I wore a Fitbit for a year but eventually decided that I preferred having just one strap around my wrist (my analog watch) and took it off. I then used the health app on my iPhone to see how many steps I took when I walked the dog and went through my daily activities. It did not count my workouts on the elliptical runner or Pilates (I didn’t put it in a pocket or wear it on my arm). But I sort of thought or hoped that I was getting the equivalent of 7,000 to 10,000 steps a day. I have to admit that one day I gave the device it to my grandson to wear; he ran around and recorded a magnificent score, which I never repeated.
Did I notice a change in my sense of well-being or weight when I took the Fitbit off? No… Yet so many of my friends use it, proudly proclaim their numbers, and state that it makes a difference in their attempt to lose weight. Of course, all our individual tales of technological smart weight control are anecdotal and a truly scientific study is needed in order to assess the reliability and usefulness of wearable technology (when combined with lifestyle intervention) on weight loss. Lo and behold, an article dealing with just this subject was published in this week’s JAMA.
Figuring out what helps weight loss is one of the most important issues in medicine. The prevalence of obesity in youth between the ages of 12 and 19 is 20.6%. It goes up to 32.3% in young adults between the ages of 18 and 35. And by the time our population reaches middle age, it’s 40.2%! The study that was published in JAMA was a randomized trial that examined whether adding wearable technology to a behavioral intervention would improve weight loss after 24 months among young adults aged 18 to 35 years. The trial included 470 individuals, over 77% of them were women. The participants had BMIs that varied between 25 and 40. Most, however, were obese with a baseline weight above 95 kg (200 pounds). They were divided into two groups, “standard intervention” and “technology enhanced intervention”. Both groups received the same weight loss intervention for six months which included counseling sessions, text message prompts, telephone counseling sessions, and access to a specific website. They were given diet and exercise suggestions. After the initial six months, the standard
group continued their own self monitoring of diet and physical activity and those in the technology enhanced group used a study website for educational materials only but also wore smart devices that recorded their steps and exercise with a web-based interface.
Calorie intake was prescribed (more likely suggested) based on initial weight. It was 1200 cal a day for individuals who weighed less than 90.7 kg, 1500 cal for those who were less than 113 kg, and 1800 cal for those who weighed more than that. Their dietary fat was supposed to be between 20 and 30% of total caloric intake. They were all given sample meal plans and during the first six months, they were instructed to self monitor dietary intake with a diary.
Non supervised, moderate to vigorous physical activity was prescribed for both groups for 100 minutes per week and increased at 4-week intervals until 300 minutes per week was achieved. During the first six months, all the participants recorded their exercise in a diary. During month 7 to 24, those in the standard group self-reported their exercise using a website designed for the study. Participants in the enhanced invention group self monitored their exercise with the interface of the system they wore (FIT Core).
After many charts and statistical analyses presented in the article, the final numbers were disappointing and surprising. There was no significant difference between the groups at six months with an estimated weight loss of 9.4% for the standard intervention group and 8.4% for the enhanced intervention. But at 12 months the standard intervention group kept more weight off and at 24 months there was a significant difference of 6.4% versus 3.6% weight loss. (In other words, both groups had trouble maintaining initial weight loss.) And in absolute poundage (or kilogramage) mean weight loss at 24 months was 5.3 kg (11.68 lbs) in the standard intervention group and 3.5 kg (7.72 lbs) in the enhanced intervention group.
The conclusion was that in young adults with a BMI between 25 and 40, the addition of a wearable technology device to standard behavior intervention resulted in less weight loss. It’s not quite clear why… My theory is that once the participants relied on their device to tell them how well they were doing, they slacked off from their diet, or ignored the device once they did not have to report what it told them.
The authors did not want to go there… In their discussion, they talked about patients that dropped out of the study (some because of pregnancy), the possibility that data was missed, or that the data was biased by the assessment staff. Clearly further studies with other devices need to be done. Meanwhile, I won’t discourage my friends and patients from wearing a technologically advanced exercise and diet reporting smart device as long as they keep up with the nutritional and exercise changes that make them healthier and hopefully lighter.