show measurable advantages to digital technology compared to analog technology.
The lack of empirical support for patient report meant that researchers questioned
patients’self-assessment as“artificially inflated.”In other words, the report based
on subjective experience was not trusted when an objective measure did not verify
what the person experienced. Mendel ( 2007 ) set out to objectively document the
improvement that hearing aid wearers reported by comparing speech perception
performance scores (sentence recognition tests in noise) with subjective
self-assessment outcome measures (by questionnaire). She was able to validate both
subjective and objective improvements in speech perception and concluded that the
addition of objective outcome measures“can help validate the patients’subjective
impressions and better determine the efficacy of treatment outcomes in hearing aid
fitting”(2007: 129).
Body image is another example of concordance, or lack of concordance,
between subjective experience and objective measurements. For example, many
people misjudge their own level of obesity (Miller et al. 2008 ). In a study by Jones
et al. ( 2010 ), those who underestimated their level of obesity reported less distress
and significantly lower levels of most eating-related psychopathology compared to
individuals who correctly described their level of obesity. The authors found this to
be consistent withfindings that theperceptionof being overweight is associated
with greater psychological distress, whereas merelybeingoverweight is not asso-
ciated with distress (Atlantis and Ball 2008 ).
In Chap. 10 (this volume), Leiberman makes the point that humans evolved
eating and energy patterns in environments where food intake was often limited and
food excess was rare. In this long ago context, worries about one’s own weight gain
were not relevant to health. Would there be a similar absence of benefit to being
able to judge the adiposity of one’s children? In systematic reviews of the literature,
it appears that half or more of parents cannot recognize when their child is over-
weight (Lundahl et al. 2014 ; Parry et al. 2008 ; Rietmeijer-Mentink et al. 2013 ). For
example, in a study of Canadian children in grades 4–6, 63% of overweight chil-
dren were classified by their parents as normal weight and parents were more likely
to misclassify boys than girls (He and Evans 2007 ). Parental education has not been
a factor associated with the ability to identify one’s child as overweight (He and
Evans 2007 ; Juliusson et al. 2011 ). Some parents describe their children as“solid”
rather than fat (Jain et al. 2001 ), and some parents prefer their children to be plump
rather than thin (Contento et al. 2003 ; Crawford et al. 2004 ). There is also a
normalization of overweight when it becomes more frequent within a population
(Binkin et al. 2013 ). One might expect healthcare providers to step in and address
concerns about overweight and obese children; however, clinicians are also unre-
liable in their ability to recognize the weight status of other people (Evans-Hoeker
et al. 2014 ; Gage et al. 2012 ).
Related to weight, measures of activity are complicated by an inability to see
exactly what children are doing at all times. As Malina (Chap. 5 , this volume) points
out, accelerometry makes activity“visible”because it is an objective indicator of the
duration and intensity of different behaviors during the course of a day. However, the
types of physical activity and sedentary behaviors remain“invisible”unless the study
15 The Shrinking Black Box of Human Biology 317