Maintaining our health is complicated, whether that is losing weight or staying fit. I was reminded of this by a piece in the New York Times that referred to a 2016 JAMA article by Dr. John Jakicic and his colleagues at the University of Pittsburgh. They randomized a group of 471 adults who wanted to lose weight to a regular weight loss intervention that included web-based supports and counseling, and an enhanced program that added wearable technology (like a Fitbit, Apple Watch or other device). Contrary to what they expected, the participants who used the wearable tech lost fewer pounds than those individuals who had the regular intervention. Furthermore, the people with the standard intervention improved their fitness just as much as the people wearing the high tech solutions. Though the authors of the study do not speculate why the wearable tech failed to outperform regular treatment, there are numerous reasons that I can think of from other research on resilience that could explain the results.
My best guess is that the tech was simply not the right intervention for people with this kind of problem. For example, the sample for the study was already quite large, with an average weight of 96 kg (212 lbs), and a body mass index between 25 and 39. Could it be that wearable tech is not an effective way to reduce weight, even if it might be a wonderful way to prevent weight gain? Let me share some principles of resilience and you can judge for yourself whether investing in wearable tech makes sense for you.
Principle #1: Complex problems need complex solutions. Time and time again, in this blog I’ve warned against trying to address complex mental and physical health issues with simplistic solutions. Children don’t repel bullies by just making a new friend. We don’t prevent suicide with self-esteem booster sessions. And we certainly don’t fix everyone’s problems through meditation when those problems include violent communities, poverty and other traumatizing events. Obesity is not a simple problem. There are issues of metabolism, genes, access to healthy food (and its cost), urban design (are there green spaces and sidewalks nearby), public safety, media influences, and social norms, to name a few. To address something as complicated as weight gain will need a multi-pronged approach. If a celebrity’s weight yoyos maybe it’s because he or she never changed enough parts of his or her life. For example, when children’s schools remove the greasy fries from the lunch menu, children still don’t lose weight unless they walk more and the pantry that their parents stock at home changes too. An effective intervention removes the fries and starts a program on healthy eating and raising healthy kids for the parents at the same time. Neither an intervention with children nor one with adults alone is broad enough to do much good on its own. Combine them, and the effects snowball.
If those Pittsburgh participants didn’t get an extra benefit from the wearable tech then maybe that tells us that the solution was too simple. It may have even suppressed the benefits of the regular intervention. Consider this hypothesis: might people who received the wearable tech think that it made them lose weight and therefore they were less motivated to participate in the other parts of the weight loss program? We know from other studies that efforts to build resilience and health can have unintended negative consequences.
Principle #2: The higher our risk, the better some interventions work. There is another powerful pattern we are seeing in studies of health and resilience. The higher our level of risk, the more we benefit from some interventions, while general population wide interventions tend to produce the most measurable good for those at the lowest level of risk. There is a growing body of evidence that whether it is harm reduction strategies for drug abuse or fighting depression, a personal contact with a therapist will have the greatest impact on those with the least resilience. In other words, the less prepared for life you are, and the more vulnerable you are to problems, the more a little bit of counseling will help. It’s the reverse for people without big problems. A general population-wide intervention might prevent difficulties for those at low risk but have little ability to change the behavior of those who are already engaged in risky lifestyles. Back to the wearable tech study, could it be that all those arm and wristbands and digital reminders are a great way to prevent us from becoming obese? Might they remind us to maintain health regimes that are preventing us from developing a serious problem later in life? Even if they do that well, they may not be the solution to our problems once we are obese. At that higher risk threshold, having the attention of a counselor and the accountability of regular meetings that establish new social norms might be the better solution. So, before you throw away your wearable tech, ask yourself: Am I using it to maintain a healthy lifestyle, or am I using it to force me to make changes I’ve not been able to yet make? If we listen to the research we may wonder if wearables are very effective once we have a severe weight problem.
Principle #3: When we change our environments, it’s easier to change ourselves: To my mind, wearable tech is useful when it reminds us that without changing our environment, lifestyle changes won’t stick. For example, it can encourage us to park our car further from our office, or maybe take public transit so we walk more. It’s the same reason that putting calorie counts on menus (as New York City has done) is likely to change the eating habits of consumers who are already sensitized to the need to eat better. Stand up desks get us to change our routines in the office, too. And a healthier lunch room, combined with better and cheaper food at the grocery store can help populations most at risk of obesity make changes before their problems get worse. In each and every case, it’s changes to the world around us that force us to be our best selves. Sure, we could try and change ourselves (and personal motivation is always key to success), but without external changes, no amount of personal transformation is going to change our BMI. The best motivators I know of to increase walking are either a friendly group of hikers that meet each weekend, or a dog that needs you to take it outside each and every day for a walk.
Thinking back to that experiment in Pittsburgh, one has to wonder whether people were coached on how to make the best use possible of their wearables. Or did the wearable just give them a dose of guilt, but cause no change in behavior?
Health research is never easy to decipher. When we look across studies, though, patterns emerge quite plainly. Here’s my best advice based on what I see:
1. If you are struggling to keep your weight down, find someone to talk to, and change your peer group so you’re hanging out with healthier people. You’re more likely to make a series of behavioral changes as a consequence.
2. Use wearable tech to help maintain a healthy lifestyle. It can likely remind you to be your best self. If you already have a serious weight problem, though, a wearable has so far not been proven to help you take the weight off. It might, however, prevent most people in the wider population from ever having a weight problem.
3. No matter whether you wear a device that counts steps, or you count calories, changing your thinking is never enough on its own to sustain a change in lifestyle. Think about the world around you and modify that at the same time you are changing your thoughts. You are likely to find it is far less difficult to modify personal behaviors, and it will take far less motivation to change, when the environment in which you live demands from you a healthier lifestyle.