Reaching Underserved Populations with an App

Tech has a very mixed track record in obesity care. Diet apps were early hits. Fitness trackers have a loyal following. The apps are free and the trackers have a lot of gee whiz pizazz. What’s not to like? Unfortunately, proving that they lead to better health outcomes has been tough. But now, in the American Journal of Preventive Medicine, we see that a simple app – integrated with a solid approach to obesity care – can actually deliver better outcomes. And most important, it’s working for a rural, underserved population.

A Randomized, Controlled Trial

Gary Bennett and colleagues conducted their RCT with patients in largely rural community health centers. This is a very basic primary care setting where clinicians work hard to reach an underserved population. Without a doubt, intensive behavioral care for obesity is rare in this setting. But it’s also the setting where obesity is growing most rapidly in America.

So Bennett randomized 351 patients to receive either usual care or a program that combined an app with clinical support. That support came over the phone with a dietitian and in the health center. But in the health center, it was the primary care provider delivering the support – with the help of personalized cues from electronic health records. In addition, patients in the program used an electronic smart scale.

As a result, all the pieces of this program could work together. The app and the smart scale delivered information that came into the health record. From all that information, those cues from the EHR could be highly personal and relevant.

Good Outcomes in an Underserved Setting

The trial delivered good outcomes – an average of nine pounds more weight loss than the control group. With the intervention, 43% of patients lost five percent or more of their starting weight. Without it, only six percent did.

This is a remarkable outcome in a rural, underserved population. Bennett explains:

Most of what we know about obesity treatment is based on people who are reasonably healthy and highly motivated to lose weight. We’ve shown an ability to promote clinically meaningful weight loss among patients who need help the most – those with low motivation who already have the health risks associated with obesity.

Digital treatments allow us to reach into the most remote settings to deliver high-quality care.

Filling a Critical Gap

Multidisciplinary teams with expert providers are important for delivering obesity care. But they don’t have much reach in rural populations. So this trial is a very important proof of principle. Technology can serve primary care clinics in remote communities.

If it’s done right, it can equip those clinics to deliver effective obesity care at a basic level. The need for such a scalable solution is great.

Click here for the study and here for more perspective from Futurity.

Texting, photograph © Giuseppe Milo / flickr

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October 30, 2018