Healing the poor, digitally

(In case you’re looking for something to take your mind off the election, watch this).

I was thrilled to close out the Duke Forward road events in New York City, along with my graduate student colleague, Shelley Lanpher. Shelley and I talked about our work using digital health to improve obesity treatment in medically vulnerable populations.

Oh, and make sure you #waitforit — there’s a “surprise” reveal at the end.

Go it alone and you [probably] won’t lose weight

Nice NY Times piece from Gina Kolata, amplifying the findings from today’s University of Chicago poll on obesity.

The self-help route has not been successful for most. Ninety-four percent of the survey participants who were obese had tried to lose weight with diet or exercise, to no avail. A quarter of those people said they had tried five to nine times, and 15 percent said they had tried more than 20 times.

“Trying 20 times and not succeeding — is that lack of willpower, or a problem that can’t be treated with willpower?” asked Dr. Louis Aronne, the director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian, who was not involved with the study.

Too many Americans (read: most all of us) are attempting weight loss using approaches that have no evidence base. Upwards of 1 in 5 American deaths is related to obesity. Obesity causes a wide range of health conditions that sap our physical function, quality of life, and money. And yet, we’ve become all too comfortable treating obesity with what amounts to well intentioned snake oil. I challenge you to think of another chronic disease where we embrace treatments that, well, don’t work.

How did we get here? Too little training in med school, too little [and otherwise anemic] treatment reimbursement policies, research that focuses on scaling outcomes vs scaling treatments, and lots and lots of stigma.

We have to do better.

GirlTrek is what’s next in [digital] public health programs

The New York Times blog, Fixes, featured one of my favorite organizations today. Girl Trek is the best public health program you haven’t heard about [yet]. Look, I’m a scientist, a wonk, a tinkerer. I’m technically inclined, and quantitatively oriented. I’m hyperbolic and excitable, but I’m not easily inspired.

But GirlTrek inspires me [big time].

Here’s a gross simplification — recruit nearly 60k women nationally, women who are mostly sedentary, who lead busy lives and who don’t [yet] take enough time for themselves. Link them with groups, comprised of women, similar and dissimilar, of all ages and backgrounds. Then, motivate them to walk. And walk. And keep walking.

Physical inactivity is one of the most pressing public health crises of our time. And yet, many of our public health efforts haven’t gotten the population moving. This is especially true in high risk groups, like Black women.

GirlTrek is different. They reach, engage, motivate, and inspire with an approach that’s organic, culturally resonant, and technologically sophisticated. My take?

“We’ve spent an enormous amount of money on research-based approaches to obesity prevention and treatment, and almost none of them have worked with black women,” says Gary G. Bennett, a professor at Duke University and a leading researcher on obesity. “One of the key predictors of positive treatment outcomes is really high levels of engagement. I’ve been doing work on obesity as it affects medically vulnerable populations for 15 years, and I don’t know of anything in the scientific community or any public health campaigns that have been able to produce and sustain engagement around physical activity for black women like GirlTrek does. Not even close.”

And, it’s working.

Their secret? Focusing on what matters to women today. Not the health benefits that might accrue in the far future.

“It wasn’t about looking good or weight loss or fitting into a certain type of clothing,” she recalled. “It wasn’t, ‘Hey, you fat person, you need to do this or you’re going to die.’ It was, ‘I love you and I want you to love yourself enough to invest in 30 minutes a day, to walk yourself to freedom like Harriet Tubman did.’ And that spoke deeply for me because my life work is showing up for other people, but I wasn’t showing up for myself.”

We researchers can occasionally have a bit of hubris (!) about what it takes to improve public health. But the data don’t lie. For some of these issues, we need bright, creative, and novel ideas that can work — at scale.

Look no further than GirlTrek.

Kinect for fun, not weight loss

(Note: I’m about to date myself).

As a kid, I was a geek pioneer. That’s right, I was part of the first generation of children to be transfixed by the beeps, blinks, and bouncing pixels of video games played on devices like the TI-99/4A, ATARI 2600, (remember that attached audiocassette “drive”?) and Commodore 64. That means I was also part of the first generation that considered staying inside as a reward, not a punishment. For us, there was a linear association between sedentary time and video game proficiency. And I was very proficient.

Every generation since has basically put us to shame. With advances in technology, screens have increased in number, and as screen time has grown, so have our kids’ waistlines.

That’s why so many were excited by the release of Microsoft’s Kinect (and the Wii). Many thought these active gaming approaches would be like those funky vegetable pastas — sneaky ways to get kids to be more healthful (still working on my metaphors).

A fascinating new study suggests that much of our exuberance was premature. The study found that adolescent boys (and only boys, unfortunately) burned more energy while playing Kinect games, compared to playing non-Kinect games or just sitting. But after a day, there was no difference in energy expenditure. This means that at some point, the boys were compensating for the extra exercise they got while playing Kinect.

Compensation is common when we exercise. There’s good science that we tend to eat a bit more after being physically active (and sometimes, more than a bit). Interestingly, in the study, when researchers offered the kids food, there were no difference in the amount that kids ate. This suggests that kids compensated, but we’re not sure how, or when.

TL; DR: Kinect is great fun. Nothing beats using a game as an excuse to hurl yourself around the room dance. However, if you want your kids to do meaningful exercise, turn off the TV.

Haggis to the rescue

I’m pretty open-minded when it comes to food. And I’m first in line to try a new obesity treatment, but…haggis?

Turns out that a British MP wants the U.S. to drop its import ban on haggis. Why? Because, public health.

He claimed haggis “satisfied hunger very much more than the junk food which Americans consume”. The surgeon and former shadow health minister…claimed that haggis consumption would help deal with the “obesity epidemic” in the US.

So there you have it. Haggis – a lovely delicacy containing, “sheep’s pluck (heart, liver and lungs); minced with onion, oatmeal, suet, spices, and salt, mixed with stock, and traditionally encased in the animal’s stomach and simmered for approximately three hours” – is the answer. Clearly, the metabolic benefits of the pluck combined with the brown fat promoted by the suet, and the oatmeal-induced GI motility produces rapid weight loss. This must be why the Scots have some of the lowest rates of obesity globally…uhh, maybe not.

Why buy a wearable when they’re [almost] free?

In this week’s addition of Another Day, Another Wearable, we present the latest offering from Pivotal Living.

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Wrist-worn? Check.
UI? Check.
Bluetooth? Check.
Hypoallergenic? Hopefully.
Price? Free (with a $12 annual subscription to their premium app … so that’s more like free-ish).

I’ve long been predicting that we’re going to see wearables (at least the non Apple variety) rapidly enter Commodity Land. It’s becoming more difficult to differentiate on features (although FitBit is trying), it’s hard to justify high prices for cheap innards, and all the action is in the software anyway. Now, for the dreaded self-quote:

I predict that we’ll see these things [on discount] lining the shelves at your local drugstore. Just like paper towels. — Me

Whoops, wrong quote. Try this one.

Commoditization … will redirect the market’s focus where it should be: on the software. After all, the challenge isn’t the [data] collecting, it’s the changing. Tracker makers have done an excellent job in developing cool tools for gathering data, but they’ve been much less creative in designing software that reliably improves people’s health. And it’s the software that offers tracker makers the greatest opportunity for differentiation. — Me

I haven’t yet used the Pivotal Living app and on first glance, I don’t see much that isn’t available in other apps. And remember, we don’t know if any of these apps or devices actually work. But, what’s important is that we’re beginning to see new business models for wearables that prize (and price) the software. If this business model catches on, I suspect that developers will need ways to better differentiate their apps. This might create opportunities for those of us who’ve been clamoring to get evidence-based approaches into the app market. Admittedly, that’s a lot of ifs, but I’m willing to play the long game because I’m convinced that focusing on the changing (vs. the collecting) will give us the best shot at using wearables to improve consumer health.

Join me at the National WIC meeting

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I’ll be speaking at the upcoming National WIC Association meeting in Pittsburgh, PA on Tuesday May 20, 3:30-4:30pm. I’ll be performing an acoustic version of my favorite standard:

When Obesity Becomes the Norm, What Do We Do?

I’m sure you know WIC, but for the other 2 of you:

The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) is a public health nutrition program under the USDA providing nutrition education, nutritious foods, breastfeeding support, and healthcare referrals for income-eligible women who are pregnant or post-partum, infants, and children up to age 5.

Hope to see you there.