An Interview with Dr. Arya Sharma (Continued)
Joseph: It seems that this could also increase the demand for contact outside regular doctors' visits. We've heard a lot of enthusiasm for mobile-health interventions: various iPhone apps and web-based programs that help you track what foods you're eating, etc. What do you think about these sorts of interventions?
Dr. Sharma: The people who've been using an iPhone app — not just for a while, but who will continue using an iPhone app — are doing it right. Can you get the entire population using an iPhone app? No, in part because that starts with having an iPhone. We have all of these different approaches. For one guy, it's just showing up at the doctor's office. For another guy, it's: "I've got a scale at home that I get on every day and I automatically send my body weight straight to my doctor's office." Another guy says, "Well, I go Tweet my body weight to the doctor's office, it goes on to my Facebook profile, or it gets Tweeted to my buddies." The next guy says, "My thing is that at the end of every week, I read my food diary." And the other guy says, "Well, you know what? I've started Weight Watchers. I go there once a week, and I sit there and I get weighed." I don't actually care. Whatever works for you.
We all live in a mobile world and there is a huge potential not just for spreading information, but for providing immediate feedback on what is going on. So an app that tells me how much I have eaten, reminds me to get up and walk around a few steps every hour or so (and actually measures if I do), tracks my medications and perhaps sends this info straight to my doctor or pharmacist — there are lots of possibilities there. The question is more whether enough people will use such services in the long term — in the short-term, I have no doubt that such interventions work — but like all interventions, they only work when people stick with them. That's not different from taking a drug. I tell my patients, stopping your food journal it is like stopping your medication.
The principle is that you're never done. The idea you're going to do something for a while and then stop doing it is not going to work. The bottom line is that obesity is a chronic condition that requires lifelong management. So don't do anything that you can't afford to do, or that is so time-intensive that you're just going to run out of time to do it, or so onerous that you're just not going to stick with it. But if you're going to stick with it, then do it.
Joseph: How about dividing it into phases? For example, one could have a really aggressive weight-loss phase, followed by more subdued weight maintenance, for patients who are overweight and obese.
Dr. Sharma: Here's what I always say: Don't do things to lose weight that you cannot do forever.
Joseph: Dr. Sharma, thank you for taking the time to talk to us today on so many fronts.
Dr. Sharma: You're very welcome.
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