Wearable technology and lifestyle management: the fight against obesity and diabetes
Authors: None The Lancet Digital Health
Journal: The Lancet Digital Health (2019)

In January, The Lancet published two Commissions investigating the link between food, health, and the environment. The EAT-Lancet Commission reported a plant-based diet that could improve human health, and other recent publications have since described the positive effects of plant-focused diets on morbidity and mortality, and on lowering the risk of obesity and type 2 diabetes. The Lancet Commission on Obesity provided evidence-based recommendations to improve nutrition and reduce physical inactivity. Among many recommendations, these commissions highlighted the need to promote adherence to healthy lifestyles and the potential of technology-based strategies to deliver more personalised, preventative health care. We are now witnessing the implementation of such digital strategies in the UK to combat the obesity epidemic and prevent type 2 diabetes. Last month, NHS England announced that up to 8 000 people at risk of developing type 2 diabetes could receive wearable technology to promote physical activity and access to a range of personalised digital self-management support tools, including education on lifestyle choices, advice on how to reduce weight through healthy eating, and physical activity programmes. The NHS long-term plan reports collaborations between the wider NHS, the voluntary sector, developers, and individuals to develop and expand digital access to the Diabetes Prevention Programme to widen patient choice and target inequality. This joint commitment by NHS England, Public Health England, and Diabetes UK is the largest undertaking of its kind in the world, used by over 100 000 people since its introduction in 2016. With the increased risk of developing type 2 diabetes in certain black, asian, and minority ethnic groups, the ability of the Diabetes Prevention Programme to reach often underserved communities by offering digital access presents an opportunity to tackle health inequalities. Published this month, the UK Chief Medical Officers' Physical Activity Guidelines to promote exercise for health benefits highlights the potential of digital technology only once, for older individuals, to aid light-intensity physical activity. The limited reference to the utility of wearables and other technology in the report could stem from the current lack of conclusive clinical evidence showing the efficacy of this technology for promoting behaviour change. A review of recent literature highlighted that, although published trials have shown that wearable devices might be able to increase physical activity, complex study designs involving multiple behavioural strategies make it impossible to assess whether wearable devices can independently affect weight loss. The IDEA randomised clinical trial reported that digital devices that monitor and provide feedback on physical activity might not offer an advantage over standard behavioural weight loss approaches. In this issue, Mhurchu and colleagues report a negative mhealth trial tailored to specific cultural needs of the Māori and Pasifika communities in New Zealand, which did not significantly reduce risk of diabetes and other non-communicable diseases by promoting adherence to healthy lifestyle behaviours. However, Morley and Floridi suggest that digital health technologies might serve best as part of a larger overall health plan, supporting clinical practice and acting as health-care companions, rather than working independently for patients trying to self-manage behaviour change. Therefore, implementing technology into a clinical setting might require cultural sensitivity and appropriate education to ensure efficacy and equity in potential public resources and opportunities. The global prevalence of obesity and diabetes is projected to increase dramatically, with the number of people with obesity predicted to rise to 22% and with diabetes projected to rise to 48% by 2045. The development of effective programmes to reduce and prevent obesity must be intensified to offer the best opportunity to impede the unsustainable prevalence of obesity and related type 2 diabetes. Although many will welcome the NHS long-term plan to introduce digital interventions to support adherence to healthy diet and exercise, further evidence is needed to determine if wearables and digital intervention can improve public health.