Case study: The impact of remote patient monitoring

A weight management program relies on an app to closely monitor patients and help them achieve their goals.

By Thomas Castles

In early 2020, Mike Shaw, who had struggled with weight loss for years, started taking bike rides and trying to eat less. He lost a little weight, but progress was slow. He shared his frustration with his father-in-law and was honest about his fears of catching the coronavirus in such a vulnerable state.

His father-in-law listened closely. Then he responded with a recommendation that he should contact Jamy Ard, M.D., a co-director at the Wake Forest Baptist Health Weight Management Center.

“It was a real heart-to-heart [between me and my father-in-law.] He pushed me, and that's when I said: ‘OK, you know what, I'll do it’,” Shaw remembers.

For Shaw, the program was nothing short of a revelation. “Everything just started to click,” he says.

In less time than he ever thought possible, he lost a total of 110 pounds in the program. A key component to the weight loss effort was the program’s remote monitoring approach.

A tailored plan

While in medical school at Duke University, Ard says, several patients in residential weight management programs helped change the way he understood his responsibility as a physician.

“These people talked about coming into these programs with lots of medical problems, and in six weeks’ time, they're doing things that they couldn't have imagined before,” he says. It affected them from head to toe, from a psychological and mental health perspective to the physical perspective. And they changed in a dramatic way in a very short period of time.” 

At Wake Forest, where he’s worked since 2012, Ard oversees programs that use innovative approaches to treat obesity, all of which revolve around the same central philosophy: individualized treatment for individual patients aided by remote patient monitoring.

Weight-loss plans are constantly updated and rewired to incorporate findings from Ard’s research. They’re the product of his drive to understand how individualized plans can be optimized to prevent subsequent conditions, such as diabetes, hypertension and heart disease.

“Mike [Shaw] will tell you: We spent a couple hours with him in that initial appointment, as well as doing some work beforehand,” Ard says. “By the time we finished building a plan for Mike, we’d probably spent four hours or so with him to try to understand his goals and motivations and some of the challenges that he faced in terms of managing diet and physical activity.”

Creating a daily structure

After collecting as much relevant data as possible, Ard’s team builds a daily structure for each patient, including the appropriate frequency and timing of meals and the amount of physical activity the patient needs to reach their weight loss goals. There’s also a behavioral counseling component, where patients learn skills that can help them avoid emotional eating, and group classes where they engage with peers and tackle specific behavioral issues, including binge eating.

“But what we mostly do is individual, one-on-one types of engagement,” Ard says.

It’s all about building relationships and trust.

“A lot of what we do, we're able to do with remote monitoring and the [Carium] app,” Ard adds. The app also keeps Shaw abreast of his progress, structures his daily meals and activities, and connects him with team members at the weight management center as often as he needs.

Monitoring patients’ progress

To help patients achieve better results using a comprehensive approach, Ard partners with a team that includes physicians, nurse practitioners, physician assistants, dieticians, behaviorists and exercise physiologists.

And the app provides the entire team with a bird’s-eye-view of every patient in their care.

“At any point in time, I can pull up Mike's profile and see what his weight was this morning. I can see what it was over the past 30 days, or since he started, and look at that trend,” Ard says.

The app helps patients log food intake, which the care team uses to track behavioral changes and offer tailored dietary feedback. Ard can use the app to see when things are going smoothly, or when a patient might need a little extra help staying on track.

For Shaw, it’s all about staying accountable. From January to May 2021, he didn’t skip tracking meals once, and he logged an average of 11 food items per day in the app.

Shaw also synchronized his Apple Watch with the app to record his physical activity and keep track of his blood pressure, so there was no need to input data manually.

The most pleasant surprise, Shaw says, was that his relationship with food was totally reformed. Leveraging meal planning, expert consultation and behavioral support, Ard’s program stripped away Shaw’s toxic eating habits and helped him develop a healthy attitude toward food and eating.

“Now I know the difference between really being hungry and just being bored and having my body trick me into thinking I'm hungry,” Shaw says.

Disease management

Ard says remote patient monitoring can play a big role in chronic disease management, helping to ensure patients’ accountability as well as their access to high-quality care for obesity and other conditions.

“There's nothing about your day that doesn't have an impact on your weight,” he says. “That’s why I need to be able to interact and engage with the patient as much as possible. And the evidence shows from our classic behavioral interventions that the more often we engage the patient, the better they do.”

Thomas Castles' article appeared on the Carium website here.

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