Obesity is a public health crisis. The trend of increasing weight amongst the population is a worrying reality, causing costly and deadly diseases. A fresh approach to tackling this endemic issue is urgently needed and digital therapeutics (DTx) have the potential to lead the way. By recognizing the substantial influence lifestyle behaviors have on this chronic condition, DTx can support individuals to make sustainable changes to their daily habits, leading to a healthier lifestyle and a reduced burden on healthcare systems.
The Heavy Burden of Obesity
With ageing populations, chronic diseases on the rise, and ever-evolving infectious diseases emerging, healthcare systems are already under massive strain. Despite the well-established burden of obesity on population health, it has continued to become a pervasive challenge for healthcare systems and providers.
Research has shown that over the last four decades in the USA, the mean BMI for an adult has increased from 23.1, which would be considered a healthy weight, to 27.7, which would be classed as overweight and approaching obese. Although not a perfect measurement indicator, this BMI increase shows that obesity is rapidly and dangerously on the rise. Widespread obesity has numerous repercussions to not only the individual, but the healthcare system and economic climate, too.
The multiplicative consequences of obesity can be extensive on the body. The individual may experience effects ranging from joint pain as a result of carrying extra weight, difficulty doing physical activity without breathlessness, poor sleep associated with snoring or sleep apnoea, and fatigue.
However, obesity also causes hidden chronic, systemic inflammation that can lead to insulin resistance and eventually, type 2 diabetes (T2D). When left uncontrolled, this can further contribute to more insidious inflammation-associated disease states, including cardiovascular disease, non-alcoholic fatty liver disease (NAFLD), Alzheimer’s disease, polycystic ovarian syndrome (PCOS), and rheumatoid arthritis (RA).
The serious symptoms and lasting damage of these conditions can result in a shorter life expectancy as well as a decrease in quality of life.
With the increased risk of comorbidities, patients with obesity account for a large proportion of healthcare usage globally.
In the UK, for example, the NHS reported in its recent Health Survey for England that 64% of adults were overweight or obese and up to 30% of children aged 2-15 were overweight or obese in 2019. In addition, there were over 1 million hospital admissions where obesity was the primary or secondary diagnosis and 294,000 prescriptions for obesity treatment, with similar trends seen in the USA.
This extensive use of healthcare system resources is disproportionate and unsustainable, particularly in light of already staggering general healthcare spending.
The Organisation for Economic Co-operation and Development (OECD) stated in its 2019 report that the economic case for investing in obesity prevention and treatment is urgent. The USA currently spends the most out of all 52 countries surveyed by the report on healthcare associated with obesity. (Fig.1)
Fig. 1 – Average annual health expenditure per capita due to obesity from 2020-2050 (Source: Statista)
It is expected that with rising cases of obesity, employment rates, absenteeism, presenteeism, and early retirement will also continue to increase. Inevitably, the workforce productivity is negatively affected, further contributing to economic loss.
How a DTx can Support Patients
Such stark statistics portray growing obesity rates as an insurmountable problem. Tackling such a large-scale issue requires an understanding of the root causes of obesity. Population health principles need to be applied creatively in order to design interventions that address underlying modifiable factors.
Population health stands on four key pillars which digital therapeutics (DTx) can address:
- Socio-economic determinants of health – employment, education, income, housing, food security, etc.
- Health behaviors and lifestyles – diet, smoking, exercise, and alcohol consumption, etc.
- Communities and infrastructure – social relationships and community networks
- Integrated, value-based healthcare systems – optimized treatment in the knowledge that comorbidities are common
Healthcare inequity is expanding and access to care can be very difficult for many communities. In the USA, one in five Americans live in rural areas, physically restricting their ability to reach healthcare centers. Likewise, those in under-resourced communities or of Black and Hispanic races also experience disparity in healthcare accessibility, which is particularly problematic as these communities are often at higher risk of obesity.
DTx offer a scalable, cost-efficient, and accessible solution for patients who may otherwise struggle to obtain access to treatment either physically or financially.
A recent RCT trial showed that a digital lifestyle-based intervention was effective in achieving significant weight-loss at two years in underserved populations, showing that a digital therapeutic can be an effective solution for those who are socio-economically vulnerable.
Obesity is influenced by a myriad of factors, including lifestyle choices such as diet and smoking. However, contributors like sleep quality, stress, and psychological wellbeing have historically received less attention in obesity research, but are now recognized as important too. These clusters of behaviors are often simple to recognize, but ‘simple’ does not equate ‘easy to change’.
DTx are therefore designed to support behavior modification through frequent, evidence-based interventions. Stress-management practices such as mindfulness, diet structuring, and educational content are all delivered through an easy-to-operate and engaging platform for the patient. No longer is a patient left to rely upon willpower alone, the DTx solution is there to encourage and assist at each step.
Research has shown that self-monitoring is consistently associated with weight loss, and participant engagement was highest when completed through a digital-based modality. Indeed, Sidekick’s own digital therapeutic platform has shown strong clinical efficacy in helping patients achieve clinically meaningful weight loss.
It is well-documented that motivation and self-discipline are key drivers to achieving sustainable weight loss and it can be very difficult to achieve without a support network.
DTx are formulated to include a human, conversative component to help retain the patient’s engagement and confidence.
Personal feedback has been shown to be key in addressing the self-esteem and emotional needs of patients. Personal and individualized support is therefore vital to ensure continuous motivation and compliance with the treatment journey.
Access to lifestyle coaches and community feeds allows the patient to connect on a personal level with coaches who are trained in supporting people to make health-connected behavioral changes. Furthermore, easy extraction of data by the patient’s physician from the platform means that patient progress can be monitored closely. This allows for unique tailoring of the program to optimize treatment, without the need for frequent and costly in-person input from healthcare professionals.
Patients with obesity are frequently faced with not just the goal of weight loss, but multiple comorbidities. As one of the main metabolic complications, T2D often involves regular treatment with medications or injections to help control blood sugar levels. An understanding of the high organizational burden for a patient tackling both lifestyle changes and medication adherence is one of DTx greatest strengths. A DTx can ensure that a patient remains on track with their schedule through personalized reminders and education on the importance of their pharmacologic treatment.
Obesity was yesterday’s concern but is today’s emergency. The alarming increase in morbidity and mortality are accompanied by equally-worrying economic ramifications. However, it is clear from how widespread obesity is that public health messages promoting self-restraint and high motivation for activity simply aren’t adequate to tackle the root causes of the problem.
Instead, the personalized, supportive, and clinically-validated measures that DTx provide have the opportunity to transform the approach to solving the obesity crisis. Through initiating and sustaining healthy habit formation, to integrating mental wellbeing into every treatment step, DTx will be crucial in breaking down the barriers to weight loss. Moreover, knowing that such outcomes will result in a reduction of hidden but deadly comorbidities like T2D, and thus decreased pressure on our healthcare systems, the pay-off for achieving them is priceless.
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