A Step in the Wrong Direction: Weight-Loss Efforts Could Be Hampered by Addition of Wearable Device

The addition of a wearable fitness device to a managed weight loss plan might hinder instead of help long-term weight management for certain patients, according to the results of a new randomized trial.

Figuring out how to best incorporate new wearable technology—such as the step trackers and heart rate monitors that have exploded into the marketplace in recent years—into healthcare is the “Holy Grail a little bit,” according to lead study author John Jakicic, PhD (University of Pittsburgh, PA). His team had hypothesized that adding a wearable device to a robust clinical weight-loss protocol that already included a low-calorie diet, prescribed increases in physical activity, group and telephone counseling, text message prompts, and online study materials “would make the program better,” he told TCTMD.

Six months after starting a low-calorie diet, 233 patients were randomly assigned to the standard intervention, which asked subjects to log their newly prescribed exercise habits and diet on a study website and 237 were randomized to the enhanced intervention arm with a wearable fitness device. Despite the hopes of investigators, those wearing the fitness monitors lost less weight by 24 months than those in the standard intervention group (mean loss of 3.5 kg vs 5.9 kg; P = 0.002).

The counterintuitive results, published in the September 20, 2016, issue of JAMA, could be due to a number of reasons, Jakicic explained. “One may be that when you are undergoing weight-management efforts, giving people a device that makes them focus a lot on their activity may be taking away the emphasis on other really important behaviors that can help to control weight.”

Also, “these devices in this situation may have given people a false sense of security,” Jakicic suggested, giving the example of someone justifying enjoying a cupcake after burning a certain amount of calories.

“The other thing that’s come up is that these things are built on the premise that if I can tell you what you’ve done and you can see what you should be doing, that will motivate you to do more,” he said. But people are motivated differently and this philosophy does not work for many of those who are “already not active and they’re struggling with their weight,” he continued. “Changing behavior is a lot more complex than thinking that all I need to do is show people what the goal is, how short they are of the goal, and then they are going to achieve the goal.” In fact, Jakicic noted that he received feedback that study participants were often demotivated if they were very far away from their daily step goals.

One explanation offered by Anand Ganesan, MD (Flinders University of South Australia, Adelaide), who was not involved in the study, is that “the group in the standard arm had an additional level of accountability to trial staff” than those in the enhanced group, because they had to actively input their physical activity and diet every day.

“Further, many participants around the world simply don’t have access to high-quality well-supported group programs such as those used in the control group in this study,” he told TCTMD in an email. “The fact that considerable weight loss was seen in the self-monitoring arm is perhaps an optimistic sign.”

Not a Problem With Devices, but With Behavior

Ganesan said that while he does advise his patients to use wearable technology if interested, he doesn’t force things. “I don’t endorse or recommend any specific devices, as I don’t think we have the evidence to suggest the benefits of one over the other at this stage,” he explained.

To TCTMD, Jakicic also reported encouraging people to use wearable devices, but said they are not for everyone. “There’s a lot of ways to skin this cat,” he commented. “For some people, these potentially could be really good. We know there are a lot of people in our study that had the device that did exceptionally well. Nothing wrong with that. Other people just don’t find it appealing.”

The devices themselves are not problematic, Jakicic continued, as they “measure what we think that they measure and provide feedback in a way that they’ve been designed. However, these devices and their interfaces aren’t really getting at real behavior change [and are] not interacting with a person the way a person would interact with a person.”

To make the best use out of them going forward, these wearable devices need to be “integrated into other systems and technologies that actually help counsel patients to overcome the barriers that they’re facing,” he said. “So partnerships between technology people and the people who know how to change behavior is probably the next horizon.”

Until more can be learned, Jakicic said, the ideal user of an activity tracker would be “tech savvy” and “a person who says, ‘I think I’m getting enough activity, but I’m not sure.’” He stressed the importance of the patient-physician discussions about how to incorporate these devices into daily life and potentially using them to attain baseline activity information before beginning a weight loss program.

“Wearable technology is likely to grow in the medical field, and particularly in cardiovascular medicine,” Ganesan predicted. “These devices have the capacity for real-time physiological measurement, to facilitate self-monitoring, and to enable structured clinical communication pathways with health professionals.”

Physicians “shouldn’t be prescribing everyone a Fitbit,” Jakicic observed. “Think about using a device like this to get information that’s going to help them interact better with their patients. That’s what’s critical.”

Despite the results of the study, “our data does not suggest that people should stop using these things,” he concluded. “If it’s working for you, by all means, keep doing it.”

Related Stories:

• Pokémon Go Forth: Cardiologists, AHA Support Use of Augmented Reality Games That Encourage Movement
• STEPATHLON: A Mobile-Based Exercise Program Increased Physical Activity and Promoted Weight Loss
• Structured Exercise Program Can Help the Sedentary Elderly but Does Not Curb CV Events