Being Heart Smart Goes Digital, but There’s no Silver E-bullet

Take-home Messages:

  • Digital technology offers new options to assist in improving health and manage disease conditions.
  • Most of the studies to date, however, have been small feasibility studies.
  • It is premature to draw conclusions about the effectiveness of e-Health efforts, but the technology – and the promise – continues apace.

The phone’s for you: your heart says it wants you to take better care of yourself.

With plants now able to send Twitter messages to their owners telling them they need watering, certainly the e-Volution has not missed medicine, with technology increasingly employed in an effort to improve health and manage disease conditions.

Importantly, it’s not just phones that have become heart smart – e-Health tools include:
  • everything digital: computers, tablets, iPads, personal digital assistants (PDAs)
  • wi-fi-enabled weight scalesthat help track weight, body mass index, and percent body fat, and can nudge you when necessary
  • surveillance cameras document food intake: smile, you’re on calorie camera, increasingly seen in school cafeterias
  • phone cameras that can analyze what’s on your plate
  • various wearable mobile devices.

Technology helps individuals access health information and track it over time. It can be used to manage health through self-monitoring programs tracking BP, diet, exercise, weight, and blood glucose, and provide automated feedback of a job well-done or warn of potential problems. It may increase the chances of success by improving motivation and providing timely auto-reminders.

No Silver e-Bullet

Recently, Lora E. Burke, RN, PhD, co-authored a scientific statement on the use of digital assistance in weight control and weight loss.1 In reviewing the limited data available, the report noted:

  • data are available for a narrow population of patients, often female and Caucasian
  • successful Internet-based weight loss programs often include personal interaction, too (email or a face-to-face counseling program)
  • attrition is high in available studies (24% to 80%)
  • because of high attrition, analyses are often limited to those completing the study
  • studies of technologies other than the Internet have been mostly pilot or feasibility studies and thus of limited sample size and limited duration

Also, few Internet studies have been conducted among minority and/or socioeconomically disadvantaged populations. Investigators have reported that low-literacy individuals may have difficulty accessing information through the Internet, due to lack of computer access, unwillingness to click on links, accessing Web sites written at or above the 10th grade reading level, and perceived higher quantity and complexity of the information. An understanding of the target population appears essential to optimize delivery of any Internet-based health information.

The authors of the scientific statement noted that the Internet is not an intervention; it is a vehicle through which behavioral interventions can be delivered. It holds considerable promise because it enables individuals to have access to empirically supported interventions that may not otherwise be available in their community. However, whether it works or not is still unclear.


The SMART Trial is a clinical weight loss trial in which 210 overweight adults were randomized equally to one of three arms: 1) paper record (PR), 2) PDA with dietary and exercise software, and 3) PDA with the same software and daily tailored feedback message (PDA + FB).2 Burke and colleagues recently reported 6-month results: Physical activity self-monitoring and adherence to activity goals were more likely in participants in the PDA + FB arm and in turn predicted higher levels of physical activity and weight loss.

One strength of the study: attrition is low, with 92% retention at 6 months and 24-month assessment available for about 85% of patients in each group. However, like many other trials, the participant pool is not broad: 85% female and 78% white.

Feedback, as noted above, is important. One study compared monthly receipt of printed materials about weight control to an intervention that included personalized text messages sent two to five times daily, printed materials, and brief monthly phone calls from a health counselor.3 At the end of 4 months, the intervention group (n = 33) lost more weight than the comparison group (-1.97 kg difference, p = 0.02) after adjusting for sex and age. Intervention participants' adjusted average weight loss was 2.88 kg (3.16%). At the end of the study, nearly all of the intervention participants stated that they would recommend the intervention for weight control to friends and family.

Finally, in a presentation at the 2011 AHA meeting, Burke noted new technology may make it easier for individuals to monitor themselves. People may not need to track their daily food intake anymore, thanks to a wearable device created at the University of Pittsburgh. The eButton, which is a worn on the chest (like a pin), contains a miniature camera, accelerometer, global positioning system, and other sensors to capture a variety of data and information.

The technology is the result of research from a 4-year National Institutes of Health Genes, Environment, and Health Initiative grant and its potential use extends far beyond monitoring food and beverage intake. It can determine the amount of time wearers spend watching TV or sitting in front of a computer screen and how much time they spend outdoors. It tracks where food is bought, how meals are prepared, which restaurants are visited, and what items are ordered. The device analyzes how long the wearer spends eating, what foods and beverages are consumed, and how the wearer interacts with family or friends at the dining table.


  1. Rao G, et al. New and emerging weight management strategies for busy ambulatory settings: a scientific statement from the American Heart Association endorsed by the Society of Behavioral Medicine. Circulation 2011;124:1182-203.

  2. Conroy MB, et al. Physical activity self-monitoring and weight loss: 6-month results of the SMART trial. Med Sci Sports Exerc 2011;43:1568-74.

  3. Patrick K, et al. A text message-based intervention for weight loss: randomized controlled trial. J Med Internet Res 2009;11:e1.

Keywords: Feasibility Studies, Geographic Information Systems, Overweight, Body Weight, Software, Beverages, Counseling, Vulnerable Populations, Computers, Handheld, Body Mass Index, Weight Reduction Programs, Blood Glucose, Motor Activity, Electronic Mail, National Institutes of Health (U.S.), Health Services Needs and Demand, Diet

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