Mobile app aids lowering blood pressure: Interview Special

Posted Oct 4, 2017 by Tim Sandle
Adults with hypertension and prehypertension can lower their blood pressure by using a mobile health app. A new study shows patients can lower their blood pressure and return to a normotensive status.
A new study has been conducted which demonstrates the short-term efficacy of how a Hypertension Prevention Program can be effectively administrated through a mobile platform. The study, reported to the Journal of Human Hypertension, found 55 percent of participants who completed the program lowered their risk of hypertension, while 40 percent of participants who completed the program lost more than 5 percent of their body weight.
The pilot study was administered through Noom Coach, a mobile behavior change platform with human coaching.
To find out more about the study, its conclusions and the app, Digital Journal spoke with Dr. Tatiana Toro-Ramos, PhD., who was the author of the study and who is the Senior Academic Researcher at Noom, Inc.
Digital Journal: What are the risks for adults with hypertension and prehypertension?
Dr. Tatiana Toro-Ramos: “Hypertension, also known as high blood pressure, can lead to cardiovascular diseases like high cholesterol, obesity, and diabetes. People with hypertension and pre-hypertension also have a higher risk for heart attack, heart disease, heart failure, and kidney failure.”
The Noon app on a smartphone.
The Noon app on a smartphone.
Noom coach
DJ: What does the Noom app do to help patients with hypertension?
Toro-Ramos: “Noom Coach creates a personalized nutrition program based on your personal lifestyle, nutrition habits and sleeping patterns. It combines the power of technology with the empathy of real human coaches to deliver, long-lasting successful behavior change.”
DJ: How does the app interpret the data?
Toro-Ramos: “The app collects daily activity data from a user and both, provides the user feedback on their adherence to the program (e.g. how many meals they logged in a row, what their calorie consumption is) and also provides this data to the user's coach.”
DJ: How have patients reacted to the technology?
Toro-Ramos: “User's reactions to the Noom program has been overwhelmingly positive. As patients trying to prevent chronic conditions, these users start the program motivated to make a change that will turn their health and quality of life around for the better. As one successful user put it - "I had a mountain to climb, and I needed help to take it one day at a time".
“Users have commented on how helpful the content of the "daily lessons" are, as they often don't know where to start with making healthy changes; they need to start with the basics and then build on that knowledge. Noom takes complex psychological behavior change information and breaks it down into short 'bite-size' articles, so users can learn a little bit more each day. Our users have explained that having lessons spread out daily made them concise and convenient but also extremely powerful, as they then found themselves applying what they just learned in their real-life situations throughout the day.”
“Users have also been vocal about the unique accountability of having a one-on-one coach always available to them, and the difference it makes to feel like someone is both rooting for them, and able to give practical insight and feedback.”
Toro-Ramos: “Digital support groups are also extremely convenient, as users have explained that in-person meetings or groups halted and disrupted their entire lives, but having their group-members support and discussions in the palm of their hand 24/7 was a 'game-changer.'
“Finally, users have talked about the power of seeing their food choices reflected at them through their food logging. Being able to log with an extensive database (instead their old-fashioned paper log that was likely to be inaccurate and gave no insight or feedback) helped hold a mirror up t\o their behaviors -- to see what they had been doing and how it impacted their health. Noom's real-time feedback including a simple 3-light color system to indicate food quality helped these users learn in the moment and understand where tiny tweaks in their food choices would make a big difference in their health.”
Alternative view of the Noom Coach pap in action.
Alternative view of the Noom Coach pap in action.
Noom Coach
DJ: What has been the interest from the medical profession?
Toro-Ramos: “Noom Coach is the first fully mobile diabetes prevention program to be recognized by the CDC and the only mobile program clinically proven in a peer-reviewed journal. Noom Coach offers several different training programs based on a person's health and weight loss goals, including pre-hypertension, hypertension, diabetes management, weight loss, and diabetes prevention programs. Noom Coach has worked with a team at the Icahn School of Medicine at Mount Sinai Hospital in New York.”
DJ: Has the technology been reported to any journal or presented to conferences?
Toro-Ramos: “We have multiple peer reviewed publications in journals such as BMJ Open Diabetes Research and Care, Journal of Human Hypertension, International Journal of Eating Disorders, Journal of Health Communication, Scientific Reports, Obesity Research & Clinical Practice, and in press at Metabolic Syndrome and Related Disorders.”
DJ: What were the main obstacles with developing the technology?
Toro-Ramos: “Creating this type of technology is incredibly difficult. First, you have to develop the underlying database to record billions of data points. Next you must design the app that's compelling to the user with simple, intuitive UI / UX so that users want to use the app. Finally, you have to roll out that application — in five languages — to millions of users around the globe, analyze how they respond to different changes and then iterate until you get a program that's effective. And the same is true for designing the coach dashboard that all of our coaches use to motivate and guide our users. It literally took years and is always ongoing, as we have incredibly high goals for our results.”
DJ: Are there any data security concerns with the use of the technology?
Toro-Ramos: “Noom is fully HIPAA-compliant and we undergo a rigorous third party security review every year. Moreover, our systems have been thoroughly reviewed by multiple health systems and we have never had any issues.”
DJ: What has the take up been to date? How do you see the market share developing?
Toro-Ramos: “The consumer interest in our weight loss program is staggering. Each month we're attracting thousands of users. For the more acute programs, which we only sell through B2B partnerships, we've seen a dramatic increase in demand during the last few years. Now that CMS has announced that they will be reimbursing the Diabetes Prevention Program in 2018 there has been an enormous uptick in inquiries about the program as within 2 - 3 years it will be ubiquitous.”
DJ: What other projects are you working on?
Toro-Ramos: “We currently work in conjunction with research institutions such as the Icahn School of Medicine at Mount Sinai and Kaiser Permanente, New York University, Stony Brook University, and Arizona State University. Projects include a 1.5M NIH grant to conduct a clinical trial to establish the efficacy of the Noom Monitor, designed for the management of binge eating disorders.
“We are also currently conducting a randomized controlled trial with Stony Brook University for the efficacy of the first fully mobile diabetes prevention program through Noom Coach. We have large NIH grant applications in progress with NYU and ASU. Just last month, we received a grant from the NIDDK (NIH) in collaboration with the Icahn School of Medicine at Mount Sinai to develop and study the efficacy of Noom Bariatric Health to help bariatric surgery patients with behavioral adaptations, nutritional and physical activity aspects of weight loss surgery.”
DJ: What other developments in healthcare technology interest you?
Toro-Ramos: “I am particularly interested in therapeutic approaches to improve the gut microbiome to regulate body weight, potentially reducing obesity and its comorbidities (hypertension, inflammation, insulin resistance, etc.). As new therapies to improve the gut microbiome are proposed, it is especially important to support a healthy microbiota through nutritional education and improved health habits. I’m interested in the potential for mHealth and new therapies to work together to effectively target obesity and manage and prevent chronic disease.”
The study published in the Journal of Human Hypertension is titled “Efficacy of a mobile hypertension prevention delivery platform with human coaching.”