New study says no, but what do experts think?
A new study found that using fitness trackers didn't seem to boost weight loss over the long term when added to a conventional diet-and-exercise program.
We contacted preventative medicine experts via e-mail to ask:
► What's your reaction to these results?
► How would you recommend patients use fitness trackers, if at all?
► What future enhancements to such devices might improve their clinical benefits?
The participants this week are:
Paul Thompson, MD, FACC, physician-in-chief, cardiology, at Hartford Hospital in Connecticut
Carl "Chip" Lavie, MD, FACC, medical director, cardiac rehabilitation and prevention at the John Ochsner Heart and Vascular Institute in New Orleans
Lona Sandon, PhD, RDN, LD, program director and assistant professor, Department of Clinical Nutrition, School of Health Professions at UT Southwestern Medical Center in Dallas
Timothy Church, MD, PhD, professor, preventive medicine at Pennington Biomedical Research Center at Louisiana State University in Baton Rouge
John P. Higgins, MD, MBA, a sports cardiologist at McGovern Medical School at UTHealth in Houston
H. Robert Silverstein, MD, FACC, medical director at The Preventive Medicine Center in Hartford, Conn.
Thompson: I am not surprised that the overall study group did not lose more weight with the monitoring device. First, it is hard to lose weight. Second, even if the device was useful at first, such novelty usually wears off. Third, the study was composed of lots of people. Some folks like self-monitoring, some do not, so folks need to decide which group they are in before they use such a technique. I know lots of folks who love their devices and talk about them a lot. The fact that the group on average did not improve does not mean no one benefited.
Lavie: These results certainly do not suggest that this particular wearable device leads to improvements in weight loss or, more precisely, prevents weight regain. The major issue with the study results, however, is that really all of the weight loss was obtained in the first 6 months, before the wearable devices were introduced. Also, before the wearable device was introduced, the more intensive group had already reduced their time in estimated MVPA by a striking 61 minutes compared to the standard group. Also, later in the study the enhanced intervention group was eating nearly 161 calories more per day than the standard group, which would account for about 1.5 kg difference in weight loss in just 2 months. Finally, both groups did considerably better than standard therapy.
Sandon: I am not surprised at all based on my own experience delivering a behavioral based weight loss program over the past several years. My observation is that participants in the program who wore technology ... did not necessarily pay attention to what the technology was telling them. If you never really look at the results or don't know how to interpret them, then they are not very meaningful and may not change eating and activity behavior to lead to weight loss. So the question that comes to mind is, what kind of feedback did the different groups get from the form of technology they used? Did the two groups differ in how results were presented to them that caused one group to make more changes than the other?
Issues with Device
Church: I am surprised. I think everyone assumed that the fitness tracker group would do better. I do believe the device being a clunky arm band instead of a cool wrist device may have impacted the results.
Higgins: While the activity tracker used, the FIT Core/BodyMedia is reasonably accurate for calorie burn data and has good analysis, it does have some disadvantages including: bulky and uncomfortable, no good instant data display/feedback, must be worn on arm, need to hook up cable to armband to transfer data, requires used to pay extra to access data. Other studies have shown that fitness trackers do make a significant difference when they are used by adults with limited access to medical care, counselling sessions, and reminder text messages (in contrast to the adults in this study). I think the take-home here is that any form of monitoring and/or feedback is better than none when it comes to improving health and wellness, and most people achieve their goals when they get objective feedback on their progress.
Technology Not the Cure
Silverstein: Overweight -- like cigarettes-alcohol-heroin-cocaine or any addiction (people willfully doing what they know they should not do and doing it to the point of obvious excess) -- cannot/will not be improved with very simple means such as wearable technology. The concept of "It takes a village" = not just a single nudge such as wearable technology, is correct. Kevin Volpp of U Penn has it correct: people will respond effectively by aversion to loss (of something important or valuable to them) such as money or an important privilege. This is called the carrot-stick approach and the stick has proven to be more valuable than the carrot. The improvement in this technology has to be a direct and frequent contact such as from an AA "sponsor" promptly if there is lack of success. We still need that (frequent) human touch which can be guided by what I say here.
Sandon: There needs to be a goal in mind and a plan for continually striving for a new goal or increased fitness level. If all you do is aim for 10,000 steps per day and you never challenge yourself beyond that, your fitness level does not improve any further and you likely plateau in weight and the tracker becomes useless. The same applies for making dietary changes. Diet trackers need to be used with a goal of changing over time. Simply entering foods and noting the calories you ate is not enough. You must do something with the information. You can also make adjust to choose healthier foods, such as eat more vegetables instead of cookies. Bottom line is you need to use the data you get from trackers to make decisions about what behavior to change.
Lavie: There will be some individuals who will run with this and others will ignore the information and quickly stop wearing or wear and ignore the results. Also, heart rate monitoring devices that give information on time and intensity of exercise are better than just step counters.
Motivation to Move
Higgins: I find fitness trackers are especially good for getting patients motivated, as well as for monitoring their activity/exercise prescriptions. Because healthcare providers see patients only about twice a year, the question is how to improve their patients' health and fitness the other 363 days? This is where activity trackers/smartphone apps may be helpful. They can monitor and improve exercise, diet, weight, stress, and sleep. Healthcare providers can learn about their patients' health and fitness activities via data summaries provided as well. Importantly, devices and apps using evidence-based behavior change techniques are more effective.
Church: I think there is still a lot to learn but from purely an activity perspective I think fitness trackers can help.
Thompson: I would recommend that folks try the trackers to see if they find them useful. The fact that a large group of overweight folks did not get benefit does not mean that no one in that group found them useful or that they might not be useful for folks who are not obese. I love my step counter and my bike ride calculator. I don't look at it every day, but often and my wife and I compete to see who has the most steps for the day.
Personalized Approach Needed
Sandon: Immediate feedback that makes suggestions on what to change. For example if you only recorded 1 cup of vegetables for the day and ate two cookies, the tracker could respond to give you suggestions on how many cups of veggies to eat the next day or offer suggestions of which food to replace, the cookies, with vegetables. The main purpose of self-monitoring with these tools is to get feedback about the behavior and then change the behavior as a result.
Lavie: Tailor the information to patients. Devices are needed that give a patient simple feedback on the amount and intensity of exercise that is needed to produce a desired outcome.
Keep Benefits in Perspective
Church: I believe these device are just devices, and the behavioral support system utilizing [technology] is critical. For example, linking the device to a well constructed game (i.e., Pokemon) could have great impact.
Higgins: We need a standardized approach to measure safety/efficacy and certify apps and products that claim to monitor and help health and fitness (the FDA regulates very few of the devices out there) – because inaccurate information can lead to unwarranted concerns or harm! Importantly, activity trackers and/or smartphone apps don't replace healthcare providers; rather, they may integrate and improve access to/for them and may serve as a handy tool to evaluate and motivate patients who have limited access to healthcare. Such devices have great potential uses including clinical, preventive, public health, and rehabilitation. With the use of cloud, data sharing will be more efficient and this will work both to benefit providers and our patients at an individual and population level.
Thompson: I am not sure what enhancements might improve their clinical benefits. Perhaps folks should be shocked by the device if they don't walk 30 minutes daily, much like rats in exercise training studies, but lacking that, regular exercise is hard to do, and I am not sure that any device can substitute for deciding you are going to do it.
This article was first published on MedPage Today and reprinted with permission from UBM Medica. Free registration is required.