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Happy Independence Day! Be safe!
We will return with our regular post tomorrow.
Image by jitphoto/123RF Stock Photo.
Happy Independence Day! Be safe!
We will return with our regular post tomorrow.
Image by jitphoto/123RF Stock Photo.
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.
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.
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.
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
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
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!
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.
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
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.”
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
Or is it? This is a casual look at some of the things that have been thought and said about technology over the past several years, particularly as related to health, and even more specifically in connection with childhood obesity.
Stanford Medicine is a name with considerable weight, and last fall that august institution published the results of a five-year study of 250 kids and their cell phones. The participants were “7 to 11 years old when the study began and 11 to 15 by the conclusion of the research,” pediatrics science writer Erin Digitale reported:
The average age at which children received their first phones was 11.6 years old, with phone acquisition climbing steeply between 10.7 and 12.5 years of age, a period during which half of the children acquired their first phones.
The decision was made by the parents. The subjects were low-income Latino children, and the phone questions were part of a childhood obesity project, which in turn is part of a larger concept, the Human Screenome Project. Senior author Thomas Robinson, M.D., noted that the parents seem to have done a good job in determining the appropriate ages for their own children, and the results “should be seen as empowering parents to do what they think is right for their family.” One interesting detail is that 99% of the kids had smartphones rather than any other kind.
The meticulously conducted study failed to find meaningful links between first-phone age and general well-being (or lack thereof). That quality was measured by looking at factors including but not limited to school grades, depression symptoms, and sleep habits. Other information had to do with the child’s sex, stage of puberty, birth order, birth country, family income, language spoken at home, and biographical information about their parents.
There are of course standards and parameters for such studies. Data must meet the challenge of being statistically significant, and determining that is a whole science in itself. Digitale continued,
When deciding to give a child a mobile phone, parents typically weigh many factors, such as whether the child needs a phone to let parents know their whereabouts, access the internet or maintain social connections; how much the phone may distract the child from sleep, homework or other activities; and whether the child is mature enough to handle risks such as exposure to social media, cyber bullying or violent online content.
Xiaoran Sun, Ph.D., of both Stanford Medicine and Stanford Data Science, and lead author of the study published by Child Development Journal, told the reporter, “There doesn’t seem to be a golden rule about waiting until eighth grade or a certain age.” According to Dr. Sun,
The researchers note it may be more important to study what children are doing with their technology than simply whether they own a phone.
For the current state of the fusion of electronic technology and childhood obesity treatment, please see Dr. Pretlow’s BrainWeighve.
Your responses and feedback are welcome!
Source: “Age that kids acquire mobile phones not linked to well-being, says Stanford Medicine study,” Stanford.edu, 11/21/22
Image by Pabak Sarkar/CC BY 2.0
When Janna Stephens wrote about technology-incorporating obesity interventions, it was clear that the meta-study she consulted had the same problems as many other such conglomerations of knowledge from many sources. Researchers who do this sort of work need to think carefully about the parameters they designate for which documents are to be considered and which will be put aside in the particular instance.
For her purposes it was, in general, hard to compare results because the proposed intervention strategies varied widely from one study to the next in the areas of “interfaces, mode of delivery of message, types of messages, dosage of intervention, and goals.”
Another important factor to consider is the strength of the evidence reported from these studies. Was each paper generated by a reputable person or group, at a reputable institution? Also, some of the intervention studies had other factors built in, aside from the technology — like calls or mailings from a healthcare provider, and even in-person visits. Stephens wrote,
Not all of the studies were randomized controlled trials; introducing potential biases, including sample selection biases and instrumentation biases. Those that were randomized controlled trials also had limitations that should be noted when examining the reported results.
Generalizability and the facility to synthesize results are subject to limitations. Since some of the studies under consideration were conducted outside the U.S., certain factors did not match up. If there was a focus on cultural elements, or the measurement tools used were culture-specific, not everything could be extrapolated to other countries.
Stephens notes that even within the U.S., when the cardiovascular risk factors having to do with physical inactivity and weight loss are involved, certain factors come into play. If the patient needs to have a smartphone, or even a less versatile mobile phone with text-messaging capability, that can present an obstacle because obviously, not everyone can afford to own such instruments.
Of course, in research of this kind and especially in studies of studies, it often seems that every answered query generates a new batch of questions. Stephens gives typical examples:
How can smartphone and text messaging interventions benefit children and adolescents? Will text messaging and smartphone applications be effective interventions in the elderly?
Is a text messaging intervention more or less beneficial than a smartphone application in reduction of weight and increasing physical activity? Would the combination of a smartphone and text-messaging be more beneficial than either intervention alone?
Are smartphone interventions effective in low socioeconomic status subgroups? What are the long-term outcomes of smartphone and text messaging interventions?
How can successful interventions be translated to populations? What is the cost-effectiveness of this type of intervention?
Your responses and feedback are welcome!
Source: “Smartphone Technology and Text Messaging to Promote Weight Loss in Young Adults,” JHU.edu, July 2015
Image by Edna Winti/CC BY 2.0
This post continues consideration of the scientific literature surveyed by then-Ph.D. candidate Janna Stephens about eight years ago. The work includes a discussion of a meta-study (described in Stephens’s footnote #14) that was published by the International Journal of Behavioral Nutrition and Physical Activity.
The 10 authors looked at 41 studies that focused on the weights, physical activity, and nutrition of college students between the years 1970 and 2014. Sadly, only nine of the sources mentioned the use of online technology, and none made use of smartphones. Still, some helpful information could be gleaned.
In several studies, regular, basic phone texting had been part of the intervention methodology. The frequency of messaging ranged between five times a day and once a month. Some tried morning as the appropriate message time, while others tried evening. Some were automated, one-way communications, while others involved personal conversations with a mentor.
In a study where the mean age of the participants was 23, the people who received reminder messages about their goals lost significantly more weight, over a month, than the control group. In another study involving women between 18 and 30 years of age, automated daily messages did not make a significant difference in their improvement as compared to the control group.
On the whole, it seemed clear that in the development of interventions that employ technology, the measurement of results should focus on weight, Body Mass Index, and waist circumference. (On the other hand, there is of course an entire school of thought which demotes the BMI from its former prominence.)
As an intervention, text messages alone, whether one per day or many, were not making much of an impression. Still, overall, the potential effectiveness of the tool appeared generally promising, if incorporated into a program that included other methods like education or group sessions.
Even back in 2015, when Stephens’s dissertation was published, there were around 17,000 health-related apps (not all having to do with obesity, of course). She noted that the new resources available to young people included “activity tracking capabilities and realtime feedback mechanisms.” Fortunately, by that time, a lot of healthcare professionals were up to speed on the new technologies, too.
In that era of experimental interventions, the idea of letting the subjects send messages was not popular. Stephens found only two studies where messaging was participant-driven, meaning that the subject could send a message and receive an immediate response. Only those two achieved “statistically significant results in at least one outcome.” People don’t want to just be told things; they want to be heard.
The Discussion section of Stephens’s paper went like this:
This systematic review revealed that text-messaging or smartphone applications are well accepted by participants and may provide beneficial effects on weight reduction, decreasing waist circumference, decreasing body mass index, decreasing fat mass, increasing physical activity, decreasing sugar-sweetened beverage intake, decreasing screen time, and encouraging healthier eating patterns.
Your responses and feedback are welcome!
Source: “Smartphone Technology and Text Messaging to Promote Weight Loss in Young Adults,” JHU.edu, July 2015
Image by Micah Drushal/CC BY 2.0
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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.
Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:
Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It
Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism
Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause
Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model
Dr. Pretlow’s invited presentation for
TEC and UNC 2016
Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.
Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.
Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.
Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.
Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.
Childhood Obesity News | OVERWEIGHT: What Kids Say | Dr. Robert A. Pretlow
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