Pokémon Go,Obesity and Diabetes: A Perspective from India

Pokémon Go, the mobile app that makes you search for virtual reality animals (“Pokemons”) within your landscape and landmarks, is already a highest grossing game in the United States and other countries. A recent article in VOX includes interesting statements from various players (“Pokémon Go you've made me exercise more this week than a gym membership ever did. And you're free”), and that this game may even be driving “pandemic of sore legs”. ¹ Is this rapidly soaring “pandemic” in young people with smartphone going to affect pandemic of obesity and diabetes sweeping the world?

Review of exercise apps on PubMed search engine (upto August 9, 2016) showed few studies on use of mobile health apps for health, and fewer specifically relating to exercise. A review on Clinical trial.gov (includes ongoing trials) with the search word “exercise app” (assessed August 8, 2016) revealed 100 results out of which only 5 were relevant to the topic.

An observational study of patients of primary care clinics of Los Angeles County showed that 57% of subjects used mobile apps and 32% of these used mobile apps related to their health, 86% of them showed interest in using a mobile app to improve their health, and 40% voiced their desire to use health-related app daily. Patients particularly showed interest to such apps that give them useful information about nutrition, exercise, and medical conditions. ²

Such devices may even be acceptable and useful to patients with chronic diseases (including diabetes in persons more than 50 years of age) particularly if these have better compatibility with personal computers or with less-expensive Android mobile phones, as they may need support to set up the device and learn how to interpret their data. ³ In Singapore, a short-term study evaluated “interactive Diet and Activity Tracker” (iDAT) among patients with diabetes in a primary care setting. Nearly 79% used it minimally, and only 9.5% used it constantly, more so females and those with higher exercise motivation scores at baseline, ⁴ thus underlining low acceptability in some settings.

In a related study, but not on tracking or gaming app, text messaging through mobile phones was shown to be an effective and acceptable method to advice and support toward lifestyle modification. Specifically, the cumulative incidence of type 2 diabetes was lower in those who received mobile phone messages than in controls: 50 (18%) participants in the intervention group developed type 2 diabetes compared with 73 (27%) in the control group (hazard ratio 0.64, 95% confidence interval [CI] 0.45–0.92; P = 0.015). ⁵

With newer apps that include gaming devices, it is likely that motivation to exercise and enhanced sustainability may produce significant impact on obesity or diabetes. A physical activity regimen combined with fun games (“exergames”; Pokémon Go is one, but “Zombies, run,” “ingress,” and “7 Minute Superhero Workout” are few others) could be an interesting concept to try on research mode.

Obesity and type 2 diabetes are increasing in the young population in developing countries, specifically in India. ⁶ Previously, we showed a steep rise in cardiovascular risk factors from age 15 years onward, leading to type 2 diabetes in the third and fourth decades in the Indian population. ⁷

Overall, with rapid nutrition and lifestyle transitions, adolescents and young adults are highly vulnerable to develop diabetes at a young age. In this context, it is important to note increasing amount of time on screen-based activities, which may lead to obesity and dysmetabolic state, in 9–11-year-old children in a 12-country study that included India. In this study, children averaged 8.6 h of daily total sedentary time (SED), and 54.2% of children failed to meet screen time (ST) guidelines. Common correlates of higher SED and ST included poor weight status, not meeting physical activity guidelines, and having a TV or a computer in the bedroom. These authors suggested that remedial measures should include “removing TV from the bedroom, and those requiring increase in physical activity.” ⁸

Forecast for 2016 shows about 2 billion smartphone users worldwide and 204 million in India (www.statista.com/statistics/467163/forecast-of-smartphone-users-in-india). With increasing smartphone usage, “exergames” such as Pokémon Go are and will, undoubtedly, be used more by teenagers and young adults. This gives us a novel opportunity to emphasize use of these “exergames” by young individuals, so that “room with TV is removed” and they could walk with smartphones outside, thus increasing physical activity, fulfilling both remedial measures as suggested by Leblanc et al. ⁸

Our young patient of type 1 diabetes has already installed “Pokémon Go” in her mobile phone and says, “Now I walk whenever I get time, Pokemon Go has improved my blood sugar.” Mother of a 12-year-old boy with type 1 diabetes said “earlier I had to literally drag my son to exercise and go for a walk, now he does it several times without telling him even once.” A young patient with type 2 patient stated, “I have a poke stop near my office canteen, so I make sure I walk before my lunch to catch a Pikachu”; he has noticed good results in his blood glucose levels too.

As one of my young patients of diabetes says often (applies to us now): I need to go to pokeshop and collect a pokeball!