Fighting Chronic Disease With Digital Therapeutics
By David Yeager
It’s estimated that more than 78.6 million American adults, or more than one-third, is obese, and obesity-related medical costs in the United States are as high as $147 billion per year.1,2
One of the most common and most expensive obesity-related diseases is type 2 diabetes, which afflicts approximately 29.1 million Americans, although approximately 8.1 million are undiagnosed.3 Busy lives, lack of exercise, poor nutrition, sedentary lifestyles, and genetics contribute to the diabetes epidemic, but an often overlooked aspect is the lack of social support.
One of the ironies of today’s digitally connected world is that people have less time for face-to-face interaction. Omada Health, a San Francisco-based digital health company, is hoping to support healthful behavior changes by using technology to create a network of social connections. To achieve this, Omada Health has created the Prevent platform, a combination of modern technology and social networking, which educates people about nutrition and exercise while pairing them with similar individuals who have comparable goals.
“We create a tiny little world around someone, where it’s almost easier for them to stay in than leave,” says Sean Duffy, Omada Health’s CEO. “They’re with other people who are on the same timeline; they’re achieving success; they have support from a coach; they’re tracking; they’re learning. It’s a multimodal world.”
How It Works
Prevent was developed from research performed for the National Institute of Diabetes and Digestive and Kidney Diseases’ Diabetes Prevention Program (DPP). DPP research estimates that as many as 57 million US adults, aged 20 and older, had prediabetes in 2007.4 Omada Health decided to focus their initial efforts on helping people with prediabetes lose weight and manage blood glucose levels, Duffy says, because that’s where they felt they could make the most immediate impact. The Prevent curriculum is based on DPP findings.
Anyone can sign up for Prevent online, but most people join through their health plan or employer. Omada Health currently works with large organizations, integrated delivery networks, and health plans such as Kaiser Permanente, Blue Cross Blue Shield Louisiana, and Stanford Hospital and Clinics. At the start of the initial 16-week program, participants are assigned to a small group of like-minded people; a dedicated health coach works with the group to offer feedback, encouragement, and advice. As the group works its way through the curriculum, they provide each other with accountability and support.
Each week, a new chapter of the curriculum is unveiled. In addition, digital tracking tools that include a wireless scale—to eliminate self-reporting errors—and a mobile app help participants track their weight, eating habits, and physical activity, among other metrics. After 16 weeks, participants graduate to the Sustain program, which involves shorter weekly lessons and continues until one year after the participant’s initial sign-up date. Once Sustain ends, they have continuing access to the tracking tools and can contact their health coach or fellow graduates via a community discussion board.
As a Prevent health coach, Sara Ansari, RD, helps people develop skills that allow them to change their eating and exercise behaviors, lose weight, and develop sustainable, healthful habits. She teaches people how to problem solve, find new ways to deal with stress, recognize and manage social and environmental cues that trigger unhealthful behaviors, and overcome negative thinking. She also teaches them about nutrition, grocery shopping, meal planning, and how to balance their plate for ideal weight loss and blood sugar management. Rather than telling people exactly what to eat, she focuses on teaching them how to make the best choices for themselves.
“When making recommendations for weight loss, I try to take into account all aspects of a participant’s situation,” Ansari says. “Whether they’re struggling with a certain health issue, relationship problem, poor habit, low self-esteem, lack of motivation, or are stressed and pressed for time, I try to see things from their perspective and put myself in their shoes before giving advice.”
In terms of food choices, Ansari encourages people to eat nutrient-dense, balanced whole foods, such as nonstarchy vegetables, low-sugar fruits, proteins, nuts, seeds, beans, and legumes, and avoid processed foods, added sugars, and artificial sweeteners; she recommends herbs, spices, and citrus to enhance flavor. Although she doesn’t prescribe specific diets, she does suggest ingredient substitutions for certain diets, such as vegan, gluten-free, or dairy-free, and specific recipes, when asked. She has designed an optional two-week Kickstarter meal plan that’s designed to promote weight loss, stabilize blood sugar, and taste good. In addition, she’s written holiday menus for Halloween, Thanksgiving, Christmas and the December holidays, Valentine's Day, and the Fourth of July.
Ansari says she’s heard about dramatic reductions in people’s A1c, blood glucose, and cholesterol levels, as well as improvements in lipid ratios. Many participants have been able to stop blood pressure medication. The biggest changes that she’s noticed, though, are in the ways that people think about nutrition and exercise.
“Participants often share positive shifts in attitude and behavior, weight loss and lab improvements, and how they’re applying the various lessons to their lives,” Ansari says.
Other dietitians say this type of program has the potential to reach a significant number of people. Tamara S. Melton, MS, RDN, LD, director and founder of LaCarte Wellness, and a spokesperson for the Academy of Nutrition and Dietetics (the Academy), says although developing technology can be a challenge, if it’s implemented effectively, it can reduce some barriers that exist with face-to-face consultations. For behavior change and chronic disease prevention, she thinks online tools could be useful because so many people are tied to their mobile devices.
“If it’s set up correctly, it’s a really effective tool for reaching people because it helps them to save time and money,” Melton says. “They’re not driving to the doctor’s office. They might be able to meet with somebody who might not typically be [close to where they live]. So if it’s well thought out, the technology works on both ends, and it’s user-friendly—especially for the client or patient—then I think that using technology to deliver health care is a great tool.”
Lauri Wright, PhD, RDN, LD, an assistant professor of nutrition at the University of South Florida’s College of Public Health and a spokesperson for the Academy, says digital platforms also provide opportunities for dietitians to increase their reach. She notes that some dietitians already are moving into this space, but she sees potential for many more. Wright agrees that social media tools also may have some advantages over traditional methods, if they’re implemented properly.
“There’s some research that has shown that people who get text messages supporting them on their diet plan actually have more weight loss than others,” Wright says. “So I think this is a really great opportunity to provide an individualized service and also the support that people need to make these lifestyle changes.”
Duffy says Omada Health plans to eventually introduce platforms for other types of obesity-related diseases, such as hypertension, high cholesterol, and general metabolic syndrome. He’s convinced that the model works.
“One person recently told us that he was shopping at the grocery store, and he found himself looking at somebody else’s cart,” Duffy says. “And he was thinking, ‘I can’t believe they’re putting all of that into their body, and the funny thing is three months ago, that was me.’”
— David Yeager is a freelance writer and editor based in southeastern Pennsylvania.
1. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311(8):806-814.
2. Finkelstein EA, Trogdon JG, Cohen JW, Dietz W. Annual medical spending attributable to obesity: payer- and service-specific estimates. Health Aff (Millwood). 2009;28(5):w822-w831.
3. National Diabetes Statistics Report, 2014. Centers for Disease Control and Prevention website.
http://www.cdc.gov/diabetes/pubs/statsreport14/national-diabetes-report-web.pdf. Accessed October 24, 2014.
4. Diabetes Prevention Program. National Diabetes Information Clearinghouse website.
http://diabetes.niddk.nih.gov/dm/pubs/preventionprogram/#type. Updated September 9, 2013. Accessed October 24, 2014.
• National Diabetes Information Clearinghouse: Diabetes Prevention Program