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Weight, Diet and Writing Things Down: Is This What You Call Health 2.0?
There is a VERY interesting discussion going on over at the e-Patients.net blog about what the heck “Health 2.0″ actually means, and whether it can really help people.
I’ve spoken and written a lot on Health 2.0 myself, and when people ask me what the term means, I usually give them this simple two-part explanation:
1) Health 2.0 is where new, interactive web technology meets a new, more patient-centered approach to healthcare. It’s giving people access to tools and information they never had before, to empower them.
2) It’s about changing the engagement model with healthcare providers, so 
that “the medical establishment” treats patients more like partners in their own care.
On Part 1, I’m quite an optimist. The great plethora of “cool new health gadgets and apps” do have a purpose, I believe: they potentially engage people in health activities to a much higher degree than ever before. I know for a fact that in our diabetes community, blogs and social networks and online logging programs have changed lives for the better.
To really succeed, these new tools are going to have to make taking good care of yourself a lot easier, and a lot more FUN. There. I said it: Human tastes are often trivial, and we’re addicted to pleasurable activities. Hmm, going on diets, losing weight, and keeping detailed records of our every food and activity — you and I both know how burdensome all that is. HATE IT!
One point of Health 2.0, as I understand it, is taking fun things like video games and applying them to the un-fun tasks of keeping yourself healthy. For those who’ve tried it, it seems to be making a difference.
But Internet & American Life researcher Susannah Fox laments that “nothing is working.” At a recent NIH conference, she reports: “Speaker after speaker talked about how nothing really works in trying to get people to change their diets for the better, to get more exercise, to save their own lives and the lives of their children. t was a parade of one step forward, two steps back interventions: media campaigns, individual counseling, community outreach. None worked long-term.”
Hell, we know it’s hard to change people’s behavior. And it’s going to take a while for all this web-health stuff to become mainstream. But it still sounds to me like the establishment is measuring success by how “complaint” patients are with following doctor’s orders: stick to meal plans and med routines, lose weight fast, and keep detailed records of everything — oftentimes without any fun inserted, and without the kind of support that struggling patients need.
I guess what I’m saying is, if Health 2.0 seems pointless to some folks, I would argue that Part 2 of my definition above is dragging behind.
As one of Susannah’s commentors puts it:
“I guess what I’d really like is for doctors to realize that (overweight) people have probably been subjected to near-incessant questioning of their weight and lifestyle habits, from everyone. And then exercise a little intelligence and work out whether their (overweight) patient actually wants lifestyle advice or not, and learn to trust people when they answer what kind of diet habits and exercise they get up to. I can tell when a doctor doesn’t believe me and frankly it sours the whole professional relationship.”
Another says:
“Unfortunately many doctors harp on weight as a health marker to the exclusion of everything else, refuse to believe that a fat person could possibly be educated about nutrition and exercise, and treat them poorly because of it. Many believe that if a fat person does not lose weight they are ‘non-compliant’ and that they just need to do some more ‘tough love.’ The doctor’s office is not an episode of The Biggest Loser.”
To my mind, the new technologies, and giving patients access to their own extensive health records, has huge potential to help. But for a real shift to a new era of “Health 2.0,” we might have to wait for the next generation of doctors and nurses to hit the clinics — those who know how to interact with patients and function in this new environment.
{Editor’s note: for a lower-tech idea on how to help people with diabetes immediately, see yesterday’s post}
I’m a bit of a techie and I’ve only had to deal with diabetes in the age of blogs, twitter, laptops, etc.
I think we could do so much more with the technology available.
It’s so archaic that I have to call our endo and recite a bunch of numbers or wait until I get to work to fax a spreadsheet. They have said that because of HIPA they cannot receive e-mails.
Though I think that a password-sensitive e-mail address is more sensitive than some fax machine that I may or may not have dialed the right number to!
How nice would it be to have a platform where our data is available both to us and our providers. Or being able to just message the nurse asking her to look at our latest numbers so we can adjust bolus rates or corrections.
My gripe is that so many of us are MAC users and companies that manufacture medical devices such as blood glucose meters and insulin pumps have not created software that would easily allow us to download our data. Instead of doing what I do: log everything in pencil and then stare bleary-eyed at the computer entering it in. Gah!
I would argue that if companies are seeing user-end results int he Health 2.0 front that either they aren’t making a product that is truly user-friendly or they don’t have a good way to track who is actually using it.
Posted by: Leighann of D-Mom Blog | February 9th, 2010 at 7:11 amA really good post, and comment too! I’m a health writer and at conferences I am always surprised/disappointed about how little faith doctors have in lifestyle measures to help people manage their weight. They tend to be much more enthusiastic about drugs and, more recently, bariatric surgery. This is in spite of evidence that lifestyle measures really can make a difference, in preventing or managing type 2 diabetes specifically.
Posted by: Christine Michael | February 9th, 2010 at 7:21 amIf doctors’ lack of belief comes across to patients, which I’m sure it does, it’s not surprising if interventions fail. So one advantage of web-based interactions might be to remove doctors’ low expectations from the process and help people feel more positive about helping themselves.
weight, diet and writing things down – how tedious and does it really answer anything? Maybe we have to focus on the cause rather than what to do once you find yourself sick. Like do we have any idea about the chemical composition of much of the food we eat and the real impact that food has on our endocrine system, including perhaps the radical changes that so called food might have on changing everything from how we metabolize to how the overall body reacts? Thanks for your post yesterday Amy.
Not enough investigation has been done – rather it’s all about assuming that everyone who is fat is eating way too much. But why are people so much fatter than they were 30 years ago. I can’t believe everyone is really just eating too much — is it something else? We’re all just focused on exercise and diet, but we don’t talk nearly enough about what’s in those diets and about the addictive power of fast foods. I won’t be at all surprised if we find definitive proof that this food is just like cigarettes – chemicals and modified and re-engineered foods create chemical changes in the body and big addictions. Then maybe we can really help people instead of blaming them – and subjecting them to using tools that don’t really work and only serve to make them quilty.
Posted by: saramy | February 9th, 2010 at 4:03 pmThanks so much for forking the discussion in this direction. As always, you’re focusing on the real-world applications and implications, looking at the issues through the D-lens.
I’m snowed in here in DC, but I’m learning as much from the conversation as I have ever learned at a conference or lecture. That’s 2.0, too.
Posted by: Susannah Fox | February 10th, 2010 at 8:26 amlearn to trust people when they answer what kind of diet habits and exercise they get up to
Posted by: affiliate | February 24th, 2010 at 11:37 pm