Health literacy, numeracy bar entry in dieting apps

At this year’s Connected Health conference in Boston, Sherry Pagoto, director of the UConn Center for mHealth and Social Media, discussed the social and skill set barriers to weight loss.
By Laura Lovett
01:30 pm

With thousands of dieting and fitness apps on the market, it’s clear technology is increasingly becoming a part of weight loss for many Americans. 

At this year’s Connected Health conference in Boston, Sherry Pagoto, director of UConn Center for mHealth and Social Media, reminded attendees that each dieter comes from a unique social structure and has a certain skill set that will impact their weight loss journey and even access to technology. 

“One question I think that is really important to ask ourselves is ‘what are the prerequisites for your solution? What does the individual user need to bring to the table in terms of literacy, meaning reading literacy but also health literacy, as well as any other types of cognitive skills that may be necessary to execute what is being asked of them in that solution?'”

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Pagoto gave the example of a calorie tracking app that helps users figure out how many calories they can eat in a day. This type of app often requires not just numeracy know-how, but some knowledge of nutrition. A user might calculate that vacuuming will burn 100 calories and allow themselves a few more calories for dinner, but this isn’t necessarily accurate. 

“The way MyFitnessPal and other activities work is activities of daily living like vacuuming or doing the laundry are all baked into her calorie goal,” Pagoto said. “That [skill] is more like nutrition literacy. She might be logging calories for all the things she is doing throughout the day and getting credit for things that are already baked into the equation.

“When I think about tools like this I worry that often times the prerequisites are such that it can actually contribute to health disparities. That is something we need to think about.”

But skill set prerequisites aren’t the only barriers for weight loss. Social factors and pressure also create challenges. Pagoto pointed to a study in the New England Journal of Medicine which linked weight to social network. 

“This is the world that [a dieter] lives in. This is the current that is working against her. Even if she is the strongest swimmer you can imagine, a current that strong will eventually exhaust you and make your behavior change attempt go awry.”

However, many have turned to social media as a way to find support that is lacking in their social ecosystem. Pagoto interviewed groups of people on their weight loss journey who had turned to a Twitter community. 

“When it comes to weight loss ... people rated their twitter [connections] as more supportive than even their family and friends,” she said.

Pagoto said there is promise for online resources, but they need to be created thoughtfully. 

“I think with technology there are so many opportunities to create social networks that facilitate that current,” she said. “Right now, social media is a bit of a free for all, and certainly there are people who are pretty good at it and find ways to create their own tribe, but I think we can get a lot more creative to link people in ways that create those meaningful relationships that carry their behavior change."