February 23, 2015

Too few, Too little, Too late: Why we are failing to reduce obesity in the UK

Writing about web page http://www2.warwick.ac.uk/fac/sci/wmg/idh/research/

USDA Photo by Tim Lauer, principal of Meriwether Lewis Elementary School in Portland, Oregon

Photo: USDA

Blog post by Professor Caroline Meyer - Professor of Digital Healthcare
Profile

On average, people in the UK are getting more and more overweight. This will continue to be the case unless we educate people better, provide better care within the NHS, develop brand new ways of helping overweight people in the community and change the rules and regulations about how foods are manufactured, advertised and sold within our society.

Latest government figures suggest that almost two thirds of UK adults are either overweight or obese costing the tax payer £5 billion a year in NHS costs alone. This situation is not just a UK problem but a global one. More than 2.1 billion people (30% of the world’s population) are either overweight or obese and these rates are increasing.

Currently, what tends to happen is that people only get targeted help for their obesity if they already have serious health problems (e.g. diabetes, heart problems or serious mental health issues). Indeed, we have well-established services, delivering state-of-the-art interventions, including bariatric surgery and tailored dietetic / lifestyle advice. There also exist many specialist obesity services. However, the current system is not joined-up and is insufficient; offering too little input to too few individuals, too late in their life.

Eating is a really complicated human behaviour. There are multiple reasons underpinning what, when and how much a person eats. These include the obvious things (such as the taste of the food, age and nutritional education). However, there are much less obvious things (such as the way people think and their mood; their social and environmental situations). For example, people’s ability to recognise and act upon how hungry they are is often overridden by the fact that they see something in their environment that they want to eat. In addition, using food to reward children for good behaviour or not allowing children to eat “unhealthy” foods serves to make those foods more desirable and leads children to want to eat those foods.

Even some hospital specialists, who are working with patients to reduce their weight, don’t focus on the full range of factors that we know affect eating behaviour. We also need better, evidence-based interventions that can be widely used by anyone overweight in the community to manage their weight before they get to the point where they develop serious physical and psychological problems.

Wearable TechnologyImportantly, there is currently a lack of knowledge in the population about those factors that affect eating behaviour. Most NHS workers encounter overweight and obese patients on a day to day basis. However, they are insufficiently trained in both understanding why people eat as they do and in ways to help people to change their behaviours.
Finally, it is essential that those scientists who really understand eating behaviour work with policy makers to help them develop better policies and practices.

We now have a great opportunity. The digital revolution such as the widespread use of smart phones and wearable technology gives us the chance to radically change how we prevent and deal with obesity. This is a core area of activity for scientists working at the Institute of Digital Healthcare at The University of Warwick. We believe that digital technology offers a real way forward in reducing levels of obesity across the globe.

Professor Caroline Meyer is a psychologist with a strong track record in the field of human behaviour. For almost 20 years, she has worked in the fields of eating behaviour and physical activity. As Professor of Digital Healthcare in the Institute of Digital Healthcare, she focuses on understanding the interactions between health-related technologies and people. Specifically, she is interested in developing digital interventions to change behaviour and measuring the impact of health technology on people's behaviour and cognition.


December 09, 2014

People get ready …

Writing about web page http://www2.warwick.ac.uk/fac/sci/wmg/idh/

wmg_idh_logo_rgb-300.jpgPosted by: David Bott, Principal Fellow, WMG

Being healthy is one of the basic needs of humanity. For centuries we have treated illness once it occurs but are increasingly aware that we could prevent it and preserve good health. Meanwhile the risks to health are changing, our understanding of diseases is increasing and the tools of technology are evolving to meet our needs, so we ought to have a plan.

There are three, very different, factors that are causing us to have to look again at how we approach health and care.

The first is the changing nature of the health challenges we face. Having mostly addressed childhood diseases in the developed world, and identified some of the more common self-inflicted problems, we are now living longer. That means we are running into the degenerative diseases that affect older adults. We are also travelling more and therefore spreading exotic diseases into populations that are not immune or at least resistant to them. This alone means that the way we approach health has to change.

The second factor is our growing understanding of how diseases affect our (human) biology and the way they impact on individual patients. We have realised that the symptoms we observe are indicators of the underlying biological problems that cause disease, and are exploring these – even down to the molecular level. However, we have also realised the complexity of most diseases and the need for co-ordination of multiple diagnostic techniques to identify the specific way a disease affects a specific person.

IDH ResearchersThe final factor – and one that we can use to offset the extra challenges caused by the first two – is the huge developments in digital technology. We can now collect, analyse and interpret information about ourselves (sometimes called “biomarkers”) and see long-term trends about our basic physical well-being and the progression of diseases. However, making this work inside the existing way we do things can cause its own challenges.

There are three main types of information that we can identify within the evolving health and care system:

There is the information that we increasingly collect ourselves. A growing number of people use a whole range of self-monitoring devices to collect information about their own health over time. Whether it is your weight, the number of steps you take, the changes in your pulse rate when exercising, your blood pressure or your blood oxygen level, all these data can be used to indicate how healthy you are. At the more sophisticated end of the spectrum, you can even have your genome read – although the detail depends on how much you are willing to pay. However, this is an unregulated and non-standardised market and the accuracy of the data and its ownership is still a matter for debate.

There are also data collected by doctors. This is part of the diagnostic process – a process which is getting more complicated. As well as measurement of parameters we are used to (temperature, pulse, blood pressure, blood components and so on) we are increasingly using imaging to understand the physical nature of disease effects. We are familiar with X-rays, but have learned the power of Magnetic Resonance Imaging and a whole range of more specific ways to see what is going on inside our bodies – as it happens. All these different sets of data have to be shared between doctors and consultants, GPs and hospitals and used in combination to identify the specific effect of the disease on the individual patient. And all this has to be carried out in a confidential and secure manner.

Digital HealthFinally, the pressure on all health services caused by the increased number and complexity of unhealthy patients means that we need to improve the efficiency of the medical system at many different levels. This is analogous to the change from craft to industry in manufacturing and it is not surprising that there is crossover between the established field of manufacturing efficiency and hospitals and general practice workflows.

The developments in these three areas are not separate. Although the personal information is currently not routinely used in diagnosis, if its provenance and quality could be better assured and securely communicated, this information about a person’s health over time could be an important input to accurate diagnosis. Also, feedback from the data provided by the doctors and hospitals could be used to modify self-help health regimes to make them even more effective at keeping people healthy and fit. Similarly, knowing the average journey patients with specific diseases make through the health system is vital to ensure the system is optimised for the real world and not an “average” patient.

So, there are plenty of opportunities to make the health system that looks after all of us more effective at preventing us from falling ill in the first place, providing early therapy to inhibit or stop the progression of a disease and treating us as quickly and effectively as possible if we do fall ill. The problem is that we already have a system designed for an older approach – to treating sick people. It has legacy systems for collecting and communicating patient data that cannot cope with the scale and complexity of what we need for this new approach. And it seems to be permanently short of money. The new frontier of user-collected health data needs to recognise its potential contribution to healthcare and either standardise itself or submit to government regulation.

Everyone knows that we have to change, but change will be difficult and cost money. The change is coming, it’s just a matter of how long it will take, and since it is the patients who will lose out if it takes longer, we need more information about what is possible and when we will currently get it, and a debate about whether that’s good enough.


Welcome!

Welcome to the blog page for the Insititute of Digital Healthcare, a five year partnership between the NHS, WMG and Warwick Medical School (WMS) which aims to improve people's health and wellbeing through the development, evaluation and use of innovative digital technologies and services.


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