Pat Hartman | Childhood Obesity News

A Decade of Tech, Part 8

Pat Hartman July 7, 2023 No Comments

Currently offered for sale (US$4,499.00) is the domain name vBloc.com, described as “a perfect fit for your business or personal project.” If, that is, your business or personal project is the manufacture of an appetite suppression gadget suitable for implantation in the body of a severely obese person who within the past five years had tried and failed to shed weight by other methods. Under its formal name, the Maestro Rechargeable System, the device was approved by the Food and Drug Administration in 2015. It included some components implanted in the body and others located outside.

The internal components include a rechargeable pulse generator (also called a neuroregulator disc) which delivers electrical signals to nerve electrodes. The electrodes are placed on the trunks of the vagus nerve in the abdomen and two electrical leads connect the electrodes to the pulse generator. The external components include a transmit coil, mobile charger, and clinician programmer.

Installation would involve minimally invasive surgery, and the externally-worn battery would be on for up to 12 hours per day, and need a weekly recharge. Its purpose was to block signals along the vagus nerve, telling the brain that the stomach was empty or full, and also to “decrease calorie absorption through lower digestive enzyme secretion.” It was said to allow patients “to address obesity without any restrictions to food intake and any adjustments to their lifestyle.” This is difficult to envision. Could a person really eat unrestrictedly and be okay, as long as they had a gadget? Wouldn’t the presence of an ever-open port necessitate some lifestyle changes?

Aaron Mamiit wrote,

Functions of the vagus nerve involve the enabling of several mechanisms in the human metabolic and gastrointestinal systems, including stomach expansion, stomach contraction, gastric acid release, stomach content release into the small intestine, digestive pancreatic enzyme secretion and the sensations of both hunger and fullness.

Patients who received over 12 daily hours of vBloc therapy “achieved more than 25 percent average excess weight loss over a period of 12 months.” These numerical statements can be tricky. If a person was judged to be 40 pounds too heavy, that would mean they lost maybe 10 pounds over a year, which does not sound so impressive when phrased that way. In 2012 during testing, it was estimated that the system would cost the patient $15,000.

One trial involved 503 Australian and American subjects, of whom 90% were women. The researchers found that clinically significant weight loss…

[…] was related to hours of device use. Post-study analysis suggested that the system electrical safety checks (low charge delivered via the system for electrical impedance, safety, and diagnostic checks) may have contributed to weight loss in the control group.

They concluded that weight loss was not impressively greater among the participants than in the control subjects. In another trial concerning morbidly obese patients, 162 received the working device and 77 were implanted with a fake, and they all had weight management education. The report concluded that:

[…] the use of vagal nerve block therapy compared with a sham control device did not meet either of the prespecified coprimary efficacy objectives, although weight loss in the vagal block group was statistically greater than in the sham device group.

On the positive, side, the device proved to be safe and well tolerated by the implantees. A couple of years later, vBloc therapy reportedly “continues to result in medically meaningful weight loss with a favorable safety profile through 2 years.” In a manufacturer-conducted study, the participants with the working device lost almost 9 pounds more in a year than those in the control group who had sham devices.

Your responses and feedback are welcome!

Source: “vBloc.com,” PerfectDomain.com, 05/07/23
Source: “Enteromedics Maestro Rechargeable System,” RxList.com 10/14/19
Source: “FDA approved a device that blocks your hunger pangs,” Mashable.com, 01/15/15
Source: “Appetite Pacemaker: Here’s How this Weight Loss Implant Works,” TechTimes.com, 01/15/12
Source: “The EMPOWER study: randomized, prospective, double-blind, multicenter trial of vagal blockade to induce weight loss in morbid obesity,” NIH.gov, November 2012
Source: “Effect of reversible intermittent intra-abdominal vagal nerve blockade on morbid obesity: the ReCharge randomized clinical trial,” NIH.gov, September 2014
Source: “Two-Year Outcomes of Vagal Nerve Blocking (vBloc) for the Treatment of Obesity in the ReCharge Trial,” NIH.gov, January 2017
Image by Beth Scupham/CC BY 2.0

A Decade of Tech, Part 7

Pat Hartman July 6, 2023 No Comments

In 2018, Fitbit came out with a new device meant to encourage healthful movement in young people. “It can automatically track kids’ activity, remind them to get up and move, and set activity goals for them to meet.” Designed especially for children age 8 and older, it was priced at $100. The various parts would track their steps and their active minutes, and remind them to get up and move. There were encouraging messages and activity goals and rewards. It also kept track of sleep time. The ad copy said,

Parents will be able to check kids’ activity and approve kids’ friend requests in the app, as well as set limits on what their kids can see.

By 2022, several different kinds of Fitbit gadgets were available for the younger crowd. The offerings included models for younger kids, for older kids, devices available at a discount, and “feature-rich” options with “all the bells and whistles” including the ability to report on blood oxygen levels and skin temperature variation.

Parents were told that, thanks to the device, they would be aware of when to reward their children for making credible efforts, and be able to pit children against each other in friendly competition. The devices were designed to protect children’s privacy from everyone except, of course, their parents. The instructions also came with various caveats:

The Parent view in the Fitbit app lets you navigate between your view and your kid’s view to check on their activity and progress. It also provides you with a means to manage who your children connect with and what information they see on the OLED display… These wearables only focus on fitness tracking so lack safety tracking functionality that can be found in certain other devices. The most important thing to know is that Fitbit does NOT gather location tracking data from your child.

An interesting twist in the product field, from SunderlandEcho, was a type of pedometer that orchestrated a “virtual trek.” In 2015, students from 30 different primary schools were issued pedometers that kept count of their steps and then, thanks to a specialized website, translated the distance they had covered into an imaginary walking tour.

The system marks out the steps on a map along the route of the Jarrow March to London and then around Europe, taking in all the major cities, including Paris and Berlin.

Students from the school that chalked up the most “travel” miles were rewarded.

Your responses and feedback are welcome!

Source: “Fitbit’s new $100 fitness tracker is made especially for kids — here’s how it works,'” BusinessInsider.com, 03/14/18
Source: “Best Fitbits for kids & teenagers – guide, recommendations,” GadgetsAndWearables.com, 12/02/22
Source: “Thousands take part in ‘virtual’ trek across Europe,” SunderlandEcho.com, 07/03/15
Image by ucniss/CC BY 2.0

A Decade of Tech, Part 6

Pat Hartman July 5, 2023 No Comments

This series looks at some of the ways in which technology has impacted obesity (and vice versa) over the past ten years or so. In 2014 there was news from Chicago about a pilot program for 6th-grade students, called “Healthy School Meals Realized through Technology (SMART) Schools.” The preliminary steps began with qualitative research done by Canyon Ranch Institute “that included focus groups and interviews with students, parents, teachers and staff.” The intention was to figure out how to help people of all ages boost their levels of health literacy.

A school nutrition software company called A+ Café helped to develop technology that enabled preventive medicine experts to know what each child chose for breakfast and for lunch. This information was then matched up with the children’s weight gains or losses. The goal was to design a way to track the kids’ food choices, for the purpose of tailoring individualized reports. One of the principal investigators, associate professor of preventive medicine Brad Appelhans, Ph.D., told the press,

The overall goal of this project is to develop a technology-based system to track student food choices in the school setting and be able to provide this information to parents and teachers along with some evidence-based strategies to help children adopt a healthy lifestyle. This could be a valuable component of future school-and-family-based child obesity interventions.

Members of the cafeteria staff, equipped with touch-screen monitors, scanned the students’ ID cards to record each food item they picked out. Every week, each child’s comprehensive report was forwarded to the grownups. It would reveal things like the nutritional and caloric values of the various items, and also make recommendations toward more suitable future choices.

Technology was used with the end goal of tailoring educational materials according to individual needs and inclinations, and to guide the children and parents to develop more effective self-management skills.

As always, there were ideological differences, as some Americans objected to the snitch factor. Did these kids, in their final year of elementary school, have any say in the matter? Is there a rights issue?

Around the same time in Mississippi, where 43% of the kids were overweight or obese, pediatric endocrinologist Jessica Sparks Lilley, MD made known her opinion of an interactive health-coaching application marketed by Weight Watchers (newly christened WW):

I’ve personally used the WW app with the desired outcome of weight loss, and found the program much easier to follow than others, with long-lasting lessons of incorporating more fruits and vegetables, for instance.

In a state with such a paucity of health literacy, anything that works at all sounds pretty good, and some things raise even higher expectations. And advice alone “doesn’t provide the structure that families seek.” They are asked to keep food journals, and ponder the entries and the possible relationship to unwanted body weight.

Dr. Lilley expected the medical community to be excited about the app, which utilized a program called Kurbo that had originated at Stanford University. She characterized the program as well-researched and successful, and as “a free app for children over age 8 that gives support for weight loss and healthy food choices, with coaching available for a fee” which apparently was $70 a month, a lot for Mississippi. But in a backlash both swift and severe, critics castigated it for not being person-centered, and…

[…] social media was ablaze with expletive-laden missives against the perception that children were being told by society that their size determined their worth.

Your responses and feedback are welcome!

Source: “Two Chicago Cafeterias to Use Technology to Create a Healthy Eating ‘Report Card’ on Students’ Food Choices and Eating Habits to Help Prevent Childhood Obesity,” Newswise.com, 08/21/14
Source: “Weight Loss App for Kids: Backlash ‘Swift and Severe’,” Medscape.com, 08/27/19
Image by Uncle Saiful/CC BY-ND 2.0

Happy Independence Day!

Pat Hartman July 4, 2023 No Comments

Happy Independence Day! Be safe!

We will return with our regular post tomorrow.

Image by jitphoto/123RF Stock Photo.

A Decade of Tech, Part 5

Pat Hartman July 3, 2023 No Comments

Ten years ago, electronic health records were making the news. Professionals were excited about the opportunity to intervene more “aggressively,” though that might not have been the most thoughtful or helpful choice of words. Programmed alerts of various kinds were welcomed by practitioners and patients alike. But in the realm of pediatric obesity, researchers could not help noticing that computers were not really doing a good job keeping track of whether the electronic systems actually helped children to reduce their weight, or at least slow down their rates of gaining pounds.

Also, it was noted that some families were not ready or able to adjust their lifestyles in order to adapt to electronic systems. At the same time, some doctors also found it difficult to change their ways. An uncredited writer reported,

To prepare physicians for these new EHR tools, the researchers provided a one-hour training class…. individual training, as opposed to group classes, could improve performance. “The alerts led to significant but not dramatic improvements,” said Ulfat Shaikh, lead researcher, pediatrician and director of Healthcare Quality at the UC Davis School of Medicine. “We believe any electronic record intervention must be combined with other approaches.”

That, in itself, should not come as a surprise. Grownups are like children in many ways, and for both groups, some learning is absorbed better if the contact is individual and personalized. This is why, for instance, pharmaceutical corporations customarily sent attractive sales reps from office to office to tell doctors one-on-one about the benefits of their products.

To measure whether EHRs enhance practice, the researchers added obesity-related alerts to health records at the UC Davis Health System’s outpatient clinic, which cares for about 12,000 children each year. The alert — highlighted in bright yellow on the screen — warned physicians when a patient’s weight hit the 85th percentile, which is considered “overweight.”

The doctor would then be electronically guided through a series of steps that had been found helpful in addressing weight issues. Patients and their families were to be educated about “diet, exercise, screen time and other behaviors associated with obesity.” These discussions were to be documented. Appropriate lab tests would be recommended, in addition to referrals to dietitians, and follow-up contacts would be scheduled.

As a result, the proportion of children with diagnoses of overweight or obesity increased from 40% to 57%. More kids were sent for lab tests for diabetes and abnormal blood levels of cholesterol and fat. Recommendations for follow-up appointments almost doubled. And yet, for some reason, referrals to dietitians did not increase. Was this necessarily a bad thing? Because, as Dr. Pretlow says, pretty much everybody already knows about calories and nutritional guidelines, and if they had not started following helpful eating practices yet, this might not be enough of a nudge to make them change their ways. It became apparent that referrals were needed not to dietitians, but to counselors, social workers, and cognitive behavioral therapists.

Your responses and feedback are welcome!

Source: “UC Davis Study Offers New Insights Into Controlling Pediatric Obesity,” Benzinga.com, 01/29/14
Image by rodgerspix/CC BY 2.0.

A Decade of Tech, Part 4

Pat Hartman June 30, 2023 No Comments

Yes, let’s talk more about the combination of technology with the search for successful interventions to reduce childhood obesity. (Apparently, the notion of eliminating it altogether has come to seem like something from the land of fairy dust and unicorns.)

In the realm of pediatrics, as well as in other areas, the innovations of telemedicine, telehealth, and even telepsychiatry have steadily become more prominent.

Back in 2014, a platform called CloudVisit was created to organize the scheduling of video appointments among people in different locations: “health care providers, patients, and families at home and at local facilities.” A successful weight management program involves participation from a number of experts — not only pediatricians, but dietitians, movement specialists, psychologists, statisticians, and more. And it has been shown that personal interaction works wonders.

Reality intervenes

But for various reasons, families cannot continue to bring children to physical locations forever, and fate provides other barriers to the perpetuation of intense, frequent personal contact. Organizations that were formed to deal with childhood obesity run out of money. “Cost-effective” is a very important phrase. The eventual goal has to be finding ways to “easily transition patients from in-office care to long-term weight management success.” As proponents of telemedicine point out, it can make a significant difference to rural and other underserved populations.

As CloudVisit President and CEO Daniel Gilbert phrased it, “Continuous care is easier, completely private, and significantly more efficient for the providers and the patients. Online wellness programs can improve long-term compliance and help patients maintain weight management goals.” One crucial facet of doing things the electronic way is that the care providers have to figure out how to monitor and influence compliance in the home, without being intrusive or bossy to a degree that causes attrition.

BrainWeighve

Now, in the present day, to truly appreciate how far the concept of long-distance helping has advanced, check out the BrainWeighve App User Manual. Here is a brief excerpt explaining how it works:

The app helps you deal with both immediate and ongoing difficult life situations and resulting eating urges. You enter your difficult life situations in the app’s Dread List, which helps you identify these situations, and then the app helps you to create Action Plans for each one.

This should stop the build-up of overflow nervous energy in your brain, and the displacement mechanism, which causes you to overeat, likewise should stop firing. For in-the-moment, immediate stressful situations with eating urges, you should tap the Rescue button. The Rescue area asks you what is bothering you the most in your life, at that moment, and then helps you come up with an Action Plan.

Your responses and feedback are welcome!

Source: “Pediatric Telemedicine Discusses Overcoming Childhood Obesity,” BroadwayWorld.com, 04/03/14

A Decade of Tech, Part 3

Pat Hartman June 29, 2023 No Comments

As we saw yesterday, personal contact is a powerful key in any self-improvement system. Often, someone attempting to make a serious change needs gym buddies to share workout tips and practice mutual encouragement with — or maybe even a personal life coach. It seems fairly common for a human to crave feedback of some kind, at some level.

Ten years ago, lots of devices had already been invented for or adapted to weight-loss purposes. Here is a typical paragraph, from a 2013 piece by Corey Radman about a Colorado health center:

Because so many of Harmony’s new clients are young adults, [a staff member] explains that they provide Kindles for patients to use for their inpatient homework. “Even Power Point is a little passe for these young adults. This way, we are touching them the way they want to learn.” They have also written a smart-phone app for graduating clients to check in daily with their counselors after they leave.

A contemporary article attested to the usefulness of personal contact in what was termed an intensive lifestyle intervention, namely “conference calls by primary care provider staff.” At a New York state university clinic, professionals were trained to facilitate two types of phone situations, either one-on-one discussions, or conference calls with as many as 8 individuals. They were all pre-diabetic or metabolic syndrome patients who needed to lose weight.

This went on for two years, while the study authors kept track of patient weight status at the 6-, 12-, and 24-month marks. After one year, the individual call and conference call patients were pretty much even. But by the two-year mark…,” conference call participants had lost more weight and continued to lose weight compared to those receiving individual calls.”

At that landmark, patients in the individual call group tended to start regaining weight. Why? It may have simply been that they would have benefited more from an extended support system. According to the article,

The conference call educators were trained to promote discussion among the group and group members shared weight loss strategies within a supportive environment.

Of course, people thrive on individual attention. The original Freudian model of psychotherapy was one psychiatrist to one patient, in privacy. In the 1960s, group therapy became a popular mental health scenario, especially among younger people trying to sort out their relationships with drugs and each other.

As much as a person can benefit from individual, intense personal attention and counseling from a single practitioner, it seems that the community devoted to mutual help is also a powerful setting that can, in the long run, be even more effective.

Your responses and feedback are welcome!

Source: “Addiction Recovery Enters a New Era,” Issuu.com, 2013
Source: “Losing weight over the phone,” AlphaGalileo.org, 07/09/13
Image by JourneyPure Rehab/CC BY 2.0

A Decade of Tech, Part 2

Pat Hartman June 28, 2023 No Comments

Sure, the intersection between obesity and technology began long ago — with the invention of the first weighing scale. But we won’t go that far. Let’s travel back in time for a decade or so, and recall what was going on then. What better source could be found, than a Childhood Obesity News post? This one just happens to recount the origin story of the iPhone app developed by Dr. Pretlow and his team.

Charleston Children’s Hospital had a problem, namely, the inability of many children who had graduated from its eight-week intensive program to return for followups. Back home, without the continuing support of peers or mentors, they tended to fall back into old habits and, not surprisingly, to gain more than their age-appropriate number of pounds. (And of course, it goes without saying — people of every age need all the support they can get.)

The fix for this situation started with an online system where the study participants were sent reminders to weigh in, along with messages of encouragement from the staff. Dr. Pretlow described it as “a kind of electronic accountability that keeps them cognizant that they’ve always got this problem.” Of later refinements, he wrote,

Now, we’ve come up with this iPhone app. These smart phones could be used forever as a tool to help these kids deal with episodes of relapse on an indefinite basis.

The key to any sort of intervention is two-way communication. One group offers suggestions on how to proceed. The other tries them out, and reports back on the results, both objectively (through weigh-ins, BMI calculations, or other metrics) and subjectively (their feelings about all of it). Having received feedback, the first group goes to work figuring out how to improve the program. This is a winning formula.

Maintaining a healthy body weight involves a lot of factors, one of them being the persistent (and erroneous) conviction that happiness can be found in a substance, whether that substance is morphine or caramel ice cream sauce. History has proven that few substances, no, not even gold or diamonds, can provide happiness.

In the pursuit of happiness, the odds are much better with a behavior, rather than a substance. First, a substance may not always be easily obtainable. The supply-and-demand factor is beyond an individual’s control. In general, a behavior is more likely to be under almost anyone’s sovereignty.

The behavior of piano playing can bring great joy to a person. The behavior of gambling can do the opposite. Substance or behavior, any plan to break addiction has to cover all the bases.

Speaking of which, catch up with the latest iteration of Dr. Pretlow’s techniques, BrainWeighve, here: https://brainweighve.com/.

Your responses and feedback are welcome!

A Decade of Tech, Part 1

Pat Hartman June 27, 2023 No Comments

This post initiates a look at what technology has been doing in relation to childhood obesity, for better or worse, over the last 10 years or so. Actually, let’s start a little further back with a 2007 article from Bloomberg.com, titled “Is Online Marketing Making Kids Obese?”

After examining a report from the Center for Digital Democracy and American University, journalist Catherine Holahan was not pleased with what she had seen. It was all about how low-nutrient food (and let’s just go ahead and call this stuff junk food) is “marketed online to kids and teens using everything from avatars in virtual worlds to instant-messaging chat tools, and from Web sweepstakes to interactive games.”

Professional observers had already begun to suspect that such tactics contributed to diet-related health problems, including obesity, among children. In other words: Technology = bad.

Their wicked ways

Junk food manufacturers were strategizing like history’s most prominent military commanders. The reincarnations of Alexander the Great, Attila the Hun, William the Conqueror, Napoleon, and George Patton were all aiming their best efforts at inducing children (and adults) to consume tons of worthless crap. The report passed along its deplorable findings to the Federal Trade Commission with the hope of improving the situation:

The FTC is currently conducting a survey of food marketing to children, across a variety of media. As part of the regulator’s study, it is demanding that 44 food-and-beverage manufacturers, distributors, and marketers disclose how they advertise to children.

The promotional techniques included catchy songs, representation by cute cartoon characters, the inclusion of toys with the products, and subtle brainwashing to cultivate a sense of FOMO (fear of missing out) in the children of America and the world. Kathryn Montgomery, the author of the appalling report, told the press,

[A]dvertisers know food, like toys, is an area where kids have both purchasing power and sway over their parents’ decisions… We shouldn’t be having debates with our kids in the aisles of grocery stores and every parent I know has had to do that.

Holahan noted the burgeoning trend of advertisers using social media to encourage children to add specific products and brands as “friends” and then introduce those fake friends to their online human friends. Back in 2007, MySpace was a hugely popular networking site where Burger King’s mascot pulled at least 150,000 “friends.” The researcher went into nauseating detail about the other methods of indoctrination employed by corporations to snag children’s attention and lead them into ever-increasing consumption of junk.

Some companies took the trouble to publicly cleanse themselves of sinister motivations, and declare their allegiance to principles of basic decency, empathy, concern, care, respect, health, and bla-bla-bla. They pledged to make heroic efforts toward self-regulation, which sounded just as ludicrous then as it still does at the present time.

But wait… For much more encouraging news about what technology is accomplishing nowadays, please visit Dr. Pretlow’s site, BrainWeighve.

Your responses and feedback are welcome!

Source: “Is Online Marketing Making Kids Obese?,” Bloomberg.com, 05/17/07
Image by Jiposhy.com/CC BY-SA 2.0

Finding the Path With Technology

Pat Hartman June 26, 2023 No Comments

The relationship between obesity prevention and technology has been developing for years, and has branched off in many directions. An interesting multi-author paper originating from Spain, Mexico, and Costa Rica, published in 2018, included input not only from technicians but from nutritionists and specialists in physical activity.

It laid out interesting general precepts to explain the reasoning behind many of the choices made in developing a system to promote healthy behaviors relating to childhood obesity. For instance,

The amount of notifications received in a mobile phone is now unmanageable for users. Therefore, we believe that combining mobile applications with pervasive computing through smart devices could have more impact in the people and enhance their user experience.

By smart devices we mean: instruments, equipment or machines that have their own computational capacity. These electronic devices are connected to a network and interact autonomously with other devices and users.

The researchers concentrated on figuring out what works for families with children aged between six and 12 years, because (as has become very obvious) early prevention of obesity is key. Younger children are more impressionable than older ones, so the sooner, the better.

One guiding principle the developers kept in mind is that “visual recognition memory is superior to auditory recognition memory.” Another is, “A system is suitable for learning when it supports and guides the user in learning to use the system.”

Peaks and valleys

There is a quality called “effectiveness decay” which has to do with how much efficacy is lost over time, and at what steps in a process the loss kicks in. A health intervention in the form of a memory aid might work quite well for a while. If a device asks its owner, “Did you floss your teeth today?,” the results might be quite productive at the start, then tend to fall off over time. The point may come where the reminder elicits only a jaded response like “Yeah, leave me alone, I’ll get to it.”

Reminders from devices are “useful when they refer to the target behavior and the situation in which it needs to be executed,” but their power to influence behavior will almost inevitably fade. Yet the authors are optimistic:

Even though the effectiveness and relevance of reminders decrease with time, reminders keep people engaged and help them to repeat the behavior, and in some cases, could support the start of the new habit, as the new behavior might develop faster than the decay of effectiveness of the reminder.

This team found that, although more than 85 different smart devices existed at the time, none quite encompassed the abilities they looked for, so part of the mission was to develop their own satisfactory device that would include, at the least, a physical activity tracker, central database, notification generator, and notification dispatcher

The system they developed was described as using different technologies “including low-cost microcontrollers, sensors and simple actuators to deliver information to the users, a NoSQL database to model people and devices into the system, and a lightweight messaging protocol to allow the devices to work with low processing capabilities consuming small amounts of energy.”

Your responses and feedback are welcome!

Source: “Smart Device-Based Notifications to Promote Healthy Behavior Related to Childhood Obesity and Overweight,” Nih.com, 01/18
Image by Tomizak/CC BY-ND 2.0

A Decade of Tech, Part 8

A Decade of Tech, Part 7

A Decade of Tech, Part 6

Happy Independence Day!

A Decade of Tech, Part 5

A Decade of Tech, Part 4

Reality intervenes

BrainWeighve

A Decade of Tech, Part 3

A Decade of Tech, Part 2

A Decade of Tech, Part 1

Their wicked ways

Finding the Path With Technology

Peaks and valleys

Profiles: Kids Struggling with Weight

The Book

About Dr. Robert A. Pretlow

Presentations

Food & Health Resources