Obesity is an intractable and serious global health crisis. Recent studies indicate that nearly 68% of adults in the US are either overweight or obese. Based on available data, nearly 5-10% of all US healthcare costs are devoted to taking care of obesity related illnesses.
Strategies which incorporate behavioral and lifestyle changes, use of medications, as well as surgical procedures have been explored as possible means to effect lasting weight loss. A number of new medications are promising, and may help some with weight loss. However, the reality is that most of these modalities are not a sustainable solution to the current epidemic.
Changes in public policy and our culture at large will be likely part of a lasting solution. In the meantime, emerging strategies which employ behavior modification along with wireless and electronic technologies will likely become more important components to a successful weight loss program in the near future. The emergence of digital health technology has the distinct ability to help motivate individuals to lose weight in a healthy fashion, helping to bolster virtual support and accountabilty when a person can’t always be able to have a face to face interaction with a health coach.
Intensive multifaceted behavioral treatment has been shown to produce clinically significant weight loss (>5% of initial body weight) in overweight and obese adults. In fact, The US Preventive Services Task Force (USPTF) recommends intensive behavioral treatment for all obese adults, citing data that more contact within the first year produces greater weight loss. Treatment involves behavioral self-management activities, self-monitoring, setting weight loss goals, improving physical activity and diet choices, addressing barriers to change, and developing ways to maintain lifestyle changes.
Recent evidence however suggests that intensive lifestyle interventions may not need to be performed in person. Both telephone and internet-based treatment have produced weight loss comparable to an in-person intervention. Hybrid interventions that use technology and remote intervention components to enhance existing in-person treatment programs represent a new reality, especially by adding an obesity program with a connective technology system which provides mobile decision support (ie, calorie and activity feedback). This technology can enable participants to transmit data to a behavioral coach who can monitor their uploads and provide scheduled telephone coaching.
Self-monitoring of diet and physical activity is associated with weight loss success and can be performed conveniently using handheld devices. Mobile devices allow real -time decision support by enabling users to check the caloric value of foods and activities and track energy balance in real time. Studies of technology-supported weight loss interventions indicate that digital tools are more effective and acceptable to participants when they supplement rather than replace contact with human interventionists.
Two recently published articles in the Archives of Internal Medicine highlight the emerging role for electronic and internet technologies for weight loss described above. In one study, 35 patients self-monitored their diet and exercise using PDAs, a technology now largely replaced by smart phones. They also received phone calls from a health coach every 2 weeks. The 35 controls received standard-of-care group treatment. After a year, the PDA group lost an average of 4 kg more than the controls.
The second study randomized 250 patients with prediabetes or metabolic syndrome into three separate groups: a 3-month coach-led group intervention; a self-directed intervention using a DVD of the coach-led sessions; or standard care. During a 12-month maintenance phase, patients in both interventions had access to additional support through e-mail. At 15 months, both coached groups lost significantly more weight than controls: BMI changed –2.2 units in the coach-led group; –1.6 units in the self-directed group; and –0.9 in controls.
One Chicago based start-up, Retrofit, has emerged as a front runner in harnessing wireless and remote technology to help its busy clients lose weight, especially when they may be away from home while on vacation or business travel. Retrofit has developed a niche in the emerging field of so called data-driven weight loss. Jeff Hyman, CEO of Retrofit, explains that his company uses a device known as a Fitbit along with a Withings scale (with state of the art wireless and tracking technology) that makes tracking your activity, sleep and weighing yourself rather simple. He explains that the data is shared with a unique personal weight loss team which includes a registered dietician, behavioral coach, along with an exercise physiologist. Primary communication occurs primarily via Skype videoconferencing, whereby clients can meet with their team who reviews progress and collected data.
According to Hyman, Retrofits’s core philosophy to weight loss focuses on “education, along with a personalized and customized approach, reinforcing accountabilty”, helping to provide ongoing motivation for “sustainable weight loss over the long term”. As evidence of early success in their short 2 year history, less than 5% of Retrofit’s clients have dropped out of the program in 1 year, compared with at least a 50% drop out rate in more conventional weight loss programs by 1 year.
As Hyman explains, the goal of Retrofit is to help their clients establish “important life long skills using modern technology” as a motivator to change lifestyle and eating habits. He stresses that Retrofit partners with clients for the long haul- a cornerstone of their philosophy. In fact, Hyman stresses that your target “should be a modest 10-15 % weight loss”, since this can lead to measurable improvements in blood glucose, as well as blood pressure and lipid profile, not to mention increase in energy and overall well being.
As evidence of Hyman’s ability to connect with specific groups that may need additional coaching or prodding after a structured career in athletics, Retrofit recently announced a partnership with the National Football League Players Association (NFLPA) to be their official official weight loss program. Reggie Smith, a former NFL player and current President of the NFLPA Chicago chapter, also works closely with Retrofit as their VP of Business Development. He initially began as a client with Retrofit, and met with success after embarking on the weight loss program. Smith believes that Retrofit has been successful thus far because it is not cookie cutter weight loss, but instead is “customised and adaptable to each client”. In the case of NFL players who may not be as active after their playing days are over, Smith emphasizes that Retrofit help players in the difficult transition, and focuses on “getting them healthy”, especially with behavioral coaches who provide struture and support”. The results and feedback from former NFL players using the program have been overwhelmingly positive thus far.
