Abstract
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In the United States, the Centers for Disease Control recently found that the number of states in which at least 35% of residents qualify as obese has almost doubled since 2018. 2 Although research shows that adults with obesity are at increased risk for serious health conditions such as heart disease, stroke, type 2 diabetes, some cancers, and poorer mental health, 3 governmental and medical organizations have yet to agree on how to evaluate body weight officially. In June of this year the American Medical Association issued a statement de-emphasizing the long-standing gold standard metric of body mass index (BMI) in the evaluation of obesity and other weight-related issues, 4 instead recommending the use of a combination of BMI data and other assessments to determine overall health.
While this policy change is an admirable step in the journey toward equitable and individualized medical care, in practice, it could add to the confusion. Doctors are expected to categorize their patients' excess body weight as a risk factor for poor physical and mental health outcomes, but they are also encouraged not to broach the topics of weight and weight loss with those same patients. Patients are told to follow a “healthy” diet, and they are offered weight loss medications and procedures, but then they encounter contradictory nutritional plans and insurance companies that deny coverage for their prescribed medication.
With both doctors and patients struggling to sift through a muddle of inconsistent information and red tape, and traditional treatment options not curbing rapidly rising obesity rates, technology can play a part in clearing a path to good health.
Those who hope to lose weight often turn to the Internet and social media for help, even before making an appointment with their physician. Who can blame them? Online information is free and available at all hours. Most importantly, a person does not need to undergo exams or admit their struggles to another person before hitting the search button. They can explore data, including evidence that severely obese teens who received bariatric surgery are healthier in the long term than those who wait to have the procedure as adults. 5 They can read reports about how intermittent fasting and calorie restriction produce similar weight loss results. 6 They can learn about new diabetes management drugs such as semaglutide and tirzepatide that accelerate weight loss, even though some are not yet approved for this purpose.
Unfortunately, the information generally available online is unvetted and unverified. Yes, bariatric surgery is a valid treatment for obesity in some patients, but others might achieve similar results with a less invasive option. Yes, changing eating habits can result in a healthier body weight, but patients prone to eating disorders might be better served by focusing on other aspects of healthy living. And while these new powerhouse diabetes medications may do a great job at helping patients lose weight, there is less information available about what happens when the medication is discontinued. One study found that people who stopped taking semaglutide gained back, on average, two thirds of the weight they had lost within a year. 7
Technology is proving to be a useful tool that can help disseminate a wealth of information to a wide portion of the population. However, many patients, especially those who are highest risk, may also need assistance from medical professionals to interpret this information and guide them toward the proper treatment modalities.
One area in which technology has excelled is in access to care. In order to keep up with sharply increasing demand for healthcare services, many organizations and companies have turned to technology to help. Some have explored using chatbots and artificial intelligence (AI) to screen or even distribute information to potential patients. Early research supports this idea. One study found that a chatbot (with a simple text-based algorithm) was successful in reducing women's concerns about weight and shape. 8
Nonetheless, clinicians are still determining how to deploy these types of programs effectively and safely. Rule-based chatbots such as the one above have the potential to reach large populations at low cost, but their application is limited. The most common issue is their weakness in understanding and responding appropriately to unanticipated user input. Recently, a bot operated by the National Eating Disorders Association found itself in the hot seat for unexpectedly recommending behaviors that might be triggering for those with eating disorders. 9 Although the organization immediately decommissioned the bot and is investigating the incidents, the fact that programs like this could potentially cause damage to users is concerning, highlighting the need for extensive testing before chatbots and AI-based assistants are released to the public.
That said, telehealth has been a game changer for people living in locations where access to high-quality healthcare is limited or unavailable. Behavioral and physical healthcare apps have allowed those who cannot leave their house to see providers who would previously have been impossible to visit. This holds true in the weight management space as well, with some apps connecting therapists to patients to address the emotional components of weight management.
In fact, there are apps out there to help with every aspect of weight loss, from simple calorie counters to proprietary weight loss programs. But these apps aren't always “sticky”; users may engage with them for a period of time, but they are unlikely to change their behavior permanently. This is where individualization and interaction are important. Many users need the help of a therapist or other medical provider to truly make lifestyle changes. This is why companies such as WeightWatchers and Jenny Craig are looking to adapt their online offerings with strategic partnerships.
For example, WeightWatchers, now known as WW International (they changed their branding several years ago to indicate a broadening of focus from weight loss to overall health), is entering the prescription drug space. Earlier this year, the company bought telehealth subscription service Sequence, which connects patients with doctors who can prescribe the medications mentioned above. 10 In addition, Jenny Craig has partnered with Sidekick Health, a wellness company that has a suite of online, customizable wellness and disease prevention programs. This affiliation will mean that employees with prediabetes who are enrolled in Sidekick's employee wellness program will be referred to Jenny Craig. 11 The companies hope that these partnerships will not only benefit their users by giving them access to more comprehensive programs, but also that they will breathe new life into lagging profits.
In these cases, technology can provide users access to multifaceted programs that include personal coaching, topic-specific social media platforms, and access to certified healthcare professionals. However, oversight will be essential to providing ethical care that leads to successful outcomes. When patients begin to seek selective treatment from selective providers (such as requesting specific medications from providers on purpose-built platforms), they become vulnerable to issues such as fragmented care or abuse. It is important that telehealth providers understand each patient's full medical history in order to provide appropriate and compassionate care.
In the end, there is no single solution for managing the global obesity epidemic. Instead, a comprehensive and holistic approach is warranted—one that includes the cooperation of physicians, nutritionists, psychologists, insurance and pharmaceutical companies, app developers, and others; one that acknowledges existing health disparities and inequities that can lead to issues with weight management; one that integrates technology to provide realistic tools that will empower each individual to take steps toward their own optimal health.