Finding the Path With Technology

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

Everything You Know About Mobile Devices Is Wrong

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 world is a stage

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.

The present

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

Perils of the Meta-Study

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

Parts of a Meta-Study

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.

In general

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

How Is a Lawyer Like a Ph.D. Candidate?

The whole point of an academic dissertation is to take all the steps that a trial attorney goes through in preparing a court case. According to writer and editor Sabrina Collier, the author will define a question, pinpoint the issues, and assess the legitimacy and reliability of relevant information, which of course must be meticulously sourced. Then the evidence on every side should be evaluated, and a competent argument made, which leads to the conclusion. The only difference is, the dissertation-writing student (rather than the legal system) proposes the original question.

Almost 10 years ago, by submitting a dissertation, Janna Stephens of Johns Hopkins University claimed the right to place the letters Ph.D. after her name. The question that interested this student was whether technology, in the form of smartphone applications and text messaging, could provide successful platforms for the delivery, to young adults affected with obesity, of needed behavioral interventions. It was partly answered by analyzing the results of a weight loss study of subjects whose ages ranged from 18 to 25.

Results: Participants randomized to the intervention group lost significantly more weight (p=0.026), significantly reduced their body mass index (p<0.01), and significantly reduced their waist circumference (p<0.01) when compared to participants in the control group.

The participants confirmed that using the tools provided by a smartphone, along with text messaging, interested them greatly. The ability to integrate this technology into their lives was not even in question, but was proven anyway. In the realm of behavioral intervention, this concept went straight to the top.

Multiple studies have reported significant weight loss, reduced BMI, reduced fat mass, and increased physical activity in participants using Smartphone technology versus those who were not.

Between 2005 and 2010, studies of smartphone applications seem to have been centered around the cardiovascular risk factors posed by overweight, obesity, and inactivity.

The author also gleaned information from other timely studies. In one, the researchers noted that “the individual who accessed the application the most, lost the most weight.” Strangely, very few studies had focused solely on the young adult demographic, a particularly egregious omission considering such factors as the tendency of college students to gain the pounds known as the “freshman fifteen.” Stephens also noted a dearth of evidence about how effective mobile phone technology might be on elderly people or young children.

Your responses and feedback are welcome!

Source: “What is a dissertation?,” TopIniversities.com, 06/01/23
Source: “Smartphone Technology and Text Messaging to Promote Weight Loss in Young Adults,” JHU.edu, July 2015
Image by Karen Neoh/CC BY 2.0