Health 2.0: Weighing In With a Reality Check - Michael Millenson

Maybe you saw the article: “Health 2.0 Helps, But Personal Contact Remains Top Weight Loss Strategy.”

OK. I made up the headline.  But the information comes from an article that provides food for thought for those of us who speak, blog and otherwise evangelize about the good things the Internet is bringing to health care. Here’s one question to start with: is there a different ethical obligation for those promoting the efficacy of an online health intervention than for those promoting a site to help you find a great hotel?

The Health 2.0 information is contained in an article with the heavyweight title, “Comparison of Strategies for Sustaining Weight Loss: The Weight Loss Maintenance Randomized Controlled Trial.”

Featured prominently in the March 12 issue of JAMA, it tips the scales with a staggering 27 authors who are members of theWeight Loss Maintenance Collaborative Research Group. 

In simple terms, the researchers conducted a two-phased randomized trial. In concert with four clinical research centers, they took a large and diverse group of large adults (average weight: 213 pounds) and worked closely with them in weekly group sessions for six months. That was phase 1. The researchers then randomized those folks who had lost at least 4 kilograms (8.8 pounds) into one of three strategies to see which rear-guard action would best prevent the pounds from piling up again. The two “intervention” groups got either monthly personal contact or unlimited access to an interactive website. (Interactivity, of course, is the foundation of Web 2.0 sites.) The “control” group was “self-directed.”

Here’s where it gets interesting.  No matter which group you were in, the majority of people weighed less than they had when the study started 30 months earlier. For those of us who have frequently “self-directed” towards more dessert, that was good news in what was the longest and largest randomized controlled study of weight loss ever conducted.

However, brief “personal contact” sessions by phone and unlimited access to an interactive website both had only “modest” benefit in sustainable weight loss. In fact, the benefit of the interactive website was most noticeable after 18 months, but it had largely vanished by the end of the study.

I certainly don’t expect this study to be posted on the website of SparkPeople, a diet and exercise community bought earlier this year by Revolution Health, or the on the sites of its competitors. But should they be looking at the results and thinking about ways they could improve? I suspect that to ask the question is to answer it. In the bricks-and-mortar business world, much less the Internet one, an 18 month- or 30 month- timeframe is irrelevant. If you are an entrepreneur, it may be unthinkable.

Well, then, what about the rest of us – the community of individuals who write about, speak about and promote Health 2.0? Do we have any obligation to keep up with the medical literature, since we are talking about health, or is the bottom line for us also the bottom line? The thrill of the new, after all, is what brings hits to our websites, attendees to our talks and clients to our consulting firms. If we turn out to merely being playing our role in the Hype Cycle of Gartner Group fame, isn’t that the natural order of things? The perfect candidate versus the not-so-perfect president, the date-of-our-dreams versus the mate-on-the-other-side-of-the-bed?

Those of us in the Internet health business like to think of ourselves as wanting to do well but motivated equally by the chance to do good for others.  And we’re way too busy to burrow through JAMA for relevant nuggets or ponder the academic articles in the Journal of the American Medical Informatics Association. (My own personal information alert system involves waiting for the pile of magazines to get high enough to slide off the file cabinet.)

These objections, while valid, beg the central question – are we open to objective data about what we do, or do we prefer to publicize only affirming anecdotes?

In practical terms, I think this question will answer itself as the Health 2.0 movement matures and grows. The data in this weight loss study may contain a profound message about interactive websites, or it may ultimately mean little. Time will tell, and time will also change the Internet health movement.

We will undoubtedly find that self-policing works as well and as poorly for us as for any other movement, be it social or business-related. Increasingly, researchers, journalists and the government will be reminding us of the gap between our performance and our promises, even if we’d much rather celebrate only our successes. That’s OK. It means we will have come of age as a far, far larger community than we are today.

In the meantime, I have two words of ancient advice for those online 21st-century consumers for whom we’re doing such wonderful things 24/7 – caveat emptor.