The Band Came Off. And She Was Still There.

Why I told my patient to race with no data

Heather crossed the finish line of her first race in a year, and there was no chip on her shoe.

No watch. No band. No screen waiting on her wrist when she stopped running.

This was my clinical recommendation.

She was back to athletic movement after a year of dedicated eating disorder treatment. Every step is a thoughtful step when re-introducing food without purging. Exercise without self-esteem evaluation. Races without measurement.

The chip on the running shoe is an old technology. Disposable. Adhered to the laces. It records when you cross the start mat and when you cross the finish mat and that is everything it knows about you. It does not know your heart rate. It does not know if you slept. It does not have an opinion about your readiness, your strain, your recovery score. When the race is over, the chip is over. Even the simple metric of placement – finish order, time elapsed – was more data than we needed this early in recovery.

Runners have always counted. This is different.

Measurement is not new.

The gym rats I have worked with over the years carry notebooks. They have always carried notebooks. Sets, reps, weights, dates — the ledger of the body, kept by hand, in pencil, on pages that warp with sweat. One of my clients tracks his lifts in spreadsheets that go back to the Reagan administration. He is not a man fighting his body. He is a man who likes a record.

Strava is twenty years old. The Garmin predates it. The chip on the shoe came in the nineties. Pace charts, split times, mile markers — runners have always been counted. During the early Covid months, when bodies could not be in rooms together, Peloton communities formed inside leaderboards. People stayed close to each other through numbers. It was beautiful. It was measurement doing what measurement at its best can do, which is connect a person to their effort, and to other people who recognize what that effort costs.

So, when I sit with clients now and we talk about what their wearables are doing to them, I am careful. The argument is not that measurement is the problem. Measurement has been here forever. It is a profoundly human thing to do — to count, to record, to want a small permanence for the enormous effort the day required.

Something else is going on.

Continuous, ambient, authoritative — the three things your wearable is that your notebook never was

What is new is three things, and the wearable is the first technology that has all three at once.

It is continuous. You do not open it and close it. The notebook gets opened at the gym and shut in the locker. The chip on the shoe begins at the start mat and ends at the finish mat. The wearable does not end. There is no closing the device. To take it off is no longer an absence of measurement; it is an event, a gap, a “lost day” the device will note when you put it back on.

It is ambient. The notebook required a decision — pen to paper, this lift, this rep, this weight. You chose what to record. The wearable collects regardless. It measures while you sleep, while you make love, while you sit at a kitchen table not eating because of something you do not yet have words for. You do not choose what gets recorded. You only choose whether to look.

And it is authoritative. The notebook recorded what you observed about your body. The wearable tells you what your body is. I’m in the red. I’m in the green. AI is built into the WHOOP now. A live coach tells you how to proceed with your day based on the red or green circle. Patients now narrate their own nervous systems in the language of the device. The voice of the measurement has created noise and signal threatening the voice of the self.

Continuous. Ambient. Authoritative.

That is not the gym rat’s notebook.

When the wearable saves babies — and might save more

And it can be a gift.

Last year I sat in a room at the Quin House in Boston and listened to Emily Capodilupo, an SVP at WHOOP, present what they were finding in their maternal health data. She showed us a signal: a measurable drop in resting heart rate, weeks before delivery. After aggregating the data and following these women they found a strong correlation between heart rate drop and preterm birth.

Weeks.

Before any of the conventional clinical signs would be visible.

What this means in maternal deserts around the country is a life-saving metric.

I was profoundly moved.

I sat there in a room of people, and I wasn’t sure who else was registering this the way I was. I track signals for a living. I have sat with the ambivalence and paradox of wearables in my consult room for years. This finding is real. It matters.

A few months later, I was approached by the early-stage founders of Oasys, a company being built by Harvard undergraduates who are integrating wearable data directly into the EMR for therapists. Go beyond the session. Connect wearables, apps, and health data to understand your patients’ wellbeing 24/7. Make data-driven decisions that improve outcomes.

I am not there yet as a must-have. The marketing language gives me pause — 24/7, data-driven decisions, outcomes — these are the optimization frames my patients are often recovering from. But the underlying impulse is the one this essay has been circling. Oasys is asking what happens when the someone reading the data is the therapist, and the data is in the chart before the patient walks in the door. They are on to something. They are a nod to where health and mental health are going. Whether that future will hold the patient or surveil her is a question worth taking seriously now.

In many scenarios, the wearable is doing what no doctor’s appointment or therapy appointment can do — being present in a body, every minute, across the long stretches of time when the provider is not in the room. That is continuous, ambient, authoritative being exactly what an early-warning system needs to be.

This spring, WHOOP was named to the first cohort of a new federal program designed to bring continuous monitoring to Medicare beneficiaries managing chronic disease. From the womb through aging, the device is now being asked to do real medical work.

There is one quiet detail in the maternal study worth noticing. The 241 women whose data made the discovery possible were not a random sample of pregnant Americans. They were active WHOOP members at the time of recruitment — women who had already chosen, before they ever became pregnant, to wear a continuous biometric device on their bodies day and night.

The signal is real.

The population that surfaced it is a particular one.

That sample is about to widen. Medicare is beginning to pay. Doctors are beginning to prescribe. The population that wears a continuous biometric device is no longer going to be the population that chose to. The findings will generalize. So will the question this essay is asking.

The watch the parents believed when their daughter wasn’t enough

A sixteen-year-old patient of mine wore an Apple Watch. She became aware of a racing heartbeat on the verge of panic attacks. Most noticeable to her at night. Just before bed. She brought it up in a session and shared her graph with me. I thought it was compelling enough to call a joint session with her mom.

She had told her parents. She had said the words. She had described the racing, the breath that would not catch, the body that was screaming at her to notice. They had not believed her. Or they had not been able to. Whatever the reason — and reasons in families are rarely just one thing — she had not been heard.

The Apple Watch was. The graph showed it. Eighty-eight. A hundred and four. A hundred and twenty-two, sitting at her desk. She took it home and showed her parents, and they believed the watch in a way they had not believed her.

The clinical-grade authority of the device was louder than her own voice. And in that case — that case — it was a relief. The wearable was the witness she could not yet be for herself.

I have other patients tracking their cycles on Oura rings, finding the day they might conceive. The body has a goal. The device serves it. They are using it the way the gym rat uses his notebook. Bounded. Specific. In service of a project they have chosen.

This is the spectrum. The same device, doing different work, in different bodies, for different reasons.

What an eating disorder does with one hour of latitude

Heather was twenty-four when she came to me. She had just finished a master’s in counseling, and she was earnest and serious in the way that people who have decided to do this work for a living tend to be. She told me, in a voice that did not waver, that she could not in good conscience help anyone if she was binging and purging five times a day.

Five times a day.

I want to sit with that number for a moment, because I have learned that people who have not worked with eating disorders sometimes hear bulimia and picture something contained — a behavior at the edges of an otherwise functioning life. Five times a day is not at the edges. Five times a day is a life that has been hijacked. The day organizes around the binge and the purge. It is a compelling, obsessive, and all-consuming preoccupation with food.

Everything else — work, relationships, eating like a person, sleeping like a person — has to fit in the spaces between. She was a fit, athletic, high-functioning young woman who ran and did yoga and took cycling classes, and she was also, in the deepest part of every day, fully paralyzed.

She had been seeing a therapist who had not been treating the eating disorder. After our first session, I recommended a serious consideration for inpatient treatment. We did a joint meeting with her mom and within days she flew to Colorado for one of the premier programs in the country.

She is, by temperament, a rule-follower. This is something I want to name plainly, because the personality that makes a person vulnerable to an eating disorder and the personality that makes a person possible to recover are sometimes the same personality. She did everything the program asked. She accepted the protocols around movement — long stretches of stillness in the early phase, walking outside as the eating disorder behaviors stabilized. She was not an acute weight-restoration patient. What she needed to restore was a relationship to food, to eating, to the cravings that had been driving the cycle.

She did have to manage her anxiety about “open-ended weight gain.” Her internal cues around food and weight had been skewed by years of binging, and she did not yet trust that her body would respond well when food had normalized.

In ED treatment, providers often use blind weights — even for patients like Heather who are not in acute weight restoration. The provider records the number. The patient does not see it. The reasoning is precise: the number creates noise. Fluctuations and increases trigger the disorder’s voice. Trust is rebuilt by handing the data over, not by managing it. Treatment often goes well when patients can do that — when they can let go of the autonomy of measurement and trust the provider to hold it.

She did the work. After about five weeks she stepped down to a partial program in Boston, the way ED treatment is supposed to work.

This is where it gets clinically interesting.

The partial program had a movement contract: up to one hour of physical activity per day, broadly defined. She came in on a Monday morning glowing about a weekend on Nantucket with her family. On Saturday morning she had taken a leisurely bike ride to the lighthouse and back with her mother — the kind of ride you take on a white bicycle with a basket. Later that day she had gone to a restorative yoga class with friends.

It had not occurred to her that two soft hours, on a bicycle she was barely pedaling and a mat she was largely lying on, might count as breaking a one-hour contract. The provider scolded her. She came in to my office disillusioned in a way I had not seen in her, asking how a slow ride and a stretching class could possibly amount to anything disordered.

It couldn’t. We agreed, she and I, that the activity was nowhere near her baseline. She had been a serious athlete before treatment; a lighthouse ride with her mother was not, by any honest reading, a relapse.

What I told her was harder than that. I told her: let’s just treat this as a really loose contract that doesn’t mean very much. It may not even make sense to you or me. But the goal right now is to follow it anyway. Even if it doesn’t make sense.

This is one of the strange truths of recovery from an eating disorder. The disorder is sneaky. It is opportunistic. It will use any latitude — any small interpretation, any reasonable exception, any case where the rule clearly does not apply to me — and it will turn that latitude into a doorway back in.

Submitting to clinical structure even when the structure is over-applied to your specific case is part of how a person learns to be held by something other than her own judgment, which the disorder has been weaponizing for years. The compliance that almost destroyed her was now being asked to do the opposite work. To hold.

She did. She finished the program. Her movement was reintroduced gradually, in collaboration, based on what was clinically relevant and healthy for her, not based on what a contract said.

When she was finally cleared to start running again, she wanted to enter that road race. I told her my protocol for athletes coming back: start gently, no pace, no time, no measurement. Skip the chip that records your place and your splits. The goal is to go out there and have fun.

She followed that protocol the way she had followed every other one. She crossed her first finish line in a year with nothing on her wrist and no chip on her shoe, and the data did not follow her home.

In a NICU, the device is held by a relationship. On a wrist, it isn’t.

It would be easy, here, to write the essay against wearables. I am not writing that essay.

The wearable saves babies. The wearable witnessed a teenager her parents could not yet hear. Continuous monitoring in the NICU keeps newborns alive. Continuous cardiac telemetry catches the arrhythmia at three in the morning that the patient would have slept through and not woken from. This is real.

This is modern health care.

The question is not whether the modern version of health and mental health care is good. The question is what happens when a clinical-grade technology migrates out of the clinic.

In a NICU, continuous, ambient, authoritative is appropriate. The stakes warrant it. A clinician is reading the data with the family. The device’s authority is held inside a relationship that knows what to do with it.

On the wrist of a healthy person at a kitchen table, that same technology is not held by anything. There is no clinician reading. There is only the person, alone with a voice that has the weight of medicine but none of medicine’s reasons. For some people, that voice is information. For others, it is a verdict.

The mind it lands on decides.

Wearing it without being worn by it

I have known Heather now for over a decade.

Somewhere along the way, a green Garmin appeared on her left wrist. Later, a WHOOP appeared on her right. She does not live by the data either of them collects. When she is training, she works with a coach who reads it on her behalf and tells her what it means for her training, her recovery, her load. There is a human between her and the device. The data goes through the coach before it gets to her.

She completed a few competitive Boston Marathons. She trained for a few triathlons. Then Ironman. She has finished two. She has said, in the way that healthy athletes can say it, that she has checked the box. She has done it. She makes space for the rest of her life alongside her goals. And the Oura ring might show up next, as she ventures into pregnancy and motherhood.

The wearable is not a problem when there is someone reading it with you. The clinician at the NICU. The obstetrician watching the heart rate signal in late pregnancy. The therapist a teenager can show her watch to. The coach who holds the training plan. In each of these, the device’s continuous, ambient, authoritative voice is contained inside a relationship. Someone else is also speaking. The wearer is not alone with the verdict. AI is beginning to fill that seat. We are about to find out what that means.

What concerns me is the wearer who is alone with it. The young athlete optimizing without a coach. The new mother with a postpartum body and a recovery score that says she is failing. The man at fifty who has begun to narrate his own nervous system in the language of his band. Who has slowly stopped consulting any other source. The clinical-grade technology is in his life now. The clinic is not.

For Heather, the band came off long ago.

She was still there.

Then it came back on, and she has been able to wear it without being worn by it because of years of careful work.

That is recovery.

That is measurement that holds instead of harms.

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The Quiet Tension Journal Prompt

What Work Is Your Wearable Doing in Your Life?

The same device does different work in different lives. The gym rat keeps a notebook by choice and closes it when he leaves the gym. The teenager shows her parents a graph and is finally heard. The patient at the kitchen table looks down at a red circle and rearranges her day around it. One device. Different bodies. Different reasons.

This prompt asks you to look honestly at the work yours is doing in yours.

• Think of the last time you looked at your device before deciding how you felt. What did the number say, and what did you decide because of it? What might you have decided about your day if the device had not been there to consult?
• Whose voice does the device sound like when it speaks to you? A coach’s, a clinician’s, a parent’s, your own, a verdict? Where did you first learn to listen to that voice, and what does it ask of you that you would not ask of yourself?
• Is anyone reading the data with you — a coach, a clinician, a partner who knows what to do with it — or are you alone with the verdict? If you are alone, write the honest answer to this question: not the answer you would give your trainer or your friend, but the one you would give a clinician who was not going to take the device away.

Wearing it and being worn by it are not the same thing. The first is a relationship. The second is a verdict. Start by noticing which one is happening on your wrist.