A Taxonomy of Unintended Negative Consequences: A Qualitative Study Examining Diet and Fitness Apps in the Context of Eating Disorder Behaviors (Preprint)

Abstract

Diet and fitness apps are intended to improve people's health. However, they can have adverse effects on some populations, such as young people. Young people, particularly college women are heavy users of mobile health applications (apps) for diet, physical activity, and weight loss (also known as diet and fitness apps). These apps are often promoted in university and college settings and touted as a means to improve health with little attention given to their actual impact and potential unanticipated negative effects, especially among those at risk for or with eating disorders.

Few researchers have studied how diet and fitness apps affect college women with eating disorder behaviors. Thus, this research investigates the unintended negative consequences of engaging with these tools to inform how these types of apps may trigger and exacerbate unhealthy app engagement as well as eating disorder-related behaviors.

This study used a qualitative approach to better understand the consequences of using diet and fitness apps among college women. This approach allowed for emergent themes unlikely to be discovered using quantitative approaches. Data collection sessions consisted of three components conducted with 24 college women with eating disorder-related behaviors who have experience with diet and fitness apps: survey (demographic and eating disorder symptoms), think-aloud exercises, and semi-structured interviews.

Findings reveal that diet and fitness apps trigger and exacerbate symptoms through focusing heavily on quantification, promoting over-use, and providing certain types of feedback. A taxonomy of eight negative consequences was developed based on these findings. The types of unintended consequences include: 1) fixation on numbers, 2) rigid diet, 3) obsession, 4) app dependency, 5) high sense of achievement, 6) extreme negative emotions, 7) motivation from negative messages, and 8)excess competition. Although these themes were very common when users' focus was to lose weight or eat less, these adverse effects were also prevalent when users wanted to gain weight, eat more, or focus explicitly on eating disorder recovery.

Unintended negative consequences are linked to the quantified self movement, conception of appropriate usage, and visual cues and feedback. Thus, this paper critically examines the design of diet and fitness apps and offers suggestions for improvement and then discusses implications for educators and clinicians. Ultimately, this research emphasizes the need for a fundamental shift in how diet and fitness apps promote health. This work also showcases how focusing on specific subpopulations can shed light on problematic aspects of design that if addressed may have a positive impact on the broader user base.

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