- Healthcare providers are studying whether a mobile health platform can help patients who have undergone bariatric surgery in managing their weight and addressing mental health issues that sometimes appear after the operation.
In a study funded by the National Institutes of Health, researchers at New York’s Icahn School of Medicine at Mount Sinai are working with Noom’s mHealth platform to create a digital health care management program that targets the 20 percent of bariatric patients who regain the weight they’d lost and the 30 percent who develop mental health-related side effects.
Dr. Andreas Michaelides, a Bronx-based psychologist and Chief Psychology Officer for Noom, is the lead researcher on the project. mHealthIntelligence recently spoke to him about the project, as well as the promise of and challenges in working with mHealth.
Q. How can an mHealth app improve care management for bariatric surgery patients?
A. An increasing number of weight loss and bariatric surgery apps exist without empirical evidence of safety and efficacy. Potential mechanisms for variability in weight loss following bariatric surgery are poorly understood. While adherence and psychosocial health are likely contributors, limited data are available to comprehensively evaluate influences on post-operative adherence behavior. Furthermore, there are no reliable pre-operative predictors of post-surgery weight loss outcomes, and conflicting data have emerged about the impact of pre-surgery behavioral interventions on post-surgery weight loss.
An empirically validated mHealth app can improve pre-surgery adherence to recommended guidelines and augment behaviors conducive to more and sustained post-surgery weight loss.
Q. How would an mHealth app enhanced with AI make that process better?
A. Numerous diet and activity alterations are needed for weight loss success; therefore, more intensive interventions have been tried for individuals pursuing bariatric surgery.
Bariatric candidates typically receive monthly nutritional counseling sessions in anticipation of extensive required changes to their diet before and after surgery. Effective weight loss, through surgical or non-surgical methods, requires high levels of physical activity (burning more than 1,680 kcal/week) and eating a low-calorie diet (less than 1,500 kcal/day). Other weight reduction strategies include a low-fat diet (less than 30 percent kcal from fat), limiting the variety of foods eaten, limiting screen time, consistent weekly dietary intake and regular self-monitoring of weight and food intake.
However, even if these interventions are effective, several significant obstacles limit the widespread implementation of this type of traditional lifestyle intervention – namely, the substantial resources needed to provide them, low rates of adherence over time and decay in the maintenance of weight loss and health behaviors over the long-term. The costs of delivering lifestyle treatments become highly unrealistic when considering the number of individuals potentially eligible to receive surgery and the training of a professional workforce to deliver these interventions.
Technological advancement – specifically, the use of smartphones with lifestyle interventions - offers a significant opportunity to reach bariatric candidates at a fraction of the cost of intensive treatments like the Diabetes Prevention Program. Utilization of specialized non-medical coaches also offers a cost-effective alternative to expensive delivery options in traditional medicine (the use of dieticians, social workers and others).
In this study, bariatric patients will receive ongoing personalized guidance and support from National Diabetes Prevention Program (NDPP) trained lifestyle coaches. Patients can cumulatively spend one hour over the course of a week (or more depending on their needs) interacting with their coach via the mobile platform in addition to 24/7 access to coaching and group chats. The platform surfaces trends and patterns on the behaviors and actions of the patient, allowing coaches to prioritize and intervene in real-time at moments of greatest impact. Coaches are able to see the big picture (eating patterns and engagement with targeted content over time, among other behaviors) as well as drill down into details (such as macronutrient breakdown) to provide meaningful interventions.
Q. What outcomes are being measured in this study?
A. This study will measure (1) change in adherence to dietary recommendations at eight weeks, (2) change in adherence to dietary recommendations provided within pre-bariatric surgery program using the ASA-24 interview (a 24-hour recall of all food and drink consumed), (3) change in adherence to physical activity recommendations (through an activity tracker), and (4) change in adherence to physical activity recommendations (IPAQ) at eight weeks.
Q. How do you foster patient engagement in this study? Are the patients engaged to begin with or do they have to be convinced?
A. Participants are recruited from the Center for Excellence for Eating and Weight Disorders Program (EWDP) at the Icahn School of Medicine at Mount Sinai who are enrolled at the Metabolic, Endocrine, and Minimally Invasive Surgery Division and are planning to receive a bariatric procedure. Surgery candidates are invited, and participation is completely voluntary.
Q. Is there a set amount of time that an app like this would be used by a bariatric surgery patient, or could it potentially be used by a patient for the rest of his/her life? If it's open-ended, how does that fit into the provider's care plan?
A. The current program is being tested during an eight week period prior to surgery. In Phase 2 of the study, the program will be tested eight weeks pre-surgery and up to one year post-surgery. The app is not designed to be used for lifetime support, yet the behavioral aspects of the program, with new habit formation are expected to be adopted long-term.