Technology: Friend or Foe? Mobile Health Technology is Challenging Traditional Clinical Care.

Walk into a restaurant; grab a table; order food. Start to eat, realize you forgot something, and pull out your phone to snap a photo of your plate before it’s too empty for show.

That process probably sounds familiar if you’re like some people who like to snap and share food photos. Food photos hold much more potential than a mere Snapchat post. In fact, with the right technology, quick snapshots can provide accurate estimates of the caloric content of a meal.

Scientists at LSU’s Pennington Biomedical Research Center in Baton Rouge are making strides in health technology, exploring the potential of mobile health platforms to help people eat better and live healthier lives. The researchers are even going so far as to investigate methods specific to different groups of people – those groups include African-American men, pregnant women, traditional dieters, and children who are at risk for developing obesity.

When gadgets and devices are often touted as health’s arch-nemesis, it’s easy to take an anti-screen time stance. But with technology so integrated into every aspect of life, it isn’t practical.

"Technology is here to stay, and we need to leverage it to promote our health," said Dr. Corby Martin, director of the Ingestive Behavior, Weight Management & Health Promotion Laboratory at Pennington Biomedical. Now that mobile devices are commonplace, the goal is to make people's devices more helpful than harmful, Martin said.

For the past several years, Martin and other scientists at Pennington Biomedical have collaborated to develop a variety of mobile apps and screen-based intervention programs with the goal of improving health across the lifespan.

Portion Control: Smart Apps to Promote Health

The Remote Food Photography Method constitutes a large portion of Martin’s work. He developed the RFPM concept after research exposed a critical issue: People are terrible at gauging portion sizes.

“The difference between what people think they’ve eaten and what they’ve actually eaten is enough to sabotage weight loss efforts,” Martin said. “All of us, even the healthiest of people, need help with this.”

Two examples of Martin’s work are the SmartIntake and SmartLoss smartphone apps. SmartIntake estimates the energy, or caloric, intake of app users. It works by prompting participants to take before-and-after photos of their meals and submit the photos to a server maintained by scientists working on the app.

The system is successful because the participants’ food photos are analyzed by dietitians, who can then counsel participants about how to meet their daily nutritional goals. What’s particularly important is that the food intake data are collected in real time and in everyday settings, rather than in a lab.

Self-report methods such as food diaries and 24-hour recalls are commonly used to estimate food intake, Martin said, but those methods are prone to inaccuracy. People tend to underestimate their caloric intake by nearly 40 percent. In the initial SmartIntake study, Martin said 94 percent of participants preferred the RFPM to pen-and-paper food diaries. Scientists hope that such apps can help people stick to their diet better.

Using SmartIntake, an app developed by scientists at LSU's Pennington Biomedical Research Center in Baton Rouge, LA, allows users to take before-and-after photos of their meals. The photos are analyzed by dietitians at the center, ​who can then counsel app users regarding their health goals.

“When it comes to measuring what people eat, a picture really is worth a thousand words,” Martin said. “Further, the images are captured and transmitted to researchers or clinicians right when we are eating. This can increase accountability and help us stick to a diet.”

After finding success with SmartIntake, Martin and colleagues, including Drs. Leanne Redman and Diana Thomas, began developing SmartLoss, which creates a virtual weight loss experience.

The mobile health platform consists of two elements: a clinician dashboard for health professionals and a participant’s dashboard, which connects to an Internet-connected bathroom scale and accelerometer. Those features allow the app to collect client information such as changes in body weight and physical activity patterns.

The SmartLoss platform generates estimated weight-pattern graphs for individuals based on their data inputs. The model calculates predictions using weigh-ins, steps and exercise logged, calories eaten, and other factors. This is a rendering of a sample graph for a fictional SmartLoss user.

Data from the individual, such as starting body weight, body composition, current activity patterns, and goals are used to guide personalized recommendations regarding weight loss and behavior change. The clinician dashboard allows professionals to easily and remotely monitor clients, which allows for timely treatment and continuous data collection, Martin said.

“In-person intensive weight-loss programs are effective, but limited by financial, geographic and time-commitment barriers,” Martin said. “If designed appropriately, mobile health programs can overcome barriers to traditional clinic-based treatments and can reach many more people who need treatment.”

Active Gaming: Using Video Games to Get Fit

Dr. Amanda Staiano of LSU’s Pennington Biomedical Research Center uses fitness testing labs to measure health outcomes in study participants. Many of Dr. Staino’s studies have successfully showed that screen-based exercise, also known as exergaming, can improve physical and mental health factors.

Dr. Amanda Staiano, a developmental psychologist with a focus on pediatric obesity, is investigating how screen time can affect youths’ physical activity. Children are receiving mobile phones and other devices at increasingly younger ages, Staiano said, and gaming systems such as PlayStation, Wii and XBox are found in many homes and even some schools.

The problem doesn’t necessarily lie in the devices themselves, she said. The problem is that the majority of time spent using them is sedentary – an alarming issue when many children and teens spend upwards of 30 hours per week gaming.

“The question is no longer how to get children to spend less time in front of screens,” Dr. Staiano said. “The new question is ‘How can we make this screen time beneficial?’”

Enter: Exergaming. Exergaming is a fairly new research concept that combines technology and physical activity to redefine fitness. In essence, it makes exercise fun, especially for those who dislike traditional, structured physical activity.

Staiano designs physical activity interventions using games like “Nintendo Wii Active” and “Kinect’s Just Dance.” These systems use motion controllers and infrared technology to sense movement, so participants can’t finagle their way out of exercising, Staiano said.

Student volunteers from the LSU School of Kinesiology demonstrate exergaming on Kinect’s Just Dance. Exergaming is a combination of video games and exercise that intends to encourage physical activity, especially in individuals who dislike traditional, structured exercise.

“If the players don’t actually move their arms and legs, their characters on screen won’t move, and they won’t progress in the game,” Staiano explained. “That’s part of the reason this type of intervention keeps kids moving because kids tend to care a lot about their scores in video games.”

One of Staiano’s studies used a 12-week exergame intervention to measure not just weight loss and other physical health factors but also psychosocial health factors. After exergaming for 60 minutes each school day, the intervention group members lost body fat compared to the control group, which did not lose weight.

Participants in the intervention group also developed positive changes in peer support and self-esteem. It’s common knowledge that increased physical activity can lead to improved health, but the psychosocial factors measured in this study offer additional insight, Staiano said.

“The goal is to make exercise a regular habit,” she said. “That part is almost entirely psychological, so measuring outcomes like self-efficacy is crucial to understanding what kind of exercise promotes adherence.”

The Health Matriarch: Battling Obesity Before Birth

One Pennington Biomedical study shows a smartphone app can help pregnant women manage their weight.

“Expecting Success,” a study published by Dr. Leanne Redman, director of the Reproductive Endocrinology Lab at Pennington Biomedical, was designed to address the two-thirds of women who exceed gestational weight gain recommendations.

The project aimed to test whether a personalized weight-management program delivered in-person or via a mobile phone app called SmartMoms could reduce the number of women who exceeded weight-gain guidelines. Researchers hypothesize that a mother’s health habits while pregnant impact the baby’s risk of chronic conditions, including obesity, in the future.

“Obesity doesn’t start during adolescence or even during childhood,” Redman said. “Obesity starts in the womb.”

Two intervention groups, in-person and mobile-only, received the same 18 lessons and behavior-modification strategies. The only difference was the mode of delivery. Each participant received a wireless internet-connected bathroom scale and a pedometer. The SmartMoms app tracked body weight and daily steps, which transferred to personalized graphs in real time, while the in-person intervention group tracked everything in hard-copy fashion.

“It is critical to provide expectant at-risk mothers with the tools necessary to try and prevent negative outcomes for both herself and the baby,” Redman said. “To be able to do that remotely is another step toward better healthcare.”

The study showed the SmartMoms app was just as effective at reducing excess weight as in-person counseling, but the app cost half as much and increased patient engagement.

“It was rewarding to see the success of an eHealth intervention and its positive impact on such an at-risk population,” Redman said. “The study’s results open the door for many more interventions using similar processes.

MobileMen: A Lifestyle Coach in Your Pocket

Some researchers are going as far as to design their studies with specific populations in mind – an important consideration because different groups have different beliefs and traditions toward diet and exercise, said Dr. Robert Newton, professor of ethnic minority health at Pennington Biomedical.

Dr. Robert Newton works primarily with ethnic minorities. His research is aimed at reducing health disparities faced by African American men and their families. Pictured is Dr. Newton explaining study procedures to a group of participants in a church-based exercise intervention.

Newton realized early in his college years that African-Americans suffer disproportionately from health disparities across many preventable chronic diseases, including cardiovascular disease, strokes, obesity and diabetes. Physical activity – or the lack thereof – is a risk factor for these conditions. His work, including the smartphone app MobileMen, aims to address those disparities.

“There is a gap in this area of research,” Newton said. “A few exercise intervention studies with African Americans have shown successful short-term behavior change, but physical activity levels must be maintained for people to get the benefits.”

Additionally, Newton said he only found a few behavior-change programs specifically for African-American men. MobileMen is a smartphone app being developed to provide African-American men with physical activity maintenance strategies. Like the other mobile health approaches, MobileMen offers several advantages for the delivery of health interventions because smartphones are portable, user-friendly and more affordable than clinic care, Newton said.

Because the app is also culturally targeted, it is more responsive, unique and distinct from generic fitness apps, Newton said, and will address an unmet need in the marketplace

Is mobile technology the future of healthcare?

With so many scientists working toward mobile health, it's possible we could see a shift in the healthcare landscape. While there is still work to be done, the research from these scientists is promising.

The implications of mobile health research are vast. For Staiano, technology is clearly the answer to improving health, especially in children.

“It needs to be easy and fun to be physically active and a healthy eater,” she said. “This is why I turn again and again to digital screens and technology to get kids up and moving.”

Martin said mobile health approaches are critical to reaching people with limited access to care. Further, they promise to be more cost-effective than traditional care for chronic conditions such as obesity and diabetes, though additional research is needed in this area. To have the advice and encouragement of a doctor, dietitian, coach, trainer or any health professional at the push of a button is a luxury unheard of 10 or 20 years ago.

“The world is changing, and healthcare needs to change with it,” Martin said. ““Technology is here to stay, and we need to leverage it to promote our health.”

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