Sustaining Patient Engagement in Medical Weight Loss: Staying Connected Through Technology

| June 11, 2014

by Wendy Scinta, MD, MS

Wendy Scinta, MD, MS, FAAFP, Medical Director, Medical Weight Loss of NY, BOUNCE Program for Childhood Obesity, Fayetteville, New York; Clinical Assistant Professor of Family Medicine, Upstate Medical University, Syracuse, New York.

Bariatric Times. 2014;11(6):22–23.

ABSTRACT
It can be challenging to keep patients excited and engaged during their weight loss journey when they are in between office visits. Today’s latest smart phone technology can be an inexpensive and useful way to bridge this gap and increase our level of patient adherence and long-term success.

One of the greatest challenges faced by obesity medicine specialists is keeping patients excited and engaged during their weight loss journey and in the maintenance stage. While current behavioral modification approaches have generally been effective in the short-term, one of the main issues we face in both the surgical and nonsurgical fields is the ability to continue to reinforce those strategies through frequent and persistent patient-clinician interactions. If the patients show up at our office for appointments, we have a shot. But what if they don’t? Consider the patient who has gained a few pounds and is embarrassed to come in for fear of disappointing you. How do you help him or her?

Engaging patients in their weight loss treatment program is critical for optimal results. Clinicians will soon be reimbursed based on quality of clinical outcomes as opposed to number of patients treated.[1] More important perhaps is the ever-evolving concept of the patient-clinician partnership. While our diagnoses and recommendations are an integral part of the treatment plan, what our patients do after they leave our offices is what will effectively lead to a successful or failed treatment plan. It is our responsibility and duty as the healthcare providers to ensure that the former takes place. Yet, regardless of how good a clinician we are, our pay will soon dramatically depend on the personal responsibility of our patients after they leave our offices. How do we manage that with minimal face-to-face contact?

Fortunately, tremendous work is being done by newcomers in the healthcare technology field, with several noteworthy patient engagement tools beginning to emerge in the weight loss market. As a technology enthusiast with a background in computer engineering, I have a specific interest in software and web-based patient engagement tools that are available for both clinicians and patients in the medical weight loss field. This article discusses some solutions that can help your practice and your patients thrive:

Web-based Forums and Online Communities
Web-based forums and online communities are platforms that are extremely helpful in promoting peer-to-peer encouragement, support, shared experiences, and positive feedback. Popular examples include Bariatric Pal and Obesity Help, which are both directed toward surgical patients, and SparkPeople. The benefits of these sites include empathy and support offered by peers who have experienced obesity and its complications, mainly from a surgical side. The downside is, as with most peer-support sites, there can be a significant amount of inaccurate information displayed, and users need to be aware that most of the suggestions are opinions of the patients themselves, not validated medical information. These sites also gather information on users and push advertisements to the websites. which some users may find cumbersome.

Consumer-focused Wellness and Fitness Applications
Mobile apps, such as MyFitnessPal and Lose It, can be tremendously helpful for patients to track their daily food intake and break down nutritional components of their meals, as well as log exercise. Many of these sites offer some basic yet valuable reporting capabilities that allow users to follow trends and monitor progress regarding their weight loss, caloric consumption, and exercise levels. One drawback of these apps is that while they are wonderful tools for empowering patients and keeping them informed, they are completely disconnected from provider supervision and clinical team input and feedback. In addition, many users may not be aware that information entered into databases such as My Fitness Pal is sold to third parties and potentially exploited.[2] Finally, some of the nutrition entries are inaccurate due to human error as they are not database dependent, meaning that the nutrition information is entered by an individual user verses compiled from the manufacturer.

Healthcare Provider Patient Engagement Tools
Several medical and surgical practices have developed their own online platforms and mobile apps to help engage patients, reduce attrition, and preserve both surgical and non-surgical clinical outcomes. The “Preparing for Bariatric Surgery” app is one example designed by the Mayo Clinic’s bariatric surgery team to help attract patients who are considering bariatric surgery, as well as to engage those who have recently undergone a surgical procedure at the Clinic.

Another emerging platform is Euco™, a patient engagement and journaling platform developed by 3Pound Health. Euco was specifically designed to address the gaps and challenges of other apps and tracking technology, and tie patients to coaches to help modify behavior and facilitate success when they are away from our offices. Some of Euco’s unique features include a secure patient-clinician connection, analytics and reporting capabilities, an exception-based patient-management dashboard that surfaces people who need attention, and an engagement and journaling interface for patients. Features include the addition of medications and lab data to help link patients’ behaviors to their clinical outcomes.

Diet Owl, an innovative app developed by Dr. Craig Primack, is a HIPAA-compliant, phone-based software application that connects weight loss providers to their patients and reminds them to take their medications at specific intervals, eat frequent small meals, drink proper amounts of water, get appropriate sleep, and contact a provider directly. The desktop program allows physicians and staff to enter specific times and then upload the alarms to the application on the patient’s smart phone.

In a recent survey of bariatric surgery clinicians, two out of three cited long-term patient engagement as their number one challenge.[3] I can vouch for the fact that the same is true with obesity medicine specialists. Whether it is long-term behavioral modification strategies in conjunction with meal replacements, intensive pre-surgical dietary adjustment, or post-surgical follow up to ensure adherence and minimization of side effects, patient engagement is key for long-term success. I have frequently heard from my patients, “I wish I could just carry you around in my pocket to keep me on track.” Well, with technology bridging the gap, they now can essentially carry their healthcare in their pockets via their smart phones.

References
1.    Health Affairs. Health Policy Brief: Pay-for-Performance. October 11, 2012. http://healthaffairs.org/
healthpolicybriefs/brief_pdfs/healthpolicybrief_78.pdf. Accessed May 21, 2014.
2.    Dredge S. Yes, those free health apps are sharing your data with other companies. The Guardian. September 2013. http://www.theguardian.com/technology/appsblog/2013/sep/03/fitness-health-apps-sharing-data-insurance. Accessed May 21, 2014
3.    Fighting Obesity With Long-Term Patient Engagement. e-Patient Experience. http://epatientexperience.com/fighting-obesity-with-patient-engagement/. Accessed May 21, 2014.

Funding: No funding was provided.
Disclosures:  Dr. Scinta helped found and currently serves as Chief Medical Officer for 3PoundHealth.

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