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How mobile phones can promote
                  vegetable consumption

         Stephanie Carter and Neema Moraveji




                                               “Tomatoes are NOT veggies!”




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Executive summary
     10 people (moderate to healthy eaters age 25-35) tracked their veggie-eating habits
     by taking photos of their meals with their phones. There were two conditions:
        – Individual (take photo, get feedback)
        – Team (Two 3-person teams that competed within the team as well as against
          the other team)
     Other variables were also varied as an experiment:
        – Image-based feedback about consumption status once vs. twice a day
        – Showing daily score of one team to the other
        – Phrases on feedback images encouraging them to eat more, etc.


     Results
     People over-predict the number of veggies they eat. The reality is that people only
     ate about 2 veggie servings per day.
     Social feedback, as compared to individual conditions, led to:
        – improved engagement
        – larger predictions about vegetable consumption habits
     Counting portions, rather than calories, is a promising direction.

Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
The Interface

             Your lunch: 3 veggie portions! Nice!




             Today: 3 veggie portions, 80% of rec. 3rd place today.




Concept 1                                                             Concept 2
Different food groups, amount consumed, single                        Veggie-only, portions, social vs. individual.
iconic representation of food group

    Stanford University, Spring 2010
    CS377v - Creating Health Habits
    habits.stanford.edu
How it
                                   worked




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Taking photos of food? Really?

         Taking a photo of your meal (a growing practice) has been shown to improve
         eating habits in a recent university study.


         Using human-based computation, data can be extracted from photos. This has
         been done with google image labeler but hasn’t been applied readily to food
         data.


         VeggieMagic participants said that photographing food was not difficult or
         socially awkward.


         Photos can be sent/recvd over MMS or Email.




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Recruiting and instructing participants
                   http://www.youtube.com/watch?v=7lUpRnWIR-c




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Communicating with participants




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Consumption behavior data




 Stanford University, Spring 2010
 CS377v - Creating Health Habits
 habits.stanford.edu
Consumption
                                      behavior
                                         visuals
                                        (of one
                                    participant)




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Results




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Results




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Survey feedback by phone and email gave
insight into user behavior and reactions




 Stanford University, Spring 2010
 CS377v - Creating Health Habits
 habits.stanford.edu
How did you feel when
a veggie you had eaten
was not accounted for?
                                   I felt like I had been slighted! I felt like
                                   something was wrong with the
                                   "system" and I felt like I wasn't being
                                   rewarded. It made me trust the
                                   system less but I also noticed that I
How did you feel when              really wanted to get the "credit."
you discovered certain
foods were not counted
as veggies?                        I felt like Homer Simpson. I thought
                                   I knew what my veggies were.




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Findings: User interface
   People anthropomorphize the service very quickly.

   Getting ‘human’ feedback (e.g. “Nice job! 3 veggies in one meal!”) was motivating.

   Not always clear what veggie-icon mapped to what portion of the user’s photo.

   Nice that it didn’t require any app installation.




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Findings: Social interaction
  It isn’t as socially awkward to take photos of your food as was predicted. It’s common, actually.

  How would teams form? We put 3 friends together for one team and another team with 1
  almost-stranger and a boyfriend/girlfriend couple in it.

  When you don’t know your team members, social feedback wasn’t as impactful. When you
  know them, it was very impactful.

  Seeing the status of the other team was motivating.

  “Didn’t want to let the team down.”
  “I have a competitive side.”

  Accountability: to your group, to your self. But accountable to yourself is less strong unless
  there were longer term goals and some progress is shown over time.

  Nobody asked for calories, fat, etc.




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Findings: Consumption behavior
All participants predicted they would eat more veggies than they actually ate.

On average, participants ate just over half as many veggies as they were asked to eat (asked for 4,
they ate 2). Over the course of a week, people only eat about 15 portions of a veggies.

Diversity in vegetable-eating seemed to increase over time.

Disproving our hypothesis, there is no “significant” difference between veggie consumption in lunch
and dinner. We hypothesized dinner would have more because feel they have to ‘catch up’.

The ‘social’ condition (6 team users) predicted and ate more than the individual group.

Smart adults don’t know what foods are vegetables vs. fruits, grains, or berries (avocados, tomatoes,
corn and olives are confusing). VeggieMagic helps them understand.

                                   The average number of veggies eaten per meal overall:         2.51
                                   For individuals:       2.33
                                   For team members:      2.72

                           data    The avg number of veggies predicted eaten per day, overall:   3.5
                summaries for      For individuals:       3.25
                                   For team members:      3.8
                11 participants
                                   Lunch average:          1.3
                                   Dinner average:         1.2
                                   Lunch total:            72
                                   Dinner total:           66

Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Findings: System
  Doing this by hand is not scalable.

  It works equally well with Blackberry or iPhone.

  After an interview with a nutritionist, she seemed to think it would be feasible to have nutritionists label
  veggies in the images.

  Tracking strange (non-foods) is hard - this aspect needs refinement.

  Only tracking veggies may be limited in the long term - perhaps in the future we should expand to
  track all food groups?




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
What’s next?
      We are planning a design-based research project over the summer to study:
     1) photo-based data collection
     2) social presence
     3) portion-based measurement... how can it be used to improve dietary habits?


      We are recruiting a tech lead to build out the system.
      Our goal: run 100 people in August to answer our “open questions” [see appendix]
      Submit to ACM IUI 2011 (Sept. 2010 deadline).




Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Appendix




   Stanford University, Spring 2010
   CS377v - Creating Health Habits
   habits.stanford.edu
Open questions
    Do we have to be more direct? Will self awareness of veggie consumption ultimately drive
    behavior change? Does this hope fall into the trap of believing that ‘information should drive
    behavior change’? Do we need more specificity? i.e. [text--> “eat a pepper right now”] or
    [Carrot Mondays- carry a carrot around with you all day. Eat it if you wish.]

    Do we need to display a direct mapping between meal and detected veggies? Do we
    need to show people exactly how many veggies came from each meal? Do we need to have
    a specific icon for “spinach” or can all “green leafy veggies” be represented by a single icon?

•   Is this sustainable? Would it have the same impact over time or would you get sick of it? Is the goal
    to continue using it?
•   How should social work? Should we do collaborative or competitive social feedback? (between- or
    within-teams) How will teams be formed?
•   How to deal with data-collection problems? How should the photo-taking work? Can you clarify an
    image with optional text? What if you forget to photograph and you ate your meal? How does error-
    correction work? How do send data if photo is impossible?

    How should triggers work? A trigger twice a day might get annoying/invisible. Do we make
    “smart triggers” that remind you when you haven’t send photos recently?


      Stanford University, Spring 2010
      CS377v - Creating Health Habits
      habits.stanford.edu
Theoretical Justifications
    Motivation
          • acceptance, fear- awareness of what i eat, how i compare to friends, and
             how my eats compare to recommended eats
          • hope - my consumption is not just about numbers- I am what I eat is visually
             represented and gives me a picture of how i could improve my wellness.
          • pleasure - It is funny, and approachable information, acting on which might
             lead me to feel better

    Trigger
          •          spark - request for input of daily photo of dinner or lunch
          •          facilitator - receipt of daily visuals of self and friends
          •          facilitator--> signal - cumulative visualization of my monthly consumption,
                     on my fridge, or on my computer desktop.

    High Ability - The simplicity factors are:
          • brain cycles are reduced (no calorie counting)
          • time is reduced (only quick input needed from user, not time to analyze)
          • physical effort is reduced (use one hand to take quick photo of meal)
          • socially acceptable (people think you’re just texting when you take photo of
              food. also, your friends are your teammates, so it’s fun)
          • routine (smart phoning- texting, checking email- is already a common
              complement to mealtime)
          • money (information is free)

Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Initial user feedback that guided roll-out
  ACTIONABLE:
  I want it compared to what a healthy diet is.
  see progress over time- competing against self
  What about a sandwich?
  What about snacks?
  Individual or social? Trusted friend circle only?


  FULL LIST:
  “[if] i have to send my girlfriend this info, maybe i’ll get a salad instead.”

  “I might not like results but think it could be interesting. would depend on how it was displayed. i wouldn’t want it to just be abstract,
  like here’s what you ate, or here are calories. i want it compared to what a healthy diet is. want to know where i’m off and where ok.
  eg: fine on carbs and veggies but bad on saturated fat. i need a benchmark.

  “i want to be able to see progress over time- competing against self.

  “It would be cool is if you could link up the data to restaurants in my area. You need to eat more of x, and here’s some places where
  you could get x within your budget.

  “What about a sandwich? How do you know what veggies are in there?”

  “I snack a lot. Each time?”

  “The link to friends puts me off a bit. it’s good in theory but i don’t think i’d use it. maybe if i was more proud in my eating habits i might
  like it, but i find it invasive and don’t think i would want that. i prefer seeing my own progress. i already know friends eat more than
  me. I don’t think my friend will keep me accountable but someone you’ll live with might, like girlfriend. but still ultimately prefer to do it
  alone. if it’s just internal, it might be easier too.

  “I already self-monitor myself by looking and thinking about my garbage. I’d love to see a visualization of all my garbage. I like the
  idea of showing that concept with food and veggies.”

Stanford University, Spring 2010
CS377v - Creating Health Habits
habits.stanford.edu
Related work
      Photographing meals 'could help weight loss'
Taking a photograph of your meal before you eat it can encourage weight loss, a new study suggests.
Slimmers began to eat healthier food when they were asked to take a picture of what they were eating, scientists found.
http://www.telegraph.co.uk/health/2674514/Photographing-meals-could-help-weight-loss.html
http://www.daviddeal.info/research/photodiaries.shtml

http://shareurmeal.com/




    Stanford University, Spring 2010
    CS377v - Creating Health Habits
    habits.stanford.edu

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VeggieMagic - How mobile phones can promote vegetable consumption

  • 1. How mobile phones can promote vegetable consumption Stephanie Carter and Neema Moraveji “Tomatoes are NOT veggies!” Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 2. Executive summary 10 people (moderate to healthy eaters age 25-35) tracked their veggie-eating habits by taking photos of their meals with their phones. There were two conditions: – Individual (take photo, get feedback) – Team (Two 3-person teams that competed within the team as well as against the other team) Other variables were also varied as an experiment: – Image-based feedback about consumption status once vs. twice a day – Showing daily score of one team to the other – Phrases on feedback images encouraging them to eat more, etc. Results People over-predict the number of veggies they eat. The reality is that people only ate about 2 veggie servings per day. Social feedback, as compared to individual conditions, led to: – improved engagement – larger predictions about vegetable consumption habits Counting portions, rather than calories, is a promising direction. Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 3. The Interface Your lunch: 3 veggie portions! Nice! Today: 3 veggie portions, 80% of rec. 3rd place today. Concept 1 Concept 2 Different food groups, amount consumed, single Veggie-only, portions, social vs. individual. iconic representation of food group Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 4. How it worked Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 5. Taking photos of food? Really? Taking a photo of your meal (a growing practice) has been shown to improve eating habits in a recent university study. Using human-based computation, data can be extracted from photos. This has been done with google image labeler but hasn’t been applied readily to food data. VeggieMagic participants said that photographing food was not difficult or socially awkward. Photos can be sent/recvd over MMS or Email. Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 6. Recruiting and instructing participants http://www.youtube.com/watch?v=7lUpRnWIR-c Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 7. Communicating with participants Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 8. Consumption behavior data Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 9. Consumption behavior visuals (of one participant) Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 10. Results Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 11. Results Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 12. Survey feedback by phone and email gave insight into user behavior and reactions Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 13. How did you feel when a veggie you had eaten was not accounted for? I felt like I had been slighted! I felt like something was wrong with the "system" and I felt like I wasn't being rewarded. It made me trust the system less but I also noticed that I How did you feel when really wanted to get the "credit." you discovered certain foods were not counted as veggies? I felt like Homer Simpson. I thought I knew what my veggies were. Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 14. Findings: User interface People anthropomorphize the service very quickly. Getting ‘human’ feedback (e.g. “Nice job! 3 veggies in one meal!”) was motivating. Not always clear what veggie-icon mapped to what portion of the user’s photo. Nice that it didn’t require any app installation. Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 15. Findings: Social interaction It isn’t as socially awkward to take photos of your food as was predicted. It’s common, actually. How would teams form? We put 3 friends together for one team and another team with 1 almost-stranger and a boyfriend/girlfriend couple in it. When you don’t know your team members, social feedback wasn’t as impactful. When you know them, it was very impactful. Seeing the status of the other team was motivating. “Didn’t want to let the team down.” “I have a competitive side.” Accountability: to your group, to your self. But accountable to yourself is less strong unless there were longer term goals and some progress is shown over time. Nobody asked for calories, fat, etc. Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 16. Findings: Consumption behavior All participants predicted they would eat more veggies than they actually ate. On average, participants ate just over half as many veggies as they were asked to eat (asked for 4, they ate 2). Over the course of a week, people only eat about 15 portions of a veggies. Diversity in vegetable-eating seemed to increase over time. Disproving our hypothesis, there is no “significant” difference between veggie consumption in lunch and dinner. We hypothesized dinner would have more because feel they have to ‘catch up’. The ‘social’ condition (6 team users) predicted and ate more than the individual group. Smart adults don’t know what foods are vegetables vs. fruits, grains, or berries (avocados, tomatoes, corn and olives are confusing). VeggieMagic helps them understand. The average number of veggies eaten per meal overall: 2.51 For individuals: 2.33 For team members: 2.72 data The avg number of veggies predicted eaten per day, overall: 3.5 summaries for For individuals: 3.25 For team members: 3.8 11 participants Lunch average: 1.3 Dinner average: 1.2 Lunch total: 72 Dinner total: 66 Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 17. Findings: System Doing this by hand is not scalable. It works equally well with Blackberry or iPhone. After an interview with a nutritionist, she seemed to think it would be feasible to have nutritionists label veggies in the images. Tracking strange (non-foods) is hard - this aspect needs refinement. Only tracking veggies may be limited in the long term - perhaps in the future we should expand to track all food groups? Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 18. What’s next? We are planning a design-based research project over the summer to study: 1) photo-based data collection 2) social presence 3) portion-based measurement... how can it be used to improve dietary habits? We are recruiting a tech lead to build out the system. Our goal: run 100 people in August to answer our “open questions” [see appendix] Submit to ACM IUI 2011 (Sept. 2010 deadline). Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 19. Appendix Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 20. Open questions Do we have to be more direct? Will self awareness of veggie consumption ultimately drive behavior change? Does this hope fall into the trap of believing that ‘information should drive behavior change’? Do we need more specificity? i.e. [text--> “eat a pepper right now”] or [Carrot Mondays- carry a carrot around with you all day. Eat it if you wish.] Do we need to display a direct mapping between meal and detected veggies? Do we need to show people exactly how many veggies came from each meal? Do we need to have a specific icon for “spinach” or can all “green leafy veggies” be represented by a single icon? • Is this sustainable? Would it have the same impact over time or would you get sick of it? Is the goal to continue using it? • How should social work? Should we do collaborative or competitive social feedback? (between- or within-teams) How will teams be formed? • How to deal with data-collection problems? How should the photo-taking work? Can you clarify an image with optional text? What if you forget to photograph and you ate your meal? How does error- correction work? How do send data if photo is impossible? How should triggers work? A trigger twice a day might get annoying/invisible. Do we make “smart triggers” that remind you when you haven’t send photos recently? Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 21. Theoretical Justifications Motivation • acceptance, fear- awareness of what i eat, how i compare to friends, and how my eats compare to recommended eats • hope - my consumption is not just about numbers- I am what I eat is visually represented and gives me a picture of how i could improve my wellness. • pleasure - It is funny, and approachable information, acting on which might lead me to feel better Trigger • spark - request for input of daily photo of dinner or lunch • facilitator - receipt of daily visuals of self and friends • facilitator--> signal - cumulative visualization of my monthly consumption, on my fridge, or on my computer desktop. High Ability - The simplicity factors are: • brain cycles are reduced (no calorie counting) • time is reduced (only quick input needed from user, not time to analyze) • physical effort is reduced (use one hand to take quick photo of meal) • socially acceptable (people think you’re just texting when you take photo of food. also, your friends are your teammates, so it’s fun) • routine (smart phoning- texting, checking email- is already a common complement to mealtime) • money (information is free) Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 22. Initial user feedback that guided roll-out ACTIONABLE: I want it compared to what a healthy diet is. see progress over time- competing against self What about a sandwich? What about snacks? Individual or social? Trusted friend circle only? FULL LIST: “[if] i have to send my girlfriend this info, maybe i’ll get a salad instead.” “I might not like results but think it could be interesting. would depend on how it was displayed. i wouldn’t want it to just be abstract, like here’s what you ate, or here are calories. i want it compared to what a healthy diet is. want to know where i’m off and where ok. eg: fine on carbs and veggies but bad on saturated fat. i need a benchmark. “i want to be able to see progress over time- competing against self. “It would be cool is if you could link up the data to restaurants in my area. You need to eat more of x, and here’s some places where you could get x within your budget. “What about a sandwich? How do you know what veggies are in there?” “I snack a lot. Each time?” “The link to friends puts me off a bit. it’s good in theory but i don’t think i’d use it. maybe if i was more proud in my eating habits i might like it, but i find it invasive and don’t think i would want that. i prefer seeing my own progress. i already know friends eat more than me. I don’t think my friend will keep me accountable but someone you’ll live with might, like girlfriend. but still ultimately prefer to do it alone. if it’s just internal, it might be easier too. “I already self-monitor myself by looking and thinking about my garbage. I’d love to see a visualization of all my garbage. I like the idea of showing that concept with food and veggies.” Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu
  • 23. Related work Photographing meals 'could help weight loss' Taking a photograph of your meal before you eat it can encourage weight loss, a new study suggests. Slimmers began to eat healthier food when they were asked to take a picture of what they were eating, scientists found. http://www.telegraph.co.uk/health/2674514/Photographing-meals-could-help-weight-loss.html http://www.daviddeal.info/research/photodiaries.shtml http://shareurmeal.com/ Stanford University, Spring 2010 CS377v - Creating Health Habits habits.stanford.edu