Understanding Support-Seeking On Lose It!

Lose It! is a diet and fitness app that combines diet and exercise tracking, weight goals, and social features to help users achieve their health goals. For my senior thesis at UCI, I looked at how users used Lose It! to seek and provide support for mental health concerns and what that meant for Lose It’s UX design.

Role: Lead Researcher. 2021-2022. University of California, Irvine Social Ecology Honors Program.

Skills: IBM SPSS, Excel, Behavioral coding, Public speaking and presentation, Statistical analysis, R Studio.

Question: How do users use Lose It! to seek support for their mental health?

Lose It! is a diet and fitness app that incorporates diet and exercise tracking, weight goals, and social features to help users achieve their health goals. For my senior thesis project, I wanted to understand a portion of users who used the social features of Lose It! to seek and provide mental health support.

Previous research had investigated discussion of mental health in both general and mental-health-focused social media platforms. However, there was a gap in academic understanding where topic-specific social media platforms were concerned: platforms such as Lose It!

Goal: Determine the ways in which users repurpose the social features of Lose It! to discuss mental health.

How did we do it?

I sought to answer my research questions by analyzing postings in the forum section of Lose It!. From over 300,000 original posts, I filtered for posts relevant to mental health by using a keyword search based off criteria from the Diagnostic and Statistical Manual of Mental Disorders. I then took proportional random samples of 400 posts from each of the top-four most common mental health categories for a total of 1,605 posts. These posts were analyzed using an iteratively-developed codebook.

Why analyze user posts?

Working with users’ postings was an exciting opportunity to understand naturalistic user interaction. If I had used an interview-based methodology, users may not have felt able to speak openly about stigmatized topics like their mental health struggles. By using an observational technique, I was able to understand user community formation and support-seeking.

Codebook Creation

The codebook I used was created using an iterative process:

  1. Create a working codebook from related research and previous findings.

  2. Code a sample of 100 posts.

  3. Identify missing themes.

  4. Revise the codebook to capture these themes.

  5. Repeat from step 2.

This process was repeated three times in total. Finally, the developed codebook was compared to the study’s research questions to identify whether the codebook would help achieve my goals. Irrelevant themes (i.e., those outside of the scope of the study) were removed.

The full codebook, with themes mapped to the research question they help investigate.

Data Analysis

I used the codebook to analyze 1,605 user postings, identifying themes within posts. I used a chi-squared test of equal frequencies to identify differences of theme prevalence between disorder-categories. Then, I conducted a series of 2-proportion z-tests to pinpoint exactly which themes and which categories were responsible for the difference in proportions. I was able to identify categories that had significantly higher or lower prevalence of certain themes, which helped me understand the primary mental health concerns of users on Lose It!.

What did we learn?

I found that the most-discussed mental health concerns of Lose It! users were depressive disorders, feeding and eating disorders, and substance use disorders. Users also commonly discussed general mental health. However, these figures may be impacted by disorder stigma or prevalence rates.

  • Finding: User Identification

    • Users identified themselves with their health information (diet, weight, exercise habits) when posting, even if their post had nothing to do with their physical health. Notably, diet, weight, and exercise are all able to be tracked by Lose It! users. 43% of all posts we examined mentioned the user’s weight! This suggests that users are influenced by the tracking design of Lose It! to identify with certain metrics.

  • Goal: Allow more user control over tracked metrics and identifications.

    • While many users find the trackers on Lose It! helpful, some expressed distress over them. For example, some users in recovery from eating disorders would use Lose It! to track exercise or nutrition, but were triggered by Lose It!’s calorie counter.

  • Suggestion: I suggest that Lose It! offer alternative and modular features. Options such as the ability to disable Lose It!’s calorie tracker or receive push notifications to remind the user to eat three meals a day would be useful to users in recovery.

  • Finding: Recovery Journeys

    • Part of my research looked at how users understood their descent into or recovery from mental illness. I found that most users posting on Lose It! about their mental health issues primarily were just beginning recovery. Most often, they had downloaded or returned to Lose It! as a recovery tool.

  • Goal: Represent many stages of the journey towards mental health

    • Recovery role models are important to recovery from chronic mental health issues. Without them, users may feel discouraged and turn away from recovery or Lose It!. By representing the full mental health continuum on the social portion of Lose It!, users will feel empowered to include Lose It! in both their physical and mental health plans.

  • Suggestion: I suggest that Lose It! encourage users to post about “recovery wins” to cultivate a community commitment to holistic recovery.

Current social interface on Lose It!

Possible redesign for a Lose It! feature to encourage sharing recovery wins

  • Finding: Stigma and Censorship

    • On Lose It!, any posts users make are pushed to the feeds of their friends, regardless of whether that post is made within a group. Many users were aware of this fact- and attempted to mitigate it with a variety of strategies.

A graph of the number of posts captured within each category

Strategies users employed to avoid public discussion of stigmatized topics

  • Goal: Empower users to disclose about themselves without switching platforms.

    • This pattern of use was problematic because it means users may be dissuaded not to use social features, leave Lose It!, or carry on conversations outside of moderator reach.

  • Suggestion: I suggest that Lose It! allow private groups and invest in developer-moderated mental health support groups.

  • Finding: Health Support Ecosystems

    • I found that users view Lose It! as just one part of a digital ecosystem to support their mental and physical health. This ecosystem includes other apps and users on other platforms. This finding indicates that Lose It! has an important role to play in supporting users’ mental health. However, this role may be relatively focused.

  • Goal: Integrate Lose It! with other parts of users’ health ecosystems.

    • Lose It! already offers integration with apps such as RunKeeper and Nike+ Running- Why not mental health support apps?

  • Suggestion: I suggest that Lose It! partner with mental health apps such as Headspace to encourage users to support their physical and mental health. Events could encourage cross-platform use or help identify correlations between mood and diet and exercise.

How did we make change happen? TBD!

I’m currently in the process of preparing to present my findings to the Lose It! team. It’s an exciting opportunity, and one that I hope will allow us to make changes to better support users’ mental health concerns on Lose It! Check back soon for updates!