, and finally seeing how their subsequent eating behavior is influenced. You can probably guess what my hypothesis of the outcome is.

Even if nothing earth-shattering would come out of it, it would be good to try my hands on this kind of experimental research. During these first three weeks, I’ve participated in one study (wine appraising – just looking, not tasting, unfortunately) and observed another bunch of small studies to gain understanding in their practicalities. The department has a pretty good lab for running all sorts of studies.

Conferences & publications. I’ll try to attend at least a couple of interesting nutrition-related conferences; one is SNEB in July, another could be APHA in October. Even better if I manage to write something presentable there too! Then there’s of course EMBC, which is so near (well, only on the other side of the continent, not the world) and such a big event that I should probably go. Good chance to meet folks from Finland as well 😉

Aaand, some journal papers will also be written, certainly.

Food & Brand Lab class. Some sort of unofficial studying going on too. Brian and Aner teach a course for undergrads, with the purpose of helping them understand consumer behavior by involving them in research. I’ve decided to participate at least in some of the classes, even though I’m old as grit, since they can provide new ideas and perspectives. This week’s class was already helpful: we used a Q-sort method to form categories for 33 different tips and select interesting comparisons to make.

Gotta say that Brian and Aner are both really smart and incredibly friendly. And the list doesn’t end there; in fact, that description fits everyone in the Lab. I feel I’ve been very fortunate to hop from one wonderful workplace to another.

I also really like the university’s motto by the founder Ezra Cornell: “I would found an institution where any person can find instruction in any study.” Although that’s probably one reason why, apparently, Ithaca is the City of Evil in some people’s books. It’s funny how caring about things such as human rights and environment can be seen in that light.

Anyway, it’s a new month now and lots of interesting stuff to be done. I wonder if it will snow in February… it’s only been a handful of days with snow so far, and it feels a bit unnatural. I was told that Ithaca should have harsh winters, but haven’t seen much of that yet.

Barriers into opportunities

Time for confessions. I have plantar fasciitis.

Didn’t even make it three weeks before breaking something. Fortunately, it’s not lethal, dementing or contagious, just pretty damn painful and limits my freedom.

In layman’s terms, plantar fasciitis is heel pain caused by inflammation of the tissue that connects the heel bone to the toes. That’s what you get for overusing your feet and not giving them proper care. Frankly, I blame last weekend’s beautiful weather which tempted me to a long jog on too hard surfaces. This week, I’ve been limping around with gradually worsening pain, still stubbornly walking to campus and back. For those who know me, it probably says something about the level of the pain that I decided to go to a doctor already today.

The people at Cornell’s Gannett healthcare center confirmed my self-diagnosis. They were also extremely friendly and projected the feeling of caring. Still, I find it kinda funny that the nurse measured my temperature and blood pressure, also asking when I had my last period. Some kind of screenings probably, but hey, it’s just my heel that’s hurting!

Anyway, the remedy is ibuprofen, stretching and rest for at least a couple of weeks. A concrete barrier to the types of physical activity that I’m used to doing – basically anything that involves being on your feet. It’s slightly frustrating, but it actually makes it easier to try out something new, since there are plenty of opportunities in Ithaca. Not sure if I’d have gone to that yoga class tonight if I would have had the option to just go for a jog whenever I felt like it. I’m glad I went: got some exercise with a dose of mindfulness, and felt relaxed and better connected with myself afterwards.

And being temporarily lame justifies accepting a ride home from a social gathering, providing a chance to chat a little bit more on the way.

Some barriers are, of course, stronger and more permanent. Even then, one can always decide how to look at them. Could there be some golden opportunity lurking nearby?