How doctors can use social media as an obesity reduction tool

According to the World Health Organization, more than 1.4 billion adults are overweight and more than 500 million are considered obese — a number that has more than doubled since 1980. Both conditions increase the risk for heart disease which is the leading cause of death globally, taking 8.5 million lives a year.

Health AffairsThe numbers are clear. But what is less quantifiable is the strain that the obesity epidemic has put on health services. London-based bariatric surgeon Dr. Hutan Ashrafian sees the effects of the disease daily, and his long patient list signals no end in sight. So he and a team of researchers began a search for digital-age tools that could help physicians effectively manage and track patients remotely.

The team first set out to find other instances where web-based tools and social media played a role in the treatment for obese and overweight patients. They then analyzed the studies’ effectiveness at reducing patients’ body mass index, or BMI. Their goal was to provide evidence of what innovative methods could be developed to help combat the lethal disease. Their study revealed promising results:

Our analysis of twelve studies found that interventions using social networking services produced a modest but significant 0.64 percent reduction in BMI from baseline for the 941 people who participated in the studies’ interventions. We recommend that social networking services that target obesity should be the subject of further clinical trials.

PBS NewsHour interviewed Ashrafian to hear what the team learned from the 12 studies that they analyzed, the results of which are published in September’s issue of Health Affairs.

NEWSHOUR: To start with, can you explain what significant although modest really means?

DR. HUTAN ASHRAFIAN: Significant means that in terms of statistical evidence it is significant, i.e. mathematically if you look at the results, they stand out because there is consistency in the result that we got throughout all the studies, so there is a definite and consistent effect to all the studies we looked at where we demonstrated that if you use social media people consistently are able to lose weight across all the studies we looked at.

NEWSHOUR: And the modest part?

DR. HUTAN ASHRAFIAN: Now the modest part is where we added and integrated all the information from the different studies; we used a marker to measure obesity to see how much social media was able to decrease their obesity once they had a social media intervention. And so when you add up all the number and look at it though the different groups that were studied, the results were relatively modest drop in the body mass index which is a measure of obesity. A body mass index measure is the number we use for height-to-weight ratio to measure obesity. Eighteen to 25 is normal, above 25 is overweight, above 30 is obese.

This drop overall from all the studies was .64 percent. The way I explain it to people is that when we look at the temperature around the world, and when we say oh look the national average temperature is going to go up by one percent, people say well one percent isn’t a big amount of temperature change, but that’s the average over the whole year so it means potentially there will be people who will lose much more and some much less, but overall there as a powerful effect.

NEWSHOUR: Why do you think it is vital health care providers and policy makers consider what you’ve learned?

ASHRAFIAN: If you have the right setup to manage patients remotely and have them manage their health care at the same time, you could have a successful treatment modality that is cost effective, and a gold standard for future treatment introduced. It is a problem affecting all classes of individuals, and a worsening issue, so we need to use as much innovation as we can. The nature of obesity has been demonstrated to exist in society through a social network. As a result, one potential therapeutic modality to combat obesity is to match the diseases’ network elements with a network-based treatment such as social networking services

NEWSHOUR: Your team analyzed 12 other studies that used social media. What was the concept behind the different methods?

ASHRAFIAN: They were all Internet-based platforms where people can report their personal results, and also get advice either individually or in a group setting to improve their weight loss.

It is a mixture of a clinic with a weight loss group combined, so it takes the best of both worlds.

NEWSHOUR: The strategy involves both personalized and group attention from the doctors. Can you explain how these come together for success?

ASHRAFIAN: The magic thing about it is the familiarity with the patients.

If you were having problems eating that week, the doctor can quickly say, “ok what was causing it, were you going through something at work, was it that you hurt your knee whilst running?” So the patients were getting lots of support and feedback on their outcomes.

It gives doctors an extra tool to help manage patients, but primarily it means they can decrease their clinic list. It would free their time, at the same time as seeing and addressing the needs of many, many patients. The commonality of having specialists who are used to doing online work for patient care as a routine would be an important part of the future.

Then there’s motivational support from peers in the groups. If someone lost a large amount of weight, they would all be able to communicate on the group and say “oh well done congratulations that is excellent, superb work.” It means that people around them caring for them will potentially be celebrating their success, and that is a huge motivation factor.

NEWSHOUR: What did you learn about the relationship between social networks and BMI reduction?

ASHRAFIAN: There is a definite and consistent effect to all the studies we looked at, where if you use it consistently, people are able to lose weight. Clearly, a lot needs to be done to address obesity, but this could be one of the arms of an armamentarium to break down a massive worldwide epidemic. It really comes down to, these methods have been shown to work and they have the potential to be cost effective in application. However, the results of our studies are relatively modest because of how many studies are out there.

NEWSHOUR: How can social networking strategies ultimately augment policy driven health care reforms?

ASHRAFIAN: The issue with obesity is that it is a multifactorial disease that has elements of diet, elements of lifestyle, elements of behavior, access to food, associated economics, and genetics. It is not an easy disease to treat because we haven’t been able to treat it well for almost half a century now. Clearly the treatments for obesity need to be so multifactorial and flexible to address all those elements and social networking services are so flexible as a strategy that they can attack many of those elements through online communication. And so if you are able to tailor make your social networking services to directly target every one of those factors that lead to obesity you would be on the road to achieving a big dent in the breadth of obesity we have worldwide.

Editor’s note: This interview has been edited for clarity and length.