10,000 Steps to the Refrigerator – Why the Promise of Virtual Health Needs More Advice and Less Tracking

How many steps did you log on your Fitbit or Apple Watch today? Did you really take that many steps? Does it even matter? What are you going to do with that information?

There’s a pretty funny commercial on television lately where bank robbers storm into a bank and one of the customers looks to a security guard for help. He says, “Oh, I’m not a security guard, I’m a security monitor.  I only NOTIFY people if there’s a robbery.”  That’s what wearables are doing these days but it’s not funny. People are being notified of their biometric data but no one is giving them any idea what to do about it.

Everyone is obsessed with tracking their steps, heart rate, and their bla bla bla, but does it really matter that you did 10,000 or 20,000 steps if you’re eating just as many calories?  People are competing with friends and co-workers as if the number of steps alone were a badge of honor.  “How many steps did you do?”, says one friend to another, while they’re guzzling humungous 1,000 calorie coffees at Dunkin Donuts.

Does anyone else see what’s happening here? The only metric that’s being moved by wearables hysteria is the revenue of companies like Fitbit and it’s competitors.

Forbes suggests that by 2020, the wearable tech market will be worth $34 billion. But are wearables and fitness trackers actually making us any healthier? The jury is out on a final verdict but the data suggests the answer is NO. And you don’t have to be a medical or wellness expert to visually survey the population of “steppers” around you to see that we’re not making much of a budge into our overweight population or its cost, by measuring steps on our watches.  Overweight numbers are still going up. The cost of obesity by 2008 was $147 billion. Based the current trend, we are expected to spend $344 billion by the end of 2018.

So what’s really happening?

In a one year trial involving 800 subjects in 2014, a study concluded that a clip-on activity tracker had no effect on overall health and fitness even when combined with a financial incentive. (The Lancet Diabetes & Endocrinology).  Without an incentive, they did worse.

A trial out of the University of Pittsburgh in 2012 explored combining a weight loss program with a fitness tracker, worn on the upper arm.  Subjects who didn’t wear fitness trackers lost 8 pounds more than those wearing trackers.  And putting the issue of weight aside, the test subjects who wore trackers were also no more active or fit than those without. (Journal of the American Medical Association).

Those are just two examples but I don’t need to smother you with details. The consensus is that trackers and wearables so far, have failed to help people live more healthily.  That is not where the debate is.  What’s more interesting is why they aren’t working and whether it’s just too soon to see a difference simply because the devices don’t yet do enough.  The devices are certainly good at aggregating data, but what does that mean for the average person or patient?

As astutely recognized in a series of articles in Wired magazine:  “wearables aren’t working and won’t work until they tell people what to do.” But how long will it be until wearable device can give you an actual wellness or lifestyle plan that takes into consideration what you need to do to reach a health or wellness goal? There’s nothing wrong with the device or the data. What’s missing is a human being to tell the wearable wearer, what to do with the information on the wearable. They’re called health care providers.  Until we replace doctors with robots, let’s combine devices with providers and start moving the needle.  That’s where the rubber will meet the road. The debate isn’t whether digital health devices are good enough to help with the problem. The problem isn’t better devices. It’s better use OF devices.

I’ve talked to 100 doctors in search of the most reliable body composition device. Here’s a shocker – no matter what information is coming out of the printer, the patient needs to be told what to do about it. And it needs to be more than “Get a Fitbit and make sure you track x number of steps every day.”  If the 10,000 steps you take are to the refrigerator, or a bar, or McDonalds, the numbers actually give patients a false sense of accomplishment and the only way to change that is with human analysis and intervention, aided by digital health as a tool.

The real challenge to delivering high quality care to patients has always been changing the behavior of patients. But you can’t change behavior unless you give someone a plan to follow in the first place.  And according to the Centers for Disease Control and Prevention, patients are 5x more likely to diet and exercise if their doctor tells them to do so. But, only 1 in 3 doctors recommend or prescribe meaningful lifestyle advice. 

In a very thoughtful and well-written article by Ezekiel Emanuel in the Wall Street Journal entitled “The Hype of Virtual Medicine“, Mr. Emanuel outlines his case for why high-tech health care hasn’t prov effective at changing patients’ bad habits.  What’s missing, according to Mr. Emanuel, “is long-term, face-to-face relationships with nurses and health-care coordinators. These interventions are decidedly not high-tech. They are high-touch, and they remain our most effective prescriptions to treat chronic illnesses.”

I agree on the high touch part, but doctors can only spend so much time with patients no matter how much they might want to do more.  Why can’t we bridge the gap with high tech?  Mr. Emanuel’s article assumes that the “hype of virtual medicine” is founded almost entirely on the aggregation of data. But what if we combine high touch with high tech through digital health guidance and solve the not-enough-touch problem that way.

Think of it as a peanut butter and jelly sandwich type of solution. The data from just wearing and monitoring is pretty weak without a human care provider who intervenes and addresses the “now what I do” problem.  And the care provider, in a world where there just aren’t enough hours in a day to touch patients enough,  is in need of digital technology to help the patient do better, get better, stay better.

It’s called digital health guidance.  And it’s here. Allow me to describe it.

What if, in one neatly integrated but powerful web platform and native app, any healthcare provider could  access their own library of protocols and care programs that are detailed enough to provide a comprehensive daily plan to any patient with any condition or need.

When the provider sees a patient in person (touch), he or she would still assess the patient’s needs through traditional means, enhanced in many cases by aggregated data (sometimes from wearables) and other gadgets.  But instead of sending the patient back into the world with nothing but gadgets for more monitoring more data, the provider says, “I’ve got a plan for you.  Here’s what we’re going to do . . . “

In about 10 seconds, the provider would enroll that patient into a program of detailed digital care instructions that meet the patient’s daily needs for the next month or two, or three. Each morning, the patient would automatically receive actionable care information chosen just for them, directly from the provider (touch), right on the patient’s phone or computer. The patient would delight in the daily touch and follow that care information, tracking their progress along the way using food, body and activity trackers and a journal and integrating wearables data, all on the provider’s same platform.

All of the data would be available to the provider and care team in real time. As needed, the provider would use the same platform that is delivering the advice and monitoring the patient’s compliance, to send the patient (touch again) both automated and personalized messages of support, guidance and additional instructions to continue to shape the patient’s path toward optimal health.

Virtual health is not hyped. And we don’t need to wait any longer for it to fulfill its promise. It’s already here. It’s called BodySite.

Try it today for free. (Yes, we aggregate your wearable health devices data too).