"Doctor in the Pocket" Aims to Increase Exercise in Overweight Youth

November 11, 2010 (Washington, DC) — An innovative mobile technology program called KNOWME Networks that shows promise in combating childhood obesity is being tested by Donna Spruijt-Metz, MFA, PhD, from the University of Southern California (USC), Los Angeles.

"Pediatric obesity is a huge problem in this country and worldwide," said Dr. Spruijt-Metz. "We've been remarkably unsuccessful at combating it. . . . To change this behavior, we have to be revolutionary," she told a packed session on health monitoring and health outcomes at the 2010 mHealth Summit. The problem, according to one graph shown by Dr. Spruijt-Metz, is that kids essentially sit down at age 11 and don't get up again.

Her revolution involves technology, specifically mobile technology, and includes a set of wearable wireless sensors that measure physical activity, stress, location in time and space, body fat, and a number of other factors. Dr. Spruijt-Metz developed this tool in conjunction with collaborators — Shrikanth Narayanan, PhD; Murali Annavaram, PhD; Urbashi Mitra, PhD; and Gaurav Sukhatme, PhD — from the USC Viterbi School of Engineering. Data are transmitted in real time to a secure server for storage and analyses. The focus of the technology — called KNOWME because it really knows the child — for these first studies is to develop a Mobile Body Area network that monitors obesity indicators in minority youth.

"We don't see this technology as replacing the physician or health educator, but possibly as strengthening it," said Wendy Nilsen, PhD, moderator of the session and a health scientist administrator in the National Institutes of Health's Office of Behavioral and Social Sciences Research, Bethesda, Maryland, in an interview withMedscape Medical News. "If you see that you have a 'doctor in your pocket,' you may feel more connected." And that connection might lead to behavioral change.

In the study, kids wear the equipment for most of the day. If they are sitting for too long, they get a tailored and specific message to get up and engage in physical activity. A pilot study of the device showed that kids could handle wearing it for 11 waking hours. Now, the device will go into to a randomized trial in which control subjects will wear the same device but won't get any messages about behavioral changes.

Dr. Spruijt-Metz considers herself an early adopter of technology. "What really got my goat is that we did an intervention with these kids that wasn't successful. We had them coming into the clinic and getting motivational training and nothing was working," reflected Dr. Spruijt-Metz in an interview. Afterward, she and her colleagues analyzed the accelerometer data from that study, and it shed light on the inactivity of the participants. "I wished that we had had these data in real time. That's what got me motivated to test this approach. We have the capacity to work in real time and we can move this technology into many populations."

Dr. Spruijt-Metz and colleagues hope to add dietary and sleep components to future modifications of KNOWME. They also envision a Facebook application where kids can see what their friends are doing in terms of activity.

Part of the potential for success with this approach is the advancement in mobile devices and a whole generation that is skilled at using them. "With the younger generation, this is such a part of their life. We may be able to get kids to become engaged in their health and promote their health without their realizing that they are volunteering to get healthier," noted Dr. Nilsen.

Dr. Spruijt-Metz agrees. "In a sense, technology is part of the reason we have an obesity epidemic [because it provides] attractive, sedentary activities," she said. "We've got to hijack the technology and make it part of the solution."

Key challenges to scaling up such technology include longer lasting batteries and smaller, more portable sensors, but the capacity is growing rapidly.

Also discussed in the session were early reports from other studies. In Ontario, Canada, studies are looking at the use of text messaging for smoking cessation and Smartphone technology to help patients newly diagnosed with diabetes and hypertension. In Auckland, New Zealand, researchers are studying elements of cognitive behavioral therapy, which are translated into text and visual messages that are then sent by mobile devices to teenagers, as a way to prevent adolescent depression.