The recent announcement that wearable activity trackers might not help people lose weight put the health care world in quite a whirl. Critics raised questions about the study – whether the data were old, whether the technology is outdated, etc. While I wouldn’t have been surprised if the study had found no differences, I was surprised that the findings suggest that people who used wearables lost less weight than the people who did not use them!
The topic of wellness – curating the perfect combination of technology and incentives to keep consumers engaged over time – is a commonly debated one in health care. While maintaining a healthy weight is just one part of the wellness equation, you may read about research like this and come to the conclusion that achieving wellness is just like trying to catch a unicorn.
My hypothesis is that fitness trackers and wearables tend to be most popular among people who already are committed to exercise and activity or were about to start a program anyway. There also is concern that workplace wellness programs tend to get the greatest take up among the same group of people, at least in the long term. Moreover, they might be typical “early adopters” – the ones that wait excitedly for new, improved versions of technology to come out so they can quickly snatch them up as soon as they’re in stores.
I’ve also read the articles that show that losing weight is much more driven by diet than by exercise. Yes, there are diet trackers. But, most require a lot more diligence on behalf of the user – entering meals and snacks to count calories – than trackers based on movement and distance, which mostly operate passively in the background.
These studies have convinced me that the perfect strategy for achieving weight loss is incredibly challenging in reality. While a lot of strategies show success…a lot do not: millions and millions of people have lost weight, but the real challenge can be sustaining their success in the long term. Many scientists believe we are biologically and psychologically programmed to like calorie-rich food, and often it is relatively cheap to eat food of poor nutritional value. We are also programmed to hold on to weight in case of famine, though in modern times, that trait tends to hurt us more than help us.
Wellness programs are popular among many consumers and employers. Deloitte’s research on the subject found that many consumers with and without chronic conditions are interested in and see value in employer wellness and disease management programs. Most are willing to participate in programs: Only 6 to 12 percent of surveyed consumers say they are not willing to participate in optional initiatives such as biometric screenings or healthy lifestyle programs. And, almost all (96 percent) of surveyed employers that offer incentive programs agree or somewhat agree that wellness programs help to control medical costs, even if fewer than half are measuring the return on investment.
Even if the effectiveness of wearables for losing weight is in question, wearables and tracker technologies may improve health by monitoring vital signs and promoting adherence to treatment for people who have chronic conditions. And many wearable technologies are improving over time and becoming better integrated into consumers’ daily lives. Some research indicates that remote-monitoring technologies – which can include wearables and other applications of biosensors in smart devices – may have enormous potential for improving health care. So they may be an important investment opportunity for stakeholders:
• Some can be used to take vital signs and transmit the data back to health care providers – whether it’s monitoring for complications after a procedure, preventing an acute event like a heart attack, or tracking chronic health conditions (e.g., diabetes). As an example, I use an app on my phone to measure my heart rate that is incredibly easy. Health care plans and employers are picking up on this potential application. Aetna recently announced it will use the Apple Watch® to monitor vitals and create an early warning system for heart attacks.
• Others can be used to remind people to take their medicine. It is by no means the whole solution, but increasing medication adherence can be critical to improving both patient health outcomes and provider performance on value-based care and related quality initiatives. Many health care organizations are developing strategies and tools to help patients adhere to their medication regimens. These include sophisticated programs that combine sensors to see whether people take their medications, electronic reminders, communication with family members, and innovative benefit designs.
Deloitte’s 2016 Survey of US Heath Care Consumers found that many consumers are interested in using remote patient monitoring; interest was strongest in using it for caregiving (38 percent) rather than for self-care. So there is another really interesting application to consider.
Even for these use cases, I tend to think that apps, devices, and incentives alone are not enough. Integrating them with clinical care from primary care physicians, nurses, care coordinators (as relevant), or even nutritionists and dieticians could make them more successful. Strategies may also need to use lessons from behavioral economics, tailoring approaches to what drives each individual. No matter how great the technology, the human connection can be important for patients and consumers.
All in all, relying only on one technology, incentive, or program to encourage wellness or better health for those with chronic conditions may be a limited strategy. These technologies and programs likely work best in combination, tailored to the tastes, motivations, and preferences of the consumer. Social determinants – the environment where people live and work, issues of food insecurity and housing, and challenges like lack of transportation – matter, too.
As health systems, health plans, clinicians, biopharma, and medtech companies respond to the incentives to improve population health, I expect we may see more experimentation around integrating these technologies into a sophisticated and effective approach. As a result, success in improving wellness over time may be less of a mythical creature in health care.