Mark Koester

Personal Blog. A Data-Driven Life. Minding the Interstitial Spaces since 2007.

Data-Driven Health: Are You Tracking a Health Indicator or Healthy Habit?

There is a lot of excitement around how technology can be applied to improve our health. It seems like every day there is some new technology, wearable, pill, test, service or app aiming to track, monitoring, improve or cure us of each and every bodily aligment. There is even a growing number of companies and tools aiming at human optimization, neuroenhancement, and peak performance, sometimes called “biohacking.”

For basically all of health tech, the goal is to improve our health, and, whether its a wearable, test or something else, each is claim to be tracking some our health.

But what are these technologies tracking? And how do they fit into the pursuit of data-driven health and wellness?

Biohacking and endless health trackers, but where has it gotten us?

The focus in the healthcare and health tech space has largely been on both major diseases and the pursuit of healthier, active lives. Hospitals, doctors and other health care professionals largely focus on treating diseases, while trainers, coaches, nutritionists, teachers and some advocates of functional medicine dedict their work to fitness and wellness. Increasingly though we see companies, blogs and services dedicated to what is often called “biohacking.”

Biohacking refers to the idea of applying IT and tech “hacks” to biological systems, most notably our own bodies. Basically, biohacking is the practice of changing your biology and environment towards the express aim of controlling and enhancing your body, mind and life. While I rarely use that word, biohacking aligns with various aspects of what I call self-tracking, the quantified self, and “data-driven life,” especially in how it relates to our health.

But where has all of these health-related tools, wearables and services gotten us?

Obesity continues to rise. Acording to the W.H.O (2018), the world has seen a 10x increase in number of obese children and adolescents ages 5-19 in the past four decades, going from just 11 million in 1975 to 124 million in 2016. All told, that equates to 1 in 5 of children globally are overweight or obese. According a 2009 report from the CDC, 65.7% of American adults were estimated as overweight in 2010, which is a marked increasing trend from 39.4% in 1997, 44.5% in 2004, and 56.6% in 2007.

Basic good nutrition still manages to baffle most “normal” folks. Anyone who follows nutrition to some extent in the media could feel overwhelmed by seeming flip-flops on what sciences says about eating do’s and don’t’s. At least once I year I have to google some new diet or eating protocal I hear about from someone. In spite of a growing consensus about the basics of good nutrition (see this article in the Atlantic or a well-written dialogue for no-non-sense summaries), we people’s eating habits are pretty lousy.

What’s to be done?

Wearables to the rescue! Maybe not so fast…

One of the most commonly reported “heath” trackers used today is wearables. Nearly 1 in 4 American adults have and use a wearable with even higher rates in Asia with over 50% in China and India among others, according a recent report from eMarketer (2019 ). This wearable usage trend continues to rise too.

In fact, a survey of 16 Western countries that went beyond just wearables found that :

one in three people track their health and well-being with the help of a Quantified Self tool (i.e., online or mobile applications, activity trackers, smartwatches, or clips), and activity trackers represent more than 50% of the wearable market. (quoted in Stiglbauer, 2019)

In spite of the seemingly endless options for tracking, wearables, and “biohacking” your health, a good deal of skepticism remains. And rightly so. When it comes to health tech and especially wearables, we’ve already gone through a couple hype cycles over the years. Everyone signals out the need to show themselves wearing this or that wearable, but then complain it annoys them with notifications or they are can’t understand why their weight hasn’t changed.

Even the medical results have been somewhat lackluster when it comes to health benefits of a wearable and health tracking apps (see Stiglbauer, 2019). Nearly everyone who is slightly in the technology space already has at least one forlorn wearable laying about or some installed health app that sits on your homescreen unused.

Wearables don’t make you healthier.

Frankly, while a few studies have shown promise and a better way to conceptualize their use (Hermsen, 2017), it shouldn’t take an academic meta-analysis to realize wearables aren’t a magic bullet to better health.

First, merely having a activity tracker doesn’t change the underlying habits we must undertake to be active, get exercise, sleep, and eat right. Having a thing on your wrist can’t make you do this (at least not yet).

Second, wearables don’t track your health status anyways. In fact, in most dimensions, wearables and much of consumer medtech weren’t designed to monitor health status or provide medical-grade health indicators.

Excluding ECG or pulse oxyimeter in some devices, these device are actually tracking your commitment and enactment of healthy habits. Admittedly your movement and sleep history might be used to see trends and interpret your heath status or underlying factors contributing to your health situation, but so far we’ve yet to see a publicly sold wearable that predicts either how long you will live or a medically veriable standard of your health situation. That’s just not what they do.

So, this leads me to one question we all should be asking: What are we tracking when we track and monitor our health?

Tracking a Health Status or a Healthy Habit?

Health is the most motivation for why people self-track and, along with fitness, it represents a huge portion of the wearables and quantified self space. We all want to be healthier, fitter and feel better. But not all health tracking services should be conflated.

In fact, there are many dimensions to track and monitor your health, and there are hundreds of companies and tools geared towards providing goods and services in all of those ways. But it’s time that we realized that not all health tracking is equal, nor should they be.

We need to separate data-driven health into two groups: those that track and monitor our health status and those that track and support us in our healthy habits and commitments.

By health status, I mean any number of assessments, tests and tools that allow you to diagnosis disease, determine how healthy/unhealthy/fit you are. You might instead call them health indicators or even better use my favorite term for them, biomakers. Typically, you get your health status checked when you visit your doctor, get a blood test or measure your blood pressure.

Health status indicators are scientifically-validated standards of our health. First, they are backed by an accurate way to measure a part of your body and health giving you a number on a scale or range. Second, based on research studies, large populations and aggregate data, you and/or your doctor should be able to read and interpret where you stand health-wise.

For example, blood pressure is a well-established way to track and measure your health status. A normal resting blood pressure for adults is 120 systolic over 80 diastolic. 120/80 is healthy while higher than 120/80 is a potential sign of Prehypertension and a systolic between 140 and 159 is diagnosable as hypertension. In short these are actual numbers that indicate your situaiton. This is also possible for nearly all blood biomarkers too.

Basically a health status indictator or a biomarker takes an accurate measurement that you can put in context to actually know if you are healthy or not. Similarly these numbers can be used across time to see trends and watch for changes.

By contrast, a lot of technologies and tools exist to support and track what we might refer to as our healthy habits and commitments. They include most wearables, smart watches, running and other fitness apps, meditation apps and whole range of things. These heathy habit trackers are great, and they save use mentral space by keeping a record of the activities we do to stay healthy, active and improve our fitness. They can also nudge you towards a better lifestyle (and, if you are like me, give you pretty charts and graphs too!).

But if we are honest, the vast majority of what we think of as “health trackers” don’t track how healthy or sick we are; they actually track our adherence to certain healthy habits, like daily steps, walking, or nighly sleep. We can know about a range of improvements in our fitness, even some that might be tied to our baseline health status (more on this shortly). But they can’t and do not indicate our actual health status.

So, if we return to the question of what we are tracking, most apps and wearables track our healthy habits, goals and committments. By contrast, tracking our actual health requires us to measure a biological indicator or biomarker that is indicative and predictive of our biological health situation. Most of these time means going to a doctor or clinic for a test, though greater access is arriving for home health care.

While this conceptual division between health status trackers and healthy habit trackers can help with understanding what and why you track certain things, this division isn’t always so black and white. Quite a few trackers could be used to either purpose. And some areas, like Sleep, Weight, Active Heart Rate, and Heart Rate Variability (HRV), are both logs of our healthy habits and commitments AND potential markers of our health status too. This points takes some explaining so let’s try and break it down more simply.

How Tracking a Healthy Habit Might Provide a Health Status Indicator

Most health tests monitor an aspect of our body, and most healthy habit trackers passively record our activity, steps, sleep, heart rate, and more. The reality is that most lifestyle diseases, like obesity, diabeties, heart disease and many others, which we can find indicators in medical tests, are the product of daily habits. For example, if you do little or no physical activity and eat poor (all unhealthy habits), then there is high statistical liklihood that your health status will be poor.

So, an interesting thing happens when we look at our regular activities tracked using a wearable, because they can often provide signals of worsening or improving healthy. On the negative side, chronic behaviors, sleep deprivation, high stress and inflammation, or not taking your medicine regularly, can can lead to medical conditions. At the same time, on the positive side, getting more activity and regular sleep might indicate an underlying health status improvement.

To put it in practical terms, excuding specific cases of major sleep disorders, we should group sleep tracking as a form of healthy habit tracking. The goal is to pursue the habit of sleeping more and we track to see how we are doing. But as multiple studies have shown not getting enough sleep and cronic sleep deprivate can lead to a range of health outcomes, like higher instances of cancer, higher probability of infection and colds and even worse mortality rate (Walker, 2017). This is one reason why I think, in spite of not enough discussion and user-friendly tools on how to do this, there is a lot of potential in applying sleep tracking to monitoring your health. This could similarly be applied to the sedentary life.

Similarly, most of fitness tracking is largely about tracking your habit, improvements and training. For example, how far or fast did I run or cycle? How many reps at a certain weight did I lift? For example, we might use running numbers for data-driven marathon training. Interesting there is one aspect or number in fitness tracking that can be used as a health indicator and biomarker, and that’s VO2 Max. VO2 Max is your maximum-oxygen-processing capacity. It’s how well you can move oxygen while under stress. It varies from athlete to athlete depending on the level of cardiovascular fitness. It can be improved through training too. While at its core it represents your current fitness level, VO2 Max has also been studies by medical researchers and found to have predictive value about your health status, chance of certain diseases, heart health and even mortality risk.

When you look a list of health trackers and tools, quite a few could fit either or both designations. Weight could be used to classify obesity or track a fitness goal. Heart Rate Varability (HRV) can also serve as a look at daily and chronic stress and other physical changes, like training adaptation. Interestingly even a medication or supplements reminder app, which largely serves the role of supporting a healthy habit of taking your vitamins and medicine, also has the potential tell you about your health status in view of how critical medication adherence is with certain diseases and treatments.

Data-Driven Health Means Knowing What You Are Tracking

At the end of the day, personal data-driven health means knowing what you are tracking and towards what purposes. Is it helping you get an idea of how heathy you are? Or is it tracking your adherence to certain habits and health goals?

Overall, I think there is a lot of potential and promise in both sides of heath tracking. We are seeing more, cheaper, and better access to ways to monitor your health status as well as interesting medical usages of that data for a deeper look at health, wellness and disease.

Personally, even though I’m partialy to more advanced daily tracking methods and exploring new areas, I think the single best way to track our health status is still regular blood tests. Forget Theranos. Forget the multivitiamins. Get a regular blood test and ask for a copy of the result. Then make lifestyle changes or take supplements based on your biomarker data, not because you read some article that says you should.

When it comes to personal trackers, wearables and other ways to measure my body and track life activities like workouts, I’ll admit to an on-going obsession with the so-called tracking tech. But, hopefully as this post indicated I’m skeptical too.

To reiterate, in nearly all cases and devices, we aren’t tracking our health status when we wear an activity tracker or use some fitness app. Instead, these are tools that enable us to track healthy habits and fitness commitments. They collect data while we do that activity, like running, and keep a log. Some help us with a data-driven training plan. Mostly they can and should nudge us to be active and support us in positive habits and routines. For example, I appreciate how my watch reminds me to stand up regularly and encourages me to move about. Having a daily score works for me too. Similarly, my suppment tracker and habit trackers help me when I am building a new habit and remind me when I forgot.

In fact, I’d argue that the principal benefit and focus of most health tech tools should be about setting goals, building habits and behaviorial change. Getting people to create and stick to good habits and routines is the principal challenge of healthcare today. These are really hard challenges, but they are key if we want to pursue a meaningful data-driven health individually and , society-wide.

So next time you are thinking about your health and how to track or monitor it, be sure to ask yourself: Am I tracking a health indicator or healthy habit?



Best of luck and happy tracking!



Academic References:
  • Ajana, B. (2017). Self-Tracking: Empirical and Philosophical Investigations (1st ed. 2018 ed.). Palgrave Macmillan.
  • Center for Disease Control (CDC). (2019). “U.S. Obesity trends”. Available Online at https://www.cdc.gov/obesity/data/index.html.
  • Cleland, I., Nugent, C., & Lee, S. (2016). The ground truth is out there: challenges with using pervasive technologies for behavior change. Proceedings of the 10th EAI International ….
  • Hermsen, S., Moons, J., & Kerkhof…, P. (2017). Determinants for sustained use of an activity tracker: observational study. JMIR mHealth and ….
  • eMarketer. (2019). Wearables 2019. Retrieved 6/28/19, https://www.emarketer.com/content/wearables-2019.
  • Stiglbauer, B., Weber, S., & Batinic, B. (2019). Does your health really benefit from using a self-tracking device? Evidence from a longitudinal randomized control trial. Computers in Human Behavior.
  • Walker, M. (2017). Why We Sleep. Simon and Schuster.
  • World Health Organization (WHO). (2018). World health statistics 2018: monitoring health for the SDGs, sustainable development goals.

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