Jim Hill:

Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:

And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

Jim Hill:

Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:

Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

Jim Hill:

Ready for the “And” factor?

Holly Wyatt:

Let's dive in.

Jim Hill:

Here we go. Holly, today's episode is one that I'm excited about because let's be honest, we're living in a digital world. Everywhere I look, there's a health app, there's a new wearable, there's a new digital tool. They all claim to help you with weight loss. I'm confused. How do we choose? What do we know? Which ones are working? Which ones aren't? How much money should I spend on these? That's what we're going to get into today.

Holly Wyatt:

Exactly, Jim. And I'm extra excited for this one because I just got, and I think we've talked about this, one of those new rings, those just little bitty ring you can wear. And it's tracking my sleep, my activity level, my stress, my heart rate, my breathing, my recovery. It's tracking everything, or at least that's what it says it's doing. And I have so many questions. How accurate are these tools really? And how can they help specifically manage our weight? So everybody wants to know, do these apps and devices really work? People ask me are they good for me? Who are they best for? And how can you tell which ones are worth the time and the money? Because some of them are pretty pricey. So I'm ready to dive in and learn what really makes these digital tools effective.

Jim Hill:

Well, you're in luck, Holly, because we have just the person to help figure it out. Dr. Deborah Tate, she's really one of the world's experts in this field. I've followed her for many years. She's a true pioneer in all things digital. She knows it all. She's a professor of nutrition at the University of North Carolina at Chapel Hill, and she spent decades studying how technology like mHealth, mobile health, and eHealth (I guess that's electronic health), tools can help people lose weight and keep it off.

Jim Hill:

From early internet inventions to today's AI-powered apps, Deb's been at the forefront of this evolution. I might also say that Deb's associated with the UNC NORC, and as our listeners know, this podcast is supported by the UAB NORC. So we love to have NORC researchers here because that's where the exciting science is happening.

Holly Wyatt:

Yeah, so Deb, welcome to Weight Loss And. I think we are ready to dive in.

Deborah Tate:

Thank you, Jim. And thank you, Holly. Well, you really make me feel old, Jim, talking about how many decades I've been doing this research. But I mean, it has been a while and technology really is changing by the day. So things have really changed rapidly in this field. And it makes us all think of what we did yesterday as sort of old news.

Jim Hill:

Boy, it is. It is moving so quick that I'm glad you're here to help us make sense of it. So let's start with how has technology changed how people manage their weight? Say, just over the course of your career?

Deborah Tate:

Well, I started doing this research during my doctoral training, and we had websites. And if I showed you some pictures, if this was actually a video, I could show you some pictures of the earliest websites that we were using. And what was happening then is that people were going online searching for recipes. They were looking for information. And I think those of us who were working in the weight loss field, especially behavioral scientists, we knew that it was going to take more than just finding information on the internet that was going to really help people change their behavior. Information was key. It's one of the necessary but not necessarily sufficient things that's going to help someone when they're trying to undertake changing their eating habits and trying to become more active to manage their weight. And so at the very beginning, I thought, well, what if we could do a lot of the things that we do in the clinic, but we could use email or we could use other communication tools to try to help support their efforts and use the web to provide the lesson materials that we would hand out on paper in our group sessions and things like that. So the first study that we did in that area was taking sort of a general set of links that there was so much coming really fast even back then.

This was in the late 90s, early 2000s, and putting all these links to calorie tracking tools and other kinds of things that people would do on the web and put those easily at people's disposal and then compare that to providing our more structured lessons, which kind of guide people through step by step, teach them some skills like problem solving and some other things that could be helpful as they're trying to change, and then follow them weekly with email. And what we found was that that follow-up, that email accountability and support was really helpful. And so the tool, the information was good, but we certainly helped people do a lot better when they had a more structured program. And then we've just kind of built on it from there. How can we take that initial finding and as technology has changed, make the support more automated and use the human when needed to try to make it a more cost-effective approach to helping people.

Holly Wyatt:

Yeah, that makes so much sense. One of the things we always say is you can have a device that makes you aware of something or that gives you information, but if you don't know what to do with it or you don't use that to change a behavior, it hasn't necessarily done anything. But it can be really helpful in helping you decide what to change, but you still need the skills or tools or something that really causes you to make the change. And I think that's a critical thing that people don't think about. They think they're going to buy one of these devices or get an app and that will do it for them. And that's, I think, exactly what you're showing there. It's helpful, but it's not the whole game necessarily.

Deborah Tate:

Well, how do you feel about all the information you're getting from your Oura ring?

Holly Wyatt:

Well, I like it. I like it. I like to look at it at night, but do I do anything about it? That's the key. Well, one thing I'm looking at, is it accurate? They're giving me a lot. So I'm always at, you know, the science in me, is it accurate? And so I want to pick your brain about that. But then it's like I haven't necessarily changed anything. I've changed a little bit though my sleep. I can see all these different parameters in my sleep. And so I've been really thinking about and going to bed at a little bit different time, doing some things to hopefully not stay awake as long. It was showing me that I had this what they call latency where I stay awake a long time So I have made a few changes, but I think I could do more.

Deborah Tate:

But it sounds like you've identified one behavior. Your sleep behaviors that you're getting information about, and then you're using that information to try to help you see whether the things you're doing is having an impact. So it's giving you information to see if what you are doing is working.

Jim Hill:

God, she's the behavior. She can't turn it off. She's the behavioral interventionist. She's already intervening with you, Holly.

Holly Wyatt:

I know. I love it. I love it.

Deborah Tate:

But that's what these tools are best for, is helping you see whether the things you're doing are having an impact. And some pieces of information are easier to already know than others, right? So you know if you took a walk, but maybe you don't know how long you actually slept. It's harder for you. You're not writing that down. Or you might wake up during the night, but you don't actually record the time you were awake. So having that information from your device is something that you might not otherwise know. Another great example of that is what we're learning when people are using continuous glucose monitors. The impact of their eating behaviors or their exercise behaviors on their blood glucose levels is not something they can otherwise have information about. Unless they're doing old-fashioned finger sticks, which most of us are not doing, especially if we don't have type 2 diabetes. But that seems to be something that is interesting to those people who are interested in learning more about their own health. And perhaps one of the things that it could be useful for is helping people be more adherent because they see those connections between what they eat and how their body is responding. And so you might see those connections between changing your bedtime and how you feel in the morning, or you might not, but those are important metrics to help you make change.

Jim Hill:

So I want to follow up with the continuous glucose monitors because I've been in many conversations about these. There's no question that if you have type 2 diabetes, these things are fabulous tools. I think where the debate is their usefulness in people who do not have type 2 diabetes and it relates to how closely can we link our patterns with our glucose. And my question to you is, do you think people without diabetes are going to really embrace these over the long term or is it something, a shiny new toy they're going to look like and they don't know what to do with it?

Deborah Tate:

Yeah, those are great questions. And I mean, I don't think we have the answers yet, especially for people that don't have diabetes. Until recently, we had to get special approval to use these tools for people without any other health conditions. But I think that at least what our research is showing is that there is an interest that seems to promote better adherence to diet tracking. At least that's what we saw in a small pilot study that we did. So utilizing the continuous glucose monitor, one of the groups was using that. They were normal glucose to impaired glucose, but they did not have type 2 diabetes. This was the study population that we were working with and the other group did not. Now, there were some other differences, so we can't quite pinpoint if it was just the continuous glucose monitor, but the group that used the monitor did have more days of diet tracking. So, there might be a feedback loop there where when they are tracking their diet and they're looking at the different things and they're taking all that effort to record what they're eating, seeing and looking for trends or looking for patterns was, interesting enough to keep them tracking.

Jim Hill:

Well, my own prediction here, I actually think people are going to embrace them, but I think something's missing. The something is missing is how to help them interpret it. And I think that's where we're going to see some innovation. So maybe it's some apps that go with the glucose monitor to help you understand it. But I think that technology is here and I don't think you can put the horse back in the barn.

Deborah Tate:

You have hit it on the head. And one of the things and why tech interventions that have human support. So in the one I was just talking about, those folks had an app and they had their glucose monitor, but they also had weekly phone calls with a dietician or weight management counselor or an exercise physiologist that was helping them to create those linkages and understand what they were seeing. And in general, the tracking piece of the technologies is pretty good. Now, are you going to say it's completely accurate? Well, it depends. It depends on which device, but also what behavior. Certain devices are better at certain behaviors and other things. And some of them it's hard to tell because the algorithms are proprietary, which means we don't know exactly how they're estimating these things. So we scientists can't quite unlock those calculations as easily as we might. But I think what they lack is the connection across the behavior. So the patterns that a counselor might be looking for between what someone's eating and how their glucose is responding or how much they're active and what's happening with their sleep. Those connections between the behaviors are not as robust or good as maybe they can be in the future.

Holly Wyatt:

Yeah. So it kind of sounds like there's almost three steps to this. You want to gather the data and the data needs to be accurate. If you're gathering data that isn't accurate, then that's not going to be helpful. You need to then kind of be able to look at it and know what to change. And that may be where other people can help is what you're talking about. And then the changes you make, you want them to be effective, to have an outcome that is something you want. So there's kind of three pieces to this. So I wanted to kind of go back to the accuracy because I still have some issues. I know I have patients who are using some of these devices and sometimes, for instance, like these rings or a device that monitors their movement in some way. There's so many different ways to do that now. And they come in and they show me some of these, you know, how much they're moving and I'm not sure it's accurate for them. And yet they're basing things on them. And I'll tell you one thing about myself is my ring is not accurate for my movement.

Deborah Tate:

Yup.

Holly Wyatt:

And I think I figured out why. Do you have any idea why? It overestimates my movement a lot.

Deborah Tate:

It may depend on what type of activity you do.

Holly Wyatt:

And I talk with my hands continuously. I am always moving my hands. And I really think that has it because it'll tell me your steps are this high. And I'm like, my, there's no way I've been walking today. So you got to be able to use that. And sometimes people say, oh, here's the number. The number's the number. And I'm like, well, if the number's not accurate, then from the very beginning, you're not starting in a good place.

Deborah Tate:

That's true. But I think sometimes what we're most interested in is how an individual's activity varies over time, right? So looking at trends for you, but not necessarily comparing you to Jim, you know, so I think it could be useful because you can see the relative increase. So if you're trying to help someone or that person is trying to help themselves become more active or see if they're less active over time, those trends can be useful even if they're not 100% accurate.

Holly Wyatt:

Yeah, but I think that's perfect to tell our listeners, look for the trends, because people come in and say, "Look, I got 10,000 steps, but I didn't walk any. I walked very little." Then that's not necessarily as helpful as saying, "Yeah, let's see how we can increase it." So I think that's a great point for the listeners to consider.

Jim Hill:

Deb, let's talk about other wearables. Are there wearables or apps that help us with our food intake? What do you see out there that's helpful for people.

Deborah Tate:

Yeah, so food intake is a little bit harder than activity, for example. There's a lot more wearables that are going to help with physical activity, tracking steps, helping you estimate the calories that you're burning. Sleep, heart rate, things like that. Those are going to be more available with lots of different devices today. So Holly mentioned the Oura Ring. People are probably familiar with Fitbits or Apple Watches. Those are all devices that can do those similar things. What they aren't doing is tracking what you're putting in your mouth. So we still are doing a lot of that manually. So there's a lot of apps out there where people can choose what they're eating, record those in a traditional way, or use voice recording to look up their calories. The one I'm most enjoying right now is using ChatGPT to look up my calories and calculate the calories for recipes that I've made and using just voice to tell it what to do. And the better you get with being specific and prompting it to do that, it can tell you the calories from your breakfast. I think you have to have a little bit of savvy with what your portions were because you need to include those pretty specifically in your prompt. But it can do a pretty good job.

And photo recognition is also on the rise in terms of taking photos of your food. The challenges with that are a little bit of just how accurate you are with your photography and other things like that that can affect the portion. But we're getting there. And I think that it really depends on how much, you know, I always say to participants who come into our programs, you know, the kind of person you are. Are you the person who wants to balance your checkbook to the penny?

And if you are, then weighing and measuring and recording with some of these diet tracking apps may be something that works really well for you because you like accuracy and you like to know the value. Weighing with a food scale. Those are the kind of people that are going to probably get the best results, but it's really only certain types of people that want to or have the motivation to do that. So then the next best step is to estimate. And a lot of ways that we can do that may not be quite as accurate, but they're good enough. So keeping track of general categories of foods, like things that are higher in calories or higher in sugar, which we might call red foods, or things like fruits and vegetables, which we might call green foods, which you can really, you know, eat an unlimited portion of if you're just trying to track categorically.

Jim Hill:

I've always said that one of the real breakthroughs in this area would be if we had a way to assess food intake like we do physical activity. I can put a wearable on. I don't have to think about it. And it records my physical activity. On the food side, I still have to think about it. And that's a difference. So that would be a game changer. And I keep thinking somebody's going to come out of left field and find some way that we can track our food intake without really having to pay conscious attention.

Deborah Tate:

Yeah, and we've tried to really work on the burden of self-monitoring of food intake and even to the point of doing some programs where we just use a physical activity tracker and a smart scale. And use just the two pieces of information, which are daily activity levels and daily changes in weight, to make suggestions for, hmm, your weight is a little bit up. You need to cut back or your weight is trending in the right direction so you can keep going with the portions that you're eating. It takes constant attention, but it's a lot easier than tracking your diet.

Jim Hill:

I like that a lot. Let's switch gears a little bit and talk about how these programs can replace the in-person weight management program. So kind of in the behavioral field, sort of the state-of-the-art is cognitive behavioral treatment, oftentimes in-person where you work with people. How closely can these programs and apps come to replacing some of that and helping people with weight management?

Deborah Tate:

Yeah. So I always quote a couple of systematic reviews that show that they are a close second to in-person programs, probably about four to five pounds less on average with those kinds of programs. But again, I know you and Holly both have interests in personalizing, and some of these technology programs can work just as well for certain people as in-person programs and, in fact, might even work better because that's something that they're willing to commit to and they're very motivated by. So it probably varies from person to person, but in general, they're not quite as good. Now, I will say if they have follow-up with phone calls, so it doesn't have to be in person, but some type of human counseling support, they can be just as good. So you don't have to be, and I think we all experience this with the pandemic, lots of programs are considered remote. They might meet, you know, synchronously together at the same time, like we are right now having a conversation. And those can be just as good when they use other digital tools as well. But in general, if it's completely automated with no human support, it's slightly, maybe about five pounds on average, less weight loss as a group.

Holly Wyatt:

Yeah, I'm glad you brought that up because one of the questions I get a lot, because we've moved our program to more of a Zoom interaction. So we still are meeting because I do believe there's something about that interaction, that connection to others and to, you know, that's very important. And so it's not all automated, but we used to meet in person in the same room, in the same location. And then you're right, we changed it. We had actually changed before the pandemic, but the pandemic really then forced it even more to do it all in Zoom. And we had to change some things to make it more Zoom. But any data about physically in person and then Zoom, what I'm going to call, remotely, in-person…

Jim Hill:

Virtual groups.

Holly Wyatt:

Any difference there? Virtual groups. Yeah.

Deborah Tate:

There haven't been a lot of head-to-head comparisons, Holly. So I don't have the evidence where there's been a study that literally randomized people to come in versus do Zoom. And you can imagine those are hard to do today because you're either recruiting for people that, you know, are available but not necessarily able to drive. I mean, we could do it, but we just don't have the head to head studies.

Jim Hill:

There's your next grant, Holly, right there.

Deborah Tate:

I mean, I don't know, I guess. I would argue that the underlying premise, which is accountability and the counseling support of the professional, they're both there. If there's something more about being in the same room, perhaps, but I wonder if it would be as long as people are going to attend. So one of the things that we do find is that attendance at either Zoom or phone calls or in-person groups is such a strong predictor of success.

Holly Wyatt:

Yeah. So what I found is you have to really people have the tendency on Zoom or equivalent to want to kind of audit, not participate as much. And you have to be really good at not allowing that or including people and not having to just kind of sit in the back and watch. It's easier, I think, on a virtual platform than when they're in the room. It's kind of a little bit harder. Oh, wait a minute. Be right back. They can't leave the room, you know, and they and you can kind of engage them. So I think that maybe is a key difference. But if you recognize that and you really design the classes where they can't do that or it's hard to do that, I think maybe can be equivalent. But it sounds like we don't have any data.

Deborah Tate:

Well, I think we might be tapping into different populations. And that's good, too, because we're increasing the accessibility of the program. So somebody who wouldn't be willing to come in, maybe you have a mom with a new baby, they can't necessarily come to groups, but they could participate in a Zoom call.

Jim Hill:

Rural folks who have trouble getting a group together could be good for that.

Deborah Tate:

Yeah, for sure.

Jim Hill:

I want to switch gears just a little bit. Everything now is AI. How's AI going to influence your work in the future, Deb?

Deborah Tate:

Yeah, thanks for asking about that. It's something we're having a lot of fun with. So we've been working with training what are called large language models. So when you work in this area, you learn a lot of new terms. We've been training a language model. We already have algorithms that bring in data from these wearables in the programs that we do and analyze those and then look at what might be an appropriate message. So, the programs we do are now called Just-In-Time Adaptive Interventions or JEDIs. It's a fun term, thinking about Star Wars and the Jedi Knights, but we're messaging folks a couple of times a day on their mobile device, and we're looking at what might be the best behavior to message on, what might be the type of message that—and we're trying to engage the participant in that. So messages that work, so they help them change their behavior, or messages that they like. We can modify the types of messages that we give people to really fit their needs. One of the things that's been interesting in this area is we found that when people are struggling, that's the time when we think they might need the messages the most, right? And we've always sort of said this in face-to-face groups. If you're struggling, that's the most important time to come in. But it was always something where maybe people felt like they shouldn't come in or they were embarrassed or they said, I've fallen off, I haven't been exercising. And what we found is that there are some people who, if you are pointing out the fact that they didn't get as much exercise yesterday, they don't want to look at those messages. So they already don't open the app at times when they're doing less activity or not recording their diet. So learning that and trying to understand how to message about positive trends that you're seeing or other ways of getting folks back in has been a way that the machine learning algorithms and some of the other effects have been really helpful.

But back to this AI, we're training this large language model. So like the message would come out and we would send a message to you, Jim. And in a normal program, you would just get this message on your phone and you would read it. And maybe you would read it and maybe it would help you. But the way we're using the large language model is to engage the participant in a conversation when we send you the message. And the reason for doing that is so we can learn more about what's going on, because the reason a lot of automated programs for weight management haven't done as well, I think, as in-person or human-supported programs is they don't learn about what's going on for the participant or what we call the context. So if I don't know that you're out of town, which we can now learn because your phone is not within a certain mile radius of your home and things like that, so we aren't going to bug you that you're not weighing yourself or we might encourage you to be active in your new location.

But we don't know that you're out of town because you had a death in the family or you are sick, you have COVID, and you're not exercising because of some of those things. And so having this conversation and engaging in that with the AI, I think, allows those messages to be modified and to work better. Because in that conversation, you're learning and you're changing what your recommendations are on the fly. And we're having fun with it, but what we're trying to make sure is that the recommendations are safe, appropriate, and that the model doesn't go off the rails with its recommendations when we engage it in these conversations. So I think what I've seen in the apps that already have AI tools is that they're still fairly generic, but because this field is changing so rapidly, I think we're going to see...

Jim Hill:

Lots more good stuff to come.

Deborah Tate:

We are.

Holly Wyatt:

Yeah, that really makes sense. And I love also what you said about it may be better. And I found this just anecdotally. I love that you've kind of studied this and found this, that to engage with their positive, what they're doing well first, then to me kind of opens the door where I can bring in what maybe we could make a change on, right? But if you start with, you know, you start with a negative mind state, it really sets the tone in a way that people shut down a lot. But start with the positive, and they may stay a little bit more open to problem-solving around things.

Deborah Tate:

Yeah, and the reason that this machine learning approach and AI is really helping us is because instead of just looking at what's happening right now, we can look at the pattern of how you've been doing over time. And if you've been really active, if we look at your data today and you're not as active, knowing that you really typically are, a human counselor would have that information and would might not make a big deal out of it. So these kinds of messages that say, oh, look, you're not active today, but you've been active for the last 10 days. Maybe we just ignore that and we move on to the next day. And that helps people.

Holly Wyatt:

Because it pisses you off, right? Man, I've been working on it every single day and you're nailing me for this one day.

Deborah Tate:

You pick the one day I didn't do it? Yeah, exactly.

Holly Wyatt:

Right. So I want to ask you about social support features in these weight loss apps. I think one of the most important thing is connection to others. I think that's associated with success. So things like online communities, accountability partners, do you have any data about how that impacts success, especially in weight management?

Deborah Tate:

Yeah. The studies that have looked at those kinds of features have shown them to be beneficial. I think in studies, we're a little bit limited by the people that we enroll. So early on, if we were doing a cohort and you had 20 people that were randomized at a time that were communicating in a social media environment, depending on how that 20 people clicked and how you were able to engage them, it really was sort of maybe not enough people, not enough. So we've gotten a lot better at trying to do those kinds of studies. I think for certain populations, it really matters. So one of my colleagues here at UNC does a lot of work with cancer survivors, and she's found that sometimes young adult cancer survivors, which is the population that she works with, they don't necessarily have other folks that are experiencing similar things to what they've been through that live near them. So bringing them together in a remote program and connecting them on social media has been really helpful. And those programs have helped, you know, she studied that for physical activity and is currently doing one for weight management in young adult cancer survivors using digital tools and social media. So I think that it probably depends on the person. We tried to do some studies looking at is it really the number of connections that people do or if they post or is there a benefit to lurking or just kind of reading what other people are saying and seeing what other people are doing and that sort of social comparison, if you will. And I think what we're learning is that for some people, that's really important. They really do need that. They thrive on that. And for others, it's perhaps less important. You kind of know different people in your life who are maybe a little more competitive or social comparison might work for them, but maybe others where it's not as much something that they need. I think it's an important tool for people, especially that are interested in seeing what others are doing and connecting with others.

Jim Hill:

Deb, Holly and I talk a lot about weight loss and weight loss maintenance being different processes with different skills. We learned a lot of that from the National Weight Control Registry, where we found they all over the map in weight loss, but consistent in weight loss maintenance. When we have done traditionally our behavioral programs, we've tried to do both. And one of the things that Holly says is nobody ever wants to be in weight loss maintenance because they want to lose a little bit more weight. Now we have these GLP-1 medications that can produce way more weight loss than you and I can in behavioral groups. Does it make sense to focus our behavioral and our digital help on people who lose weight on the medications and either want to stay on the medications or, as we're learning, very few people actually do that, of who can then use lifestyle to actually keep from regaining the weight?

Deborah Tate:

Yeah, we need some studies in that area, Jim. And I'll add to your weight loss maintenance piece, weight gain prevention, which is near and dear to my heart. And I know yours. On the one side while we're waiting all the way until this other point, we're working right now with the U.S. Air Force doing some work with digital tools trying to help airmen to not gain weight over time. But I think that there really is a great opportunity because seeing those behaviors and what they were doing when they were on the GLP-1 and then comparing that, I think you know from your work with the National Weight Control Registry that maintaining a high level of physical activity is going to be important for weight loss maintenance. And certainly these digital tools are one of the easier ways to keep up with that and see those trends over time. I think what we don't have as much of may be some of the appetite awareness pieces that we might need to focus a bit more on and learn a bit more about. I know you recently had Corby Martin on your podcast and you were talking about food noise.

Jim Hill:

Oh, yeah.

Deborah Tate:

Some of the apps that may monitor sort of how people are feeling, I think, and what they're thinking. But the tools we need to perhaps dampen down that food noise if it starts recurring after the GLP-1 is stopped, I don't know if we know a lot about what tools will work and how we could potentially adapt those for digital.

Jim Hill:

I think you are right on. I think there probably are strategies we can use to address that.

Deborah Tate:

Yup.

Jim Hill:

I mean, this whole concept of food noise is new. We're just learning about it. But I think you're right. I think we probably can come up with strategies to address it.

Deborah Tate:

And certainly we can monitor weight changes very easily with smart scales and take into account the physical activity changes and help people at least be aware if their behaviors are changing in ways that are going to promote weight regain.

Jim Hill:

So I'll ask one more, Holly, and then I'll shut up and let you talk a little bit. But we're starting a study.

Holly Wyatt:

Promises, Jim. Promises. That's a promise, right?

Jim Hill:

Maybe I'll do that. We're doing some work in this area of, you know, we have a lot of clinical trials on the GLP-1 meds, but we don't have a lot of data on real world.

Deborah Tate:

Yeah.

Jim Hill:

You go to your primary care and you get a GLP-1 meds. What happens? What do you eat? Do you increase your physical activity?

Deborah Tate:

Well, I would say most people probably don't get a lot of good recommendations about what to be doing.

Jim Hill:

You're exactly right. So why would we expect people to do that? So we're real interested in learning what they do. I mean, a lot of people will say, oh, you take the meds, you're going to want to eat healthy, you're going to love fruits and veg, and you're now going to want to go out and exercise. I'm not sure that's the case. I think there are a lot of people that are very happy to take their meds, sit on their couch, not worry about what they eat because they're not eating very much, and they keep the weight off.

Deborah Tate:

They're not hungry. Yeah. I want to see that data. So I'm glad you're doing those studies.

Jim Hill:

Well, I suspect it's going to be all over the map. I don't think everybody's going to respond the same, but I think we need to know a little bit about what they're doing before we can come back and sort of help them say, here's what you should do. For example, you certainly don't have to exercise to lose weight on the GLP-1 meds, but if you don't exercise, you're losing some other benefits of health.

Deborah Tate:

Sure. And you are going to (if you go off the medication) need to be doing more activity in order to maintain that weight loss. So how are we going to get you to go from zero to 60?

Jim Hill:

Bingo. Bingo.

Deborah Tate:

I mean, normally during the weight loss program, we're helping shape people's physical activity behavior and helping them learn to develop that habit. So now it's having to be done at a time when maybe that strong motivation, which really urges us to change, which is the weight loss, right? That's the motivation isn't there anymore.

Jim Hill:

I think it's a wonderful opportunity. I mean, Holly and I have done several programs on the meds. We love the meds as tools, but I think we're still figuring out how to use these tools. They're not the magic bullet. They're not the end-all be-all, but they can produce way more weight loss than we ever could.

Deborah Tate:

Yeah, and that's great for people's health.

Jim Hill:

Absolutely.

Deborah Tate:

It's really helping people improve their sleep apnea, all the things.

Holly Wyatt:

Yeah. Well, I think you hit on a really good point, though, is that the weight loss is doing the motivation. And once that weight loss stops, you've got to be ready to switch that motivation, to switch over to other things that will motivate you that's different than weight loss, or aswe like to say, bigger almost than weight loss. And so just like the you don't have to have the physical activity there to lose the weight. You don't have to have the bigger motivation to lose the weight because the weight itself may be the motivation. But in weight loss maintenance, the game changes.

Deborah Tate:

Yeah.

Holly Wyatt:

In so many ways.

Deborah Tate:

We did a study some years ago. Jim and I both have worked with Dr. Rena Wing for years. She and I did a study some years ago called Stop Regain where we recruited folks who had already lost weight. Some of them had been on a very low calorie diet. Some of them had been using a low carbohydrate diet. Some of them had followed traditional means many, many different ways. And we recruited them just for the weight loss maintenance. And what we found was that keeping very close tabs on weight and doing physical activity. So we really built the whole program around weighing yourself every day to keep those tabs on your weight changes and then trying to prevent small gains and reverse them immediately. Because we know from the work Jim's done and Rena's done with the weight loss registry that once those weights are regained, it's much harder to take them off again. So I think we're going to have to do the same thing when we're helping people who are wanting to come off of a GLP-1.

Jim Hill:

I agree. One of the other things Holly and I are working on, Deb, is that, you know, in most of our programs, people couldn't see beyond the number on the scale as a goal.

Deborah Tate:

Yup.

Jim Hill:

Now, a lot of people are reaching their goal weight, they're losing amounts of weight where they want to be. I think we have a wonderful opportunity to redefine success. Success says, why do you want to lose weight? So your scale says a certain number? No, you want to lose weight because it's going to make your life happier.

I just think this is such a fun time for behavioral scientists. And I keep constantly saying, the drugs are not your enemy. The drugs are your friend. They're giving you wonderful new opportunities.

Deborah Tate:

Absolutely. And just the opportunities for health, for people to be able to have those successes and improve their health and feel so much better. That's really terrific.

Holly Wyatt:

Yeah, I agree. So, Jim, it's time for listener questions.

Jim Hill:

All right. Here's a listener question, Deb. Do fitness trackers and weight loss apps actually help people lose weight? Are they just gimmicks?

Deborah Tate:

They are important and I would say essential tools for knowing what the food intake side of the energy balance equation and what the exercise side looks like. But alone, without changing those actual behaviors, without doing the tracking, without trying to increase physical activity, they're not going to help someone lose weight. So, first of all, people have to use them. And second of all, we know they work better when they have guidance, when they have actionable goals and other things like that, that they can get through a structured program. But yes, they are helpful.

Holly Wyatt:

All right, here's another one. How do you know if a weight loss app or let's use a device is credible, if it's actually based in science, if it's actually delivering good data?

Deborah Tate:

So one of the things that I always tell people to look for is whether or not they're trying to sell you something else. So one of the things is to see if the guidance or the recommendations that you're getting are asking you to buy other supplements or asking you to buy other types of things. They can still be credible, but you might need to do a little bit more due diligence to look into what they're recommending and whether there's evidence behind that. The other red flag is things like quick fixes, right? We know this is a difficult thing to do. It takes a lot of dedicated time and energy. Something that sounds too good to be true likely is. So that's the other sort of red flag. Is it a sensible approach that is not promising something to happen in a very short period of time for you? And then the third thing is to see who the source and who the creators are. So where did the app come from? Who's behind it? You can usually get that information within the app store itself. See what other people are saying about it. And then there are some general guidelines that the National Institutes of Health and the American Diabetes Association and others have put forward for reputable weight loss recommendations. And sort of thinking about those things, which include things like quick fixes and other things, are important to just keep in mind when using any technology.

Holly Wyatt:

I just want to clarify one thing. Because most of these devices, at least that I found, they want you to do a monthly subscription. In other words you kind of buy the device but they really want you to keep paying them monthly to get more information or to get the information in a different way. How do you feel about that? Or how do you kind of unpack that?

Deborah Tate:

Yeah, so some are definitely more than others. I think that each consumer has to evaluate whether what they would get for that extra, sort of the upsell, is going to be valuable to them for their health. So is it going to be human support or coaching and they think that might be something really useful for them, then that might be worth that. I think it's hard to tell sometimes though, right? When you're looking at it to see exactly what you're going to get, whether it's going to be automated or whether it actually is going to be human supported. And I think that there are some good tools out there that are free. There are some good basic tools that you can use. I mean, by buying like a very basic Fitbit Inspire, you don't have to go much beyond getting the device and utilizing the tracking to be able to track your diet and physical activity with a pretty inexpensive device. But it really depends on the device.

Holly Wyatt:

Right.

Jim Hill:

All right, Holly, you know what it's time for now.

Holly Wyatt:

Yes. Vulnerability questions. These are questions we do here. We want to know something a little bit deeper about you, something a little bit vulnerable about you. Deb, you've seen kind of the highs and the lows of technology and weight management. What's been one of the most challenging moments in your research? How did you navigate it? Maybe it's something you got wrong or something that really challenged you.

Deborah Tate:

As Jim said before, I've been doing this for a very long time. And there were some opportunities early on to try to commercialize or disseminate some of the work that we were doing because we were doing a lot of program development with digital tools. And at that time, there was a real negative cast to doing some of that commercialization or dissemination, which has changed now. But back at that time, it was sort of like you can have a career in academia or you can kind of go in this other direction. And I made the decision to stay in academia. One of the regrets that we still have and we still work on is trying to get some of these amazing programs and tools that we've developed out to people to be able to use them even for free. There are a lot of roadblocks that still exist based on liability or other things that would have to be managed. And so, you know, I still have regrets about not being able to do some of that early on. But I think I've made an impact in other ways. I've certainly helped a lot of commercial companies to improve their tools by helping them to get the evidence that they need to make those programs more evidence-based.

Jim Hill:

Okay, here's my question for you, Deb. What digital tools do you use?

Deborah Tate:

Well, I have an Apple Watch. I have a Fitbit. I don't yet have an Oura ring, but it's in my list of... I wanted to hear how Holly liked hers. Oftentimes, I'll wear multiple of those. We definitely use ChatGPT. Yeah, so those are in my wheelhouse. I really do use it for tracking sleep and physical activity. I have used continuous glucose monitors just out of interest. I think there is still a lot to learn. I'm mostly interested in how do we help people, like you said, interpret that information. So sometimes I'll have various devices on that I'm just testing or interested in what they do.

Jim Hill:

Well, Deb, this has been an incredible conversation. Thank you so much. Before we end, I'm going to put you on the spot. If there's one key takeaway you want our listeners to remember about using technology for weight management, what would it be?

Deborah Tate:

I would say focus on your trends and don't expect perfection. So the tools are going to help you recognize how you're doing over time, but you're going to have good days and bad days. And that it's more about having more good days than not over time. That's really going to make a difference for your health.

Holly Wyatt:

Love it. Such a great thing. Any actionable steps someone can take today? I always like to end what we call pie in the plate, right? Not just the theory, but can they do something today?

Deborah Tate:

Yeah, I would say my favorite lately, like I said before, is using ChatGPT if I'm stuck at home and I'm trying to find a dinner option based on something I have in my pantry to fit within a certain number of calories. I'll just say, you know, ChatGPT creates some simple, easy to cook meals with what I have on hand. I have chicken breast. I have broccoli, kale, cucumbers, peanut butter. I have some tofu. I have some rice. And I want three portions that are 500 to 600 calories that maximize fiber and minimize unhealthy fats. And I want to be able to prepare it in 25 minutes or less. And literally, you speak that into ChatGPT, and they will give you multiple options based on what you have in your pantry, and it'll be within your calorie budget for that meal. It's really helpful.

Jim Hill:

Sounds like you can get some wonderful dietician-approved meals out of that.

Deborah Tate:

Yeah, and the more specific, I'll say the more specific you are, the more helpful the advice will be.

Holly Wyatt:

Well, I love it that you gave them the prompt. What you ask and what you tell it is the key to what you get out.

Deborah Tate:

It absolutely is.

Jim Hill:

So play around with ChatGPT. Wonderful idea.

Holly Wyatt:

She gave the perfect prompt. Write all that out and see what you get back. I love it. That is such a good actionable item.

Jim Hill:

All right. We have to close out, Deb. Thanks so much. This was a wonderful conversation. And to our listeners, let us know, how are you using technology? Are there particular apps or digital tools that are working for you? Let us know and send us your questions.

Deborah Tate:

Thanks so much, Jim and Holly. I've had a great time.

Holly Wyatt:

Yeah, thank you.

Jim Hill:

We'll talk to you next time on Weight Loss And.

Holly Wyatt:

Bye, everybody.

Jim Hill:

And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:

If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

Jim Hill:

We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at [weightlossand.com](http://weightlossand.com/). Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:

And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.