Omron HealthCorps

Meeting July 18-19, 2013

Location: Anschutz Wellness Center, Denver Co

www.anschutzwellness.com

July 18th, 4:00pm – 6:00pm

Note Taker: Erica Irvin

Omron HC Meeting.

• In Attendance:

  • Jim Li, Omron

  • Hironori Soto, Omron

  • Shiga Toshikazu, Omron

  • Stanley Bassin, UCI

  • Judith Wylie-Rosett, Einstein

  • Shawn Hayes, HealthCorps

  • Melanie Fisher, HealthCorps

  • Erica Irvin, HealthCorps

  • James Hill, Anschutz Health and Wellness Center

Welcome and Relevant Literature Review Summary by Dr. Shawn Hayes

• Today and tomorrow we will look at a couple of big questions, which are the idea behind this advisory board. First of all, we know there is a lot of technology out there to help us measure our calorie output. (i.e. Fitbed, jawbone). What is missing is the fundamental technology around calorie intake.

• In terms of measuring calorie intake, we are stuck with food diaries, which have no time or date tracking abilities. They have devised a paper dairy version with a senor that allows us to determine when people are logging and which has helped us understand that people do a lot of unreliable back logging. There is also the PDA, which has become the tool of choice for logging; especially sense there is feedback involved. This feedback is important, since studies have shown that there is more accuracy when a diary is giving you daily feedback.

• The ultimate problem with these food diaries is that patients are often inaccurate, dishonest, or they don’t know how to document their food intakes. A few studies that have been done with men have showed that they seem to more accurately report their food consumption compared to woman.

• Dr. Hayes showed the below graph:

  • This graph shows:

    •  Only 35% of the people that used paper diaries (with no time or date tracking) kept up with the diary entries after 24 weeks.

    • About 50% of people that used electronic diaries (PDAs and software) kept up with the diary entries after 24 weeks.

    • About 60% of people that used electronic diaries with daily feedback, kept up with the diary entries after 24 weeks.  

    • This trend shows that the more feedback that a patients receives, the better then adhere to a food diary.

• Review of end-user real time diary applications

  • With Smartphones we have taken a big jump – we can track time and date and supply lots of reminders and feedbacks. These real time diaries are built into many different APPs. The input side is very sophisticated.

  • There is a learning curve with an app, but once you learn the first one, it is easier to learn the next one.

  • The problem of these applications is at the root, these are diaries and they are only as honest as the person wants to be. Also, some organizations have been accused of underreporting their calories for a specific portion size which is an issue for standard dairying

  • A few new technologies on the horizon:

    • The Digital photography of foods– You take a photo of your full plate and then of your leftovers (what you didn’t eat). This is used to guess standard portion that was consumed.

    • Remote Food Photography Method – new, not yet validated yet. Shawn believes this will be a great research tool, but perhaps not the best individual tool because it doesn’t take into account the ingredients of the food.

  • Dr. Bassin’s comment on school food – a unified school district has one buyer that orders foods 2 months in advance. You know the size and appearance way in advance. But if you go to a small district they could be making their own food. So in the big district, you know what they are doing in advance in the schools. The difficult side in this is the consumption – what do they eat, not eat, trade, etc.?

  • A note on weight tracking effectiveness –it turns out that in general, if you are overweight, the more often you weigh yourself the more weight you will loss. So in general, the more often you weight yourself the better. The sweet spot was weighing once a week, and very slightly better if they measure themselves everyday. This was all about understanding if tracking what is a useful feedback mechanism.

  • Dr. Hayes explained the momentum app HealthCorps co-created

  • Dr. Wylie-Rosett commented on using the social media is an infrastructure to promote competition

  • Dr. Hayes commented that there is an age border for technology, but for the younger generation it is a great opportunity

• A review of Physical Activity Monitors

  • Pedometers – inexpensive and effective. HealthCorps uses them with staff competition. The downside is that they have been seen to be used for the short term

  • Accelerometers – very sophisticated. The Nike Fuel ban is an example. The downside is that they are more expensive then the pedometers. These devices are now being used in many big research designs.

    • Dr. Wylie-Rosett – asked whether it’s the program are more complicated to create?

    • Dr. Li said creating the hardware is easier, but using the data is harder.

  • Dr. Wylie-Rosett commented– PE teachers are being trained to do Fitness Gram but we really want them to be assessing the physical activity.

  • Dr. Bassin commented– in the Healthy Study they did observations in PE classes and they counted the time that a selected middle child was active in rural, urban, and metropolitan centers. The time average was 12 minutes, but the intervention helped increased it to 29 minutes. They did this by working with SPARK. They didn’t use pedometers or accelerometers because it was too expensive. Doctors are looking for some way to measure activity that is cheap and would allow the patient to bring in for conversation.  The market is going to split… they need a high more sophisticated version and a type that is cheaper and more available for low-income populations. There is an increase desire to help people be healthy so they can work.

• Wrapping up the review –We know we can improve technologies, but we have to understand what we want in the tool. What do we want the tool to do? We know a lot of what we want the PA tool to do and we have an idea for the food side. We know we want to be able to more accurately determine want people are eating (etc. a tool that we could wear and then sync it with a lab top so that you know how many calories you ate for the week). Even knowing the amount of calories would be useful. So as we go through tonight and by the end of tomorrow we should be able to say what the attributes of the ideal tool would be. We can’t maybe have the Cadillac; we need something more fugal for the layperson.

• Judy brought up – the potential use of food equations

Personal Introductions

• James Hill

  • The center has been open for a year. Hill has worked with obesity for years. This is a health and wellness center, because Hill believes that obesity is more like a marker for health. They do translational research, then create programs that they pilot and then help bring to the community.

• Judy Wylie-Rosett

  • At Einstein, she does large clinical studies. Used to work with 70 year olds, but is now working with 7 year olds. She also does a study with Chinese at risk for diabetes. Working with HealthCorps to help engage students in the wellness council and other initiatives

• Stan Bassin

  • Clinical Professor of Medicine. Researches obesity in minorities and Hispanics. He ran the Healthy Study that was 85 million for ten years to prevent type 2 diabetes in children. It wasn’t disseminated well – the translational research didn’t follow through as planned. He was in preventative cardiology and now he is the director at the Lifestyle. He has worked internationally and nationally.

• Erica Irvin

  • HealthCorps Research Scientist I. She was a previous Coordinator for 3 years, a Coordinator Team Leader, and went to Columbia University for her MPH in Sociomedical Studies. She currently helps Dr. Hayes with all evaluation and research projects at HealthCorps.

• Melanie Fisher

  • Shawn Hayes’s Assistant. She has a background in business management and film. She managed the documentary for Benson High School. She is a super star.

• Hironori Soto

  • An engineer for 15 years before coming to Omron. Working to improve blood pressure technologies. He has visited Benson High School and Cleveland High School to witness the HealthCorps Program. He also visited the HealthCorps summer training for new coordinators.

• Shiga Toshikazu

  • Engineer, studied biological engineering. He developed tools to help measure the oxygen levels in the muscle before joining Omron. He’s job is to help look for new technology. Obesity and Diabetes and high blood pressure are most important. The measuring devices help determine blood pressure, glucose and the relation to diabetes and obesity.

• Jim Li

  • Chicago based. Main function is the medical affairs and business development. Before Omron he worked with many research projects for heart implantation and open-heart surgery. He then spent 5 years with an organization that developed the health implantation, did the surgery and followed up with them. He then did management consulting with McKenzie. Omron is very sensitive to society’s needs. They want to identify the needs of studies so they can develop tools that will help society evolve.

• Shawn Hayes

  • Chief Academic Officer at HealthCorps. Shawn was working at Abbot Lab. He was recruited by HealthCorps to build an assessment program. We have developed a survey system – behavioral survey, community assessment tool, fidelity tool, student assess tools. We are using HC as a laboratory to test out new ideas, run focus groups, etc. Before Abbot he was at Penn State looking at neuron-control. Before that he was in construction and owned a restaurant in Denver

    • Dr. Hill asked – how do we use schools as a laboratory?

    • Shawn – we have a full time staffer who is the gatekeeper. Some schools are receptive while some are not; the coordinator primes the school and staff to do different. The program costs 81,000 a year, which covers the coordinator salary and budget and overhead. The school does not pay for any of the program.

5:00pm – 5:30pm      Child Obesity Status & Gaps

                                                 Presented by Dr. Hill & Dr. Bassin

Omron Presentation Presented by Dr. Jim Li

• The purpose of this project is to address this social need and its big potential impact on society.

  • Dr. Li shared a chart showing the alarming levels of child obesity in major countries globally.

• Dr. Li shared another graphic organizer titled  “To improve behavior of children by consulting at school with measurement data at home and school”

  • In the Initial stage of this project, HealthCorps and Omron are the enablers

  • We need think ahead and think about how to make this project more sustainable and stable using stakeholders (government or insurance or medical establishment community) to subsidize the project. We need to know how we can duplicate this project that into schools at large, not just HealthCorps schools.

    • Dr. Wylie-Rosett commented– The affordable care act will be incentivizing preventable care. Other interested groups could be CDC, NIH, insurance companies, HMOs – in order to get these to help you have to show them that it works with evidence and that it is scalable

  • Tomorrow – after we talk about the model we can come back to this. We will work to build the technology, then pilot in schools, then scale up, then find national partners/supporters

• Dr. Li Reflected on Omron’s Recent Observations at Target Schools

  • The Controversy:

    • Students said cooking is fun

    • Some students read books at cooking class

    • Some students just ate at cooking class

  • Alarming

    • Students used too much soy sauce for sushi

    • Students didn’t pay attention for eating too much

  • Reality

    • Less PE classes are provided in some schools

  • Perception

    • Some students believe that… (did not finish typing out what was on the slide)

• Dr. Li Reflected on the “Unmet needs”

  • A complete loop with right indices of tracking calorie intake and physical activities, and motivational & feedback system that enable stakeholders involved in fighting child obesity. Current system or program still has

    • Gaps b/w the perception of food intake and weight control

    • Gaps between children’s motivation and behavior

    • Disconnections between home and school

    • Lack of effective tools or indices to keep track of key drivers for weight control

  • Calorie intake tracking tool

    • Practical, user friendly, objective device

  • Dr. Hill – suggested wouldn’t if be cool to measure the schools in academics and health (because people tend to buy homes based on school quality)? This is powerful

  • In Japan they have a “Wellness Link” that people with pedometers upload their numbers to this website. There are a 100,000 people and the maps show how PA differs throughout Japan by season.

    • **** This idea/suggestion existed all meeting participants****

• Dr. Li Presented a Solution (Hypothesis)

  • Measure and calculate scores to motivate changing behavior

    • Behaviors – Rewarding/penalty

    • Health Score – status

    • Trend Score – efforts

  • Scores should be developed as new indices

  • Consulting based on individual data

  • Steps To Take:

    • Step 1

      • Measure activity levels & calorie intake enable behavior change

        • Involves some professionals, some consulting providing feedback

    • Step 2

      • Measure weight while monitoring activity level and calorie intake to motivate behavior change

    • Step 3

      • A scoring system (rewarding/penalty), to motivate change

        • A choice system

    • Overall – A closed loop with stakeholders

      • A close loop system involving parents, teachers, health professionals, enablers (such as HC coordinators), and government

      • Connected and feedback

      • Scores, Status, Efforts

      • Multiple levels – individual, schools, community

Viewing of HealthCorps Documentary

Dinner at The Summit