Weight issues are endemic nationwide. In 2014, 71 percent of American adults were overweight, with 35 percent of men and 40 percent of women diagnosed with obesity. About one in three children and teens are overweight or obese in the U.S. On a global scale, obesity has nearly tripled since 1975. As of 2016, more than 1.9 billion adults, were overweight. Of these, over 650 million were obese.
Being overweight or obese is often a catalyst for other serious health issues, such as type 2 diabetes, heart disease, and some cancers in adults, and high blood pressure, type 2 diabetes, and heart disease in children. The financial burden of obesity is exorbitant on the U.S. health care system with costs ranging from $147 billion to nearly $210 billion each year and approximately $4.3 billion annually in lost productivity. Factor in the comorbidities and medical costs significantly increase.
Obesity is an extremely complex condition to treat and manage. In addition to eating habits and physical activity—genetics, familial, social, and cultural circumstances, among other factors, can play a big role in treating and managing weight loss. As a result, quick fixes and one-size-fits-all solutions will not suffice.
Behavioral approaches, such as behavioral therapy (BT), have long been applied to obesity and proven useful, however, require steadfast dedication and participation from patients and their care teams. Behavioral approaches are only effective if consistent, and therein lies the challenge.
Changing behaviors to impact obesity
Modifying harmful behavioral patterns is an important aspect of BT and other behavioral approaches to weight loss and essential for helping obese and overweight patients lose and maintain weight loss. Common components of BT include self-monitoring (such as by keeping a food diary), stimulus control, slower eating and eating smaller portions, realistic goal setting, nutritional education, increased physical activity, and enhancing social support.
“There was an increase in the average weight loss in patients enrolled into BT programs by 75% from what was seen in 1974 to what was achieved in 1994,” according to research published in 2012. “This has been due to the gradual realization that BT interventions are more effective when they are of longer duration and are more intensive.”
Similarly, another study looking at participants treated with a comprehensive behavioral approach including group therapy, goal setting, self-monitoring, and stimulus control, found that patients achieve a 10 percent weight loss—enough to significantly improve health—and “approximately 80% of patients who begin treatment complete it.”
Over the years, new components have been added to the behavioral approach repertoire, but according to the study, “the most parsimonious explanation for the larger weight losses is the longer duration of treatment.” Additionally, “Weight loss often reaches its peak at approximately 6 months, and then weight regain often begins in the absence of weight maintenance therapy.”
Behavioral approaches for patients who are obese or overweight have proven to be effective but the ability to maintain behavior change after treatment ends is often the barrier to improving health outcomes long-term. Digital health can be a solution to facilitate patient engagement and the ongoing high-touch patient support needed to achieve lasting behavior change.
Sustaining weight loss through digital health
Digital health has been widely used to help patients improve lifestyle behaviors related to weight management and other complex chronic conditions. For example a recent study found that combining mHealth apps and intensive health coaching can improve weight loss and overall heart health in patients.
In the case of behavior approaches to weight management, the data emphasizes that in order to preserve the benefits gained from behavioral treatments, after a certain period of time, patients require some form of ongoing engagement or “interactive technology-based intervention.”
For patients with any chronic condition, navigating one’s daily environment after treatment ends can be daunting. Everyday stressors, from a bad day at work to a lack of access to healthy food choices, can impact a person’s ability to sustain weight loss. But digital health tools can connect patients to consistent support as they traverse the triggers or events which could derail them.
Apps and wearables help put patients in the driver’s seat by monitoring and tracking food intake, nutrition, and physical activity, and collecting useful data related to patient behavior and health that can be relayed back to care teams. These tools can also easily connect peers who are going through the same experience, offering comfort and encouragement via social support.
The British Columbia Medical Journal, (BCMJ) reported that “66% of Americans age 66 and older want to use mobile technologies to improve their health by receiving medication reminders and tracking diet and nutrition, physical activity, and symptoms.”
Sensors can be useful in managing the health of patients remotely. They can be integrated into a watch or arm band, adhesive bandage or clothing, and then programmed to collect data such as glucose levels, heart rate, and blood pressure, according to the BCMJ. “Clinicians can provide timely and patient-centred care to those living at a distance with chronic disease and can coordinate care when multiple providers are involved, reducing costs to the health care system.” This can be particularly useful for patients managing weight who also have one or more comorbidities.
Digital health can also help leverage the human connection. Health coaching is increasingly being seen as an effective tool to guide and support long lasting behavior changes in patients with complex chronic conditions. Integrating health coaching into programs aimed at helping patients manage weight loss could be hugely valuable.
“Frequent, long-term patient-provider contact, following initial weight loss, is perhaps the most successful method of preventing weight regain,” says research published in The Psychiatric clinics of North America. Such consistent communication is the kind afforded by health coaching. Health coaches can provide patients with support, guidance, education, and encouragement when they need it, delivered in a way that works best for them, such as by email, text message, phone call, app, or video chat.
For most patients with chronic conditions, such as obesity, maintaining their health requires day-to-day, hour-to-hour, even minute-to-minute vigilance. Often, managing weight loss for obesity relies on a complete change in lifestyle, patient education, and relearning how to manage health issues and their stressors. Using digital health tools for effective therapies, such as behavioral approaches, can ensure patients receive the ongoing, meaningful support they need to create behavior change that sticks for healthier, happier lives, and reducing the costs to both health care and workplace productivity.