‘Tweet it Off:’ Leveraging Social Media for Health Behavior Change

More than 72 percent of online adults — and 89 percent of online young adults — belong to at least one social network, according to a 2013 Pew Research Center survey. The average Facebook user spends more than 40 minutes per day surfing the site, according to the company’s CEO.

Given stats like these, the broad reach of Facebook, Twitter and other sites could provide a new tool to help more people lose weight and make other health behavior changes, according to University of Massachusetts Medical School psychologist Sherry Pagoto, PhD, an expert in the behavioral aspects of obesity control and cancer prevention.

iStock_000054305248_MediumPagoto, who presented her research here, was interested in translating an evidence-based weight loss program called the Diabetes Prevention Program (DPP) into something that could be shared via social networks. The DPP trains “lifestyle coaches” to help people at risk for diabetes learn to eat more healthily and increase their physical activity. The Centers for Disease Control and Prevention  runs the program at more than 700 sites throughout the U.S., through a partnership with local organizations like the YMCA.

An online program could potentially treat many more people, according to Pagoto. In an initial study, she organized 45 participants who wanted to lose weight into four groups. One group participated in a traditional 12-week in-person DPP. Another participated in a combined in-person program and Twitter group. A third participated in just a Twitter group. And the fourth also participated in the in-person and Twitter program, but with the additional factor that the participants suffered from depression.

In the Twitter program, trained facilitators logged in daily to tweet links to content from the program, as well as generate discussion among participants. The participants would also support each other – one participant, for example, tweeted a picture of doughnuts from her office kitchen with the caption “look what my office does for Halloween!” and others chimed in to encourage her to resist the temptation.

In the end, Pagoto found that the Twitter program worked for patients who were not depressed — the Twitter-only participants lost as much weight as the in-person and the Twitter-plus-in-person ones – but it was not effective for the depressed patients.

In a follow-up study, Pagoto tested a Facebook version of the program, this time also providing incentives to some participants to post more often. She wanted to see if encouraging these “superusers” would help everyone lose more weight. That study just ended, Pagoto said, but early data suggest that the program did help participants lose weight, though the effect of the superusers was unclear.

So far, all of Pagoto’s studies have used closed, private groups. But one of the advantages of Facebook and Twitter is the way in which popular groups, posts and memes can spread exponentially. So in future research, Pagoto wants to open up her studies and allow her participants to invite friends into the groups throughout the study.

“There are IRB issues to figure out” and methodological ones too, she said. But the payoff could be worth it. “It has the ability to take on a life of its own.”

APA Working Group Reports on Stress and Health Disparities

An APA working group formed in 2013 to explore stress and health disparities presented its first findings Friday at the APA convention in Toronto, focusing on depression, cardiovascular disease and cancer.

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Not surprisingly, these problems occur disproportionately among African-Americans, people of low socioeconomic status and sexual minorities. Research has found that health behaviors are critical contributors to these disparities, the researchers said. For instance, African-Americans may be more likely to succumb to heart disease because they have less access to health care services or fewer opportunities to eat healthy. There are psychological contributions as well, specifically stress.

During the symposium, Elizabeth Bronodolo, PhD, a professor at St. John’s University in New York City, discussed the importance of understanding the various levels of stress to which people from  vulnerable groups are exposed. In addition she stressed the role of community factors, such as neighborhood violence or a loss of jobs in a community. The working group also looked at how stress contributes to health disparities, including the development of social cognitive schemas that contribute to how one views the world, and thus sets up vicious cycles of stress.

Also in the presentation, Cheryl Woods Giscombe, PhD, described the working group’s recommendations, many of which touched both on individual interventions that take into account the context in which they are delivered, and on population-level interventions.

Health disparities are one of the greatest challenges to the health-care system and to population health at large. APA should be applauded for taking a leadership role in attempting to mitigate this problem.

Women’s Life Problems Aren’t Always Medical Problems

Medicine and the media are helping to medicalize everyday life experiences like anxiety, sadness, weight loss, menopause, and reproductive health, and women are the primary targets, according to psychologists and co-authors of a new book, “The Wrong Prescription for Women,” who spoke at a symposium on the topic.

While it’s important to acknowledge and treat real illness, women are too often prescribed medicines and medical procedures, more so than men, even when their experiences are normal.  “Many of these treatments aren’t problematic,  but the problem is they make normal parts of our lifes and bodies and experiences [seem abnormal]. The pharmaceutical industry created [these issues] to sell drugs to everyone, and sadly they’ve been very effective at this,” said Maureen McHugh, PhD, of Indiana University of Pennsylvania.

For example, modern society has a tendency to look at the prolonged grief that may naturally accompany a loss as depression that needs medication. Women are more likely to express their grief more explicitly and intensely, said Leeat Granek, PhD, Ben-Gurion University of the Negev.

“Women [have long been] expected to carry grief for their families and communities and states. Today, women are being pathologized for doing this job too well,” Granek said. Society — and clinicians — see grieving as a much briefer process with a deadline for moving on, which can be as little as two weeks, she said.

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Women are far more likely than men to be diagnosed with depression and to be prescribed medications for it, which can be a broad form of social control, said Alisha Ali, PhD, of New York University. “If you’re a deviant outside the norm, we are believed to have the responsibility of ‘fixing you’ so we can bring you inside of the norm,” she said.

However, women most prone to depression are also the most marginalized, including those who are abused, poor or victimized. When they take medication for depression, women report reduction in self-destructive thoughts, but also report apathy and disengagement, Ali said.

“Therefore, treatment for depression chemically neutralizes the very feelings most needed to fight for social change. We need approaches to depression that can support women in changing the material conditions of their lives. We need empirical research documenting the effectiveness of feminist-informed approaches to treating depression and other mental health problems,” she said.

Even menstruation is becoming taboo, said Jessica Barnack-Tavlaris, PhD, of The College of New Jersey. Perhaps influenced by advertisements that promote convenience, women are increasingly using contraceptives to suppress menstruation, and doctors giving them to young women to counter the effects of early puberty.

“Viewing menstruation as negative, not normal, or unnecessary has implications for women’s physical and emotional well-being. Some women will then experience shame with menstruation and those who do that are more likely to self-objectify,” she said.

Mindy Erchull, PhD, associate professor at the University of Mary Washington, spoke of how media promote an unnaturally thin body, with the result that it has become the norm for women to be dissatisfied with their bodies.

The thin ideal now often encompasses a fit ideal, especially in advertisements, Urchell said – a dual standard that may be even harder to achieve, as “Most people assume that to be fit you have to be thin. But muscles take up room,” she said. At the same time, breasts are seen as desirable, yet they mainly consist of body fat.

Even public health officials may cause undue worrying with the so-called war on obesity that primarily targets women, said Christine Smith, PhD, of the University of Wisconsin-Green Bay. Women are more likely to be labeled obese and more likely to turn to bariatric surgery – now offered to women who are as little as 20 pounds overweight — which can have serious side effects, such as digestive problems and nutritional deficiencies. Yet the link between weight and health isn’t definitive, she said: “The war on obesity is common trope … that we need to have people lose weight, otherwise our health system is going to collapse.”

Worrying about your body can limit women’ lives on multiple levels, including “how we think of our bodies, of ourselves and how we think of other women,” McHugh said. “When you feel your or your body isn’t good enough, it makes it hard to become socially engaged. And worrying about our thighs takes attention away from other activities.”

Weight Stigma, Stress and Obesity

We have all heard about the perils of the obesity epidemic and its cost ho society. But something you may not know is that it’s not all about willpower and the make-up of the food environment. In this regard, Dr. Janet Tomiyama, an assistant professor at UC Los Angeles, gave a spirited, and impressively convincing, invited talk as part of Div. 38’s programming on the insidious role of weight stigma.

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So how does feeling stigmatized hurt your waistline? In a recent paper, she outlines a model in which weight stigma increases one’s psychological stress, leading to increases in one’s stress physiology- in particular, levels of cortisol (that pesky stress hormone). Cortisol has many known effects, including contributing to visceral fat deposition and a drive to eat, both of which certainly undermine the goal of losing weight. Not only does weight stigma fail to motivate individuals to lose weight, it may, as Tomiyama hypothesizes, lead to additional weight gain.

Is weight stigma that prevalent? Maybe in the general population, but not among experts or clinicians who treat obese individuals, right? WRONG. In another recent study, Tomiyama examined the explicit and implicit biases against obesity among attendees of a national obesity conference. Participants (around 200 of them) completed several measures of bias, and consistent with Tomiyama’s hypothesis and prior research, even the experts showed a high level of negative bias toward obesity. In fact, compared to a similar study carried out 10 years earlier, explicit bias is actually on the rise. To follow up on this work, she turned to the laboratory and subjected participants to pictures of thin and heavier people. The participants were under the impression that they were there to judge the pleasantness of different lotions (all the lotions were actually odorless). It turns out that individuals exposed to pictures of obese people rated the odors as less pleasant than when exposed to leaner stimuli. This is disturbing, of course, but also a fine example of great social psychology.  Tomiyama described a number of other studies supporting her model, as well as several forthcoming studies.

Weight stigma reflects a novel, and often unacknowledged, contributor to the obesity epidemic. It will take further scientific creativity from Tomiyama and others to move weight stigma onto the national stage. Until then, as I told Tomiyama after her talk, “if I was still an undergraduate and had heard you talk, I would have wanted to become a social psychologist.”