BREAKOUT SESSION B4 Guiding The Primary Care Patient Who Uses Digital Tools For Weight Management
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BREAKOUT SESSION B4
Guiding The Primary Care Patient Who Uses
Digital Tools For Weight Management
Mark Berman MD, FACLM
#CIAHKHL
CONFLICTS OF INTEREST Chief Medical Officer, Better Therapeutics
OUTLINE
Background
The Role of the PCP
Digital Therapeutics
AI is coming
MAIN TAKE HOMES Digital Health Tools In Primary Care: 1. Every nutrition, exercise, weight management tool has been digitized; 2. These tools work better with human support; 3. Current tools have not created new workflows in primary care; 4. PCPs should use the same clinical approach to digital tools as they did analog; 5. Currently, I can not give you evidenced based recommendation in each category — if there were really 1 best, there would not be 400,000 options; 6. Digital Therapeutics will eventually augment your approach; 7. AI is coming — automation will hopefully augment your efforts.
BACKGROUND
#CIAHKHL
THE GREAT DIGITIZATION HAS HAPPENED over 260 million U.S. smartphone users www.statista.com/statistics/201182/forecast-of-smartphone-users-in-the-us
APP USE HAS EXPLODED
MORE THAN 400,000 VARIATIONS
Diet Fitness Behavior Change
- Food diary apps - Wearable activity trackers - Health coaching services
- Recipe collections - Exergames - Tele-dietitians
- Meal planning tools - Training & exercise video apps - Commitment services
- Food & cooking blogs - Connected Gym Equipment - Behavioral economic tools
- Mindfulness tools
Tracking Convenience Misc
- Wifi scales - On-demand groceries - Smartwatches
- Home monitoring devices - Meal kits - Self-help books
- Dietary assessments - Meal delivery services
A BEST IN CLASS EXPERIENCE: PELOTON…
—
—
—
… CONNECTED TO STAVA & APPLE WATCH….
—
—… CONNECTED TO MYFITNESSPAL.
THEN CAME THE DIGITAL DISILLUSIONMENT
gartner.com/technology/research/methologies/hype-cycle.jspMETA-ANALYSIS OF WEB-BASED LIFESTYLE
MODIFICATION ON WEIGHT CHANGE
23 weight loss studies
8697 participants
2-3 lbs added weight loss
S Kodama, K Saito, S Tanaka, C Horikawa, K Fujiwara, R Hirasawa, Y Yachi, K T Iida, H Shimano, Y Ohashi, N Yamada and H Stone / 21 June 2011WHY THE DISSILUSIONMENT? Speculation from an innovator: 1. Because of business forces, most innovations lack staying power. Even effective ones. 2. Effect size expectations are unrealistic given lack of primary care, public health and public policy support. The obesogenic environment (and culture) is far too powerful. 3. Automated dietary sensors are elusive. Feedback loops depend on willingness to log. 4. Existing tools amplify dietary culture, they are not changing culture. 5. Digital health companies (like diet companies) brilliantly use data to market success, while ignoring failure. They have not uncovered new recipes for sustaining behavioral change.
A case study in using data to present success:
• 35K participants, 22.7% with > 10% weight loss at 6 mo;
• … but 10 million downloads (0.35%);
• Only included those who used app for 6 mo;
• No control group.STILL, THE DIGITAL HYPE CYCLE CONTINUES…
400 Million Medical Apps Downloaded Globally in 2018
gartner.com/technology/research/methologies/hype-cycle.jspTHE ROLE OF THE PCP
#CIAHKHLTHINGS PCPS SHOULD KNOW
#1
Your patients
are using
digital health
tools…THINGS PCPS SHOULD KNOW
#2
Dieting tools
are most
common…
used in a yo-
yo fashion.
Pourzanjani, A., Quisel, T. and Foschini, L., 2016. Adherent Use of Digital Health Trackers Is Associated with Weight Loss. PloS one, 11(4), p.e0152504.THINGS PCPS SHOULD KNOW
#3
They work
when people
use them. But
lasting change
is elusive.
Pourzanjani, A., Quisel, T. and Foschini, L., 2016. Adherent Use of Digital Health Trackers Is Associated with Weight Loss. PloS one, 11(4), p.e0152504.THINGS PCPS SHOULD KNOW
#4 12 month, Randomized Controlled Trial
70 adults, BMI >25 andTHINGS PCPS SHOULD KNOW
#4
Connected
interventions
can offer
additive
benefit.
Adding an online program + pop management improved outcomes
Baer H. et al. Effect of an Online Weight Management Program Integrated With Population Health Management on Weight Change: A Randomized Clinical Trial JAMA. 2020;324(17):1737-1746. doi:10.1001/jama.2020.18977THINGS PCPS SHOULD DO 1. Provide “some” counseling & regular follow-up. (most PCPs won’t until training and reimbursement provided) 2. Present informed, expert view on fads/trends. 3. Emphasize skill-building over calorie-cutting. 4. Anticipate failure by framing objective as learning. 5. Provide the patient their macro health view, using risk factor data and evidenced-based goals.
THINGS NOT BEING DONE YET 1. Until patient-generated digital health data are summarized in actionable way for PCP, integrated into workflows, and reimbursed, these data will not be reviewed. 2. Unless app-makers present rigorous clinical trial data, along with cost-effectiveness data, PCPs should not recommend one consumer tool over another.
DIGITAL THERAPEUTICS
#CIAHKHLDIGITAL THERAPEUTICS ‣ Clinically & Behaviorally Oriented ‣ Validated ‣ Regulated (De Novo/510K) ‣ Prescribed ‣ Reimbursed
Pear Therapeutics ‣ First digital therapeutic authorized by FDA to treat disease (Substance Use Disorder) ‣ Second digital therapeutic for Opioid Use Disorder authorized ‣ Sanofi & Novartis have invested in Pear ‣ Third therapeutic for Insomnia/Depression submitted
Akili Interactive & Others Follow
Digital Therapeutics May Enable Digital Biomarkers Guthrie NL, Carpenter J, Edwards KL, et al. Emergence of digital biomarkers to predict and modify treatment efficacy: machine learning study. BMJ Open 2019;9:e030710. doi: 10.1136/bmjopen-2019-030710
WHAT IS THE FUTURE PCP ROLE? Speculation from an innovator: 1. PCP’s will begin prescribing digital tools for diet and lifestyle-related diseases in the next 2-3 years; 2. PCP’s will be reimbursed for reviewing patient-generated data; 3. AI will begin to influence lifestyle-related care in 3-5 years. 4. Clinical data and financial impact will begin to be tracked automatically.
AI IS COMING
#CIAHKHLDIFFERENT TYPES OF “AI” 1. Automation 2. Chatbots 3. Machine Learning 4. Natural Language Processing
Chatbots are already in use:
• Case study: Lark
• Company claims 2 MM users & top 10 health
app
• Study of 250 users:
• 70 judged “active” and analyzable;
• Mean weight loss of 2.4% at 21 weeks;
• 76% had some weight loss.https://www.youtube.com/watch?v=ty-kTUzMnjk
AliveCor KardiBand $200 + $100/year
Abbot Freestyle Libre CGM
Dexcom G6 CGMTAKE HOMES
#CIAHKHLMAIN TAKE HOMES Digital Health Tools In Primary Care: 1. Every nutrition, exercise, weight management tool has been digitized; 2. These tools work better with human support; 3. Current tools have not created new workflows in primary care; 4. PCPs should use the same clinical approach to digital tools as they did analog; 5. Currently, I can not give you evidenced based recommendation in each category — if there were really 1 best, there would not be 400,000 options; 6. Digital Therapeutics will eventually augment your approach; 7. AI is coming — automation will hopefully augment your efforts.
THANKS! mark@bettertherapeutics.io
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