Internet-based tracking and coaching are being employed wherever health becomes a matter of lifestyle. Technologies can reach into every detail of a patient’s life: how to eat when they visit a buffet, where’s a good place to take a walk nearby, etc. This article, part of a series about obesity, interviews a number of experts to explore the philosophy and practice of behavioral therapy for obesity.
Medical and Behavioral Interactions
Dr. Luke Twelves, medical director of the contract research organization Lindus Health, says, “Obesity is a multifactor disease.” He believes that technology helps people take control of their own treatment. For instance, a continuous glucose monitor (CGM) allows patients to decide what food or medication they need at each moment in the day.
A similar viewpoint was cited by Eric Bormel, a director in the Healthcare Group at Solomon Partners, an investment bank. He writes, “Prescribed weight loss medication is most effective when paired with behavioral lifestyle change. Behavioral change is being viewed as an attractive off-ramp for the expensive weight-loss medications. Many companies also target consumers, payers, and employers with solutions to enable lifestyle awareness and education in the hope of avoiding the weight loss medications altogether.”
He adds, “This is where the army of digital companion solutions are most effective. I expect there will be many winners across the Consumer Healthtech ecosystem in verticals such as health and wellness activity tracking, content and coaching, virtual care, employer/payer integrated physical wellness, and chronic care management solutions.”
Dr. Cynthia Horner, chief medical officer at Amwell, thinks that behavioral modification is crucial even if medications or surgery is offered. Drugs might be considered successful, she said, if they take off 15 pounds, but most people being treated for weight need to lose much more. Even a 50-pound loss—pretty much the maximum success one can expect from drugs—is not enough for some people. And 10%-20% of individuals don’t achieve any weight loss from the drugs.
Amwell focuses on “delivering health care where access is a challenge.” They offer a direct-to-patient weight management app. They reach out to ask whether members are following their plan and picking up their medications, and offer a group support site.
tb2.health describes itself as a “leading direct-to-patient weight loss prescription solution.” Toni Adamrovich, chief of medicine and cofounder, offered a taxonomy of digital interventions that show promise: remote monitoring and feedback systems, online communities and support groups, telemedicine and remote coaching, Virtual Reality (VR) and Augmented Reality (AR) devices that promote physical activity and healthy eating habits, behavioral therapy apps, ans gamification with elements of competition, rewards, and challenges.
In particular, he says, “VR, AR, and gamification have the potential to revolutionize the way we approach weight loss and promote healthier lifestyles by making exercise more enjoyable, providing personalized support and guidance, and fostering a sense of community and accountability.”
Paul T Jaeckel, a private practice dietitian at Paul Jaeckel Nutrition, emphasizes the ability of digital solutions to connect people to supportive communities. He says, “Weight loss takes time, and it’s hard to keep motivated when you are alone or have a poor support system. So being able to have a social group where you can talk to like minds is a perfect inclusion for meaningful and long-lasting habit changes.”
From Human Touch to Automated Interventions
There is a spectrum ranging from fully automated solutions (such as using patient data to trigger reminders) to human interactions (such as televisits). A literature review suggests that “interventions with human contact work better than those that are fully automated.”
Dr. Ronald Razmi, co-founder and managing director at Zoi Capital, points out that people in traditional behavioral change programs often start out excited and achieve some short-term success. But the “novelty factor” wears off.
And Dr. Omar Manejwala, chief medical officer at DarioHealth, says people’s circumstances change—for instance, they might injure themselves or develop depression. So for many reasons, either their motivation or their ability to follow through on the plan trails off. This is why monitoring is important, and a digital intervention can alter the treatment plan quickly as appropriate.
According to Dr. Tim Church, chief medical officer of Wondr Health, technology allows treatments to reach more people. “Accessibility is key,” says Church. “Having 24/7 access to on-demand behavior-change resources breaks barriers and has a real impact on the amount of people who improve their sleep, stress, physical activity, weight loss, and more.”
Kevin Kumler, president of Virta Health, calls its service a “virtual clinic” that’s available everywhere for all patient demographics, operating on mobile devices.
Giving people facts—as doctors and nutritionists typically do in office visits—is not enough. In actuality, Church says, generic advice might not work for a particular person. “Prioritizing personalization and adapting to each person’s lifestyle, schedule, and leads to means higher engagement, improved clinical results, and a bigger impact on their quality of life.”
Wondr Advanced can take in data from devices or patient input, and then helps a patient through personalized feedback as well as a library of videos and other resources. The app uses AI to identify what is likely to matter most to the user, and then makes personalized recommendations that are likely to inspire positive behavior change and healthy habit formation: for instance, what times of day work best for them to exercise, and whether they prefer to walk, dance, or do some other activity.
Sweetch is a fully automated approach to behavioral management. Dr. Jennifer Meller, chief medical officer, says this permits them to scale up to serve more people.
Inputs include the eating, sleeping, and exercise habits reported by patients, data from fitness devices, scales, and CGM, and even local conditions such as the weather (which helps the service choose when to recommend exercise). Figure 1 shows one of their displays.
They market their system through various types of companies and can customize the app for different groups of patients. For instance, they are currently partnering with a CGM company to treat people with diabetes, with a pharma company offering a GLP-1 medication, and with a large clinic to treat obesity.
9amHealth is a virtual care solution for cardiometabolic health, focused on human interaction. Dr. Avantika Waring, 9amHealth’s chief medical officer, says that a string of visits spaced several weeks apart is not enough to keep most people on their plan for behavior change. “Telehealth is more than single visits,” she says.
9amHealth logs heart health, glucose, and metabolic markers, and can use a variety of modalities for engaging the patient, such as an app, text messages (some of which are auto-generated), and instructional videos (Figure 2). By tracking behavior, it learns when someone is likely to see a message, to check their blood pressure, etc. The platform is generally used for medication management and coaching for behavior change, and can be input to predictive risk modeling.
I’ll end this article with an observation from Adamrovich: “Ensuring accessibility and addressing disparities in digital health literacy and access is essential to maximize the impact of health interventions on a global scale.”
The next article in the series will look at tracking, devices, and some particular applications to metabolic control and diet.
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