Tim Lobstein: Can wearable technology help patients tackle obesity?

tim_lobsteinTechnology offers solutions to many health problems, but can the new generation of wearable sensors help patients manage their weight? Experience from an EU funded project suggests that there are challenges and opportunities.

One in eight British adults is now using wearable technology to support and change their health behaviour. Many products are aimed at encouraging more physical activity, and some are aimed at improving our diets. Do they also have a role in supporting clinical practice, especially for patients trying to manage their body weight?

Firstly comes a question of accuracy. It is well known that when several different brands of sensor are worn simultaneously, they can come up with different estimates of the activity levels of the wearer. In a sense, this may not be important if the wearer only wants to know whether he or she has made a significant increase on their daily level of activity—as long as the sensor is consistently inaccurate any increase or decrease should show up.

Accuracy of dietary intake is even harder to ensure. Most dietary intake apps use either European or American databases of food items, and ask the user to name or identify the foods they have eaten and the amounts of each food. With complex foods, such as a pizza or mixed salad, either the quantity or the component ingredients may not be obvious to the user. And with databases of several thousand food items, finding the right description can be tedious and deter the user from recording their intake accurately.

From a weight loss point of view, it may not be strictly necessary to record every item. Dieticians helping their clients manage their weight might be content to see a general change in their dietary patterns, such as a reduced number of between meal snacks, fewer sugar sweetened beverages, a greater variety of fruits and vegetables, and a healthy breakfast. These four indicators alone could be more useful than a seriously inaccurate report of the daily calorie intake.

Assuming that we can find the very best sensors and ensure that the dietary input has been accurately recorded, do we have the perfect system? For certainly such a system could have value.

In a study undertaken for the EU supported DAPHNE project, adolescents attending a weight management clinic in an Italian hospital were asked to wear movement sensors and complete food diaries, and the results were made available to the young person and to their health professionals in the clinic. Over a two month period the adolescents were monitored and asked about their experiences. By the end of the second month they were wearing the sensors on fewer than two days per week, and using the dietary diaries on average once per week.

Despite this apparent lack of motivation, the young people described the experience as empowering, giving them control over their own clinical treatment using digital systems they were familiar with. The feeling of self-empowerment is considered important in ensuring motivation for behaviour change, and indeed several of the children in the trial showed a significant decrease in body mass over the period. Quite possibly this is an example of the Hawthorne Effect—that is, the individual’s behaviour changes because of the fact that he or she is being observed in an experiment.

But perhaps that is the real treatment effect we seek. Even if it is a form of placebo, the transmission of the data from patient to doctor appears to be motivational. The doctor or clinical team colleague will have a record of the patient’s behaviour between appointments, for which the patient is accountable. It extends the motivation to comply with the doctor’s treatment instructions—as if the doctor is able to see your progress every day. Without such continuing supervision, the patient may be less motivated and the sophisticated technology largely ineffective. And if this is the case, then it may not be so important whether the doctor actually looks at the patient data between appointments, as long as the patient knows it could occur.

Lastly, we need to be aware of potential inequalities. While integrated communication technology has emerged as a solution for many modern needs, it has the potential to work best for those who are familiar with the technology and want to use it. Like any treatment that depends on patient motivation, there is a tendency for those who fail to respond to be the ones with the greatest need. Technology enabled behaviour change can work well for the young and better educated patient, but may widen the health divide that already exists between people of different educational levels, and between the old and the young.

Tim Lobstein is the director of policy at the London based World Obesity Federation, an association of national and regional professional groups concerned with research and treatment of obesity. He is also a visiting professor at the Public Health Advocacy Institute of Western Australia, Curtin University, Perth, Western Australia.

Declaration of interests: Tim Lobstein is policy director at the World Obesity Federation and is a participant in the DAPHNE project consortium. The World Obesity Federation received funding from the European Commission in order to participate in the DAPHNE project. The DAPHNE project is co-funded under the European Commission FP7 research programme (grant 610440). The European Commission is not responsible for any use that may be made of the arising material.

  • Bill Cayley

    Physical activity is an important intervention to address the significant problem of obesity, yet while the Daphne results are interesting better-quality evidence from a RCT suggests that efforts at weight
    loss withOUT the use of a wearable activity monitor may lead to more loss of weight than efforts at weight loss pursued with regular monitoring by a wearable activity monitor – see https://lessismoreebm.wordpress.com/2016/09/26/wearable-technology-combined-with-a-lifestyle-intervention-and-long-term-weight-loss/ and https://www.ncbi.nlm.nih.gov/m/pubmed/27654602/ . Perhaps less is more!

  • Tim Lobstein

    Good point Bill. But my reading of the RCT trial you cite shows a crucial difference: the RCT trial did not have a software platform to share the participants’ outputs from the wearable sensors with the clinic staff. In the DAPHNE project the clinic could monitor the sensor output, and could look at the same data that the patient saw. This could have been a key element in the DAPHNE project – i.e. the wearable sensors were less about ‘patient empowerment’ and more ‘patient accountability to their doctor’. Perhaps it is about relationships!
    That said, the DAPHNE pilot was run with a small group of adolescents and was only designed to check feasibility, so the results are only speculative.

  • Bill Cayley

    Good points- although I do think the important lesson from the RCT is that “wearables” may not be all they are talked up to be – accountability and reporting may be just as do-able with paper and pencil, for less cost. Would be interesting to see THAT tested in a RCT!