Expert Interviews: Heart Health, Obesity, and Human Behavior with Cardiologist Dr. Ethan Weiss

By September 17, 2017Uncategorized
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Dr. Ethan Weiss is an Associate Professor of Cardiology atAssociate Professor of Medicine at the University of California San Francisco (UCSF). He leads a research group at the Cardiovascular Research Institute at UCSF that is focused on the intersection of cardiology and endocrinology, specifically diabetes. He is also an advisor to Virta Health among other digital health technology companies.

Q: What’s the thing gets you out of bed in the morning and excites you the most?

Dr. Weiss: That’s a question i’ve thought about it a ton. The short answer is that if you look at the statistics on what’s happening with obesity and diabetes in the world, and the slope of change, to me at least there’s no greater threat to human health than this. And i don’t think we understand what’s going on. We don’t understand the mechanism, which means we can’t understand the problem and how to fix it. That’s what gets me out of bed of the morning today. It’s a pretty obvious and big set of problems with huge opportunity. I’m looking forward to spending the rest of my life on that.

Q: Where do you think digital technologies can make a difference to help solve this big problem?

Dr. Weiss: This is a longer answer. For me, there are two things. For one, I don’t think there will be a better tool for capturing what people are doing and where they are both passively and actively…what they are eating, how much activity they have. And whether that is through a smartphone by itself or smartphone connected to a device, we’re going to begin to learn so much more about what human behaviors are and how they relate to things like how much weight people carry and their risk of metabolic diseases. It’s also a great tool to be able to deliver digital therapies, getting people connected in some sort of social weight loss program, or whether its delivering information to them. But i see the real promise in understanding in a fundamental way some things that we haven’t been able to understand for. So I’m excited to really probe.

The simplest way to answer this is that I have a teenage daughter that is profoundly addicted to snapchat, so much so that she has hacked into her mom’s phone to be able to keep up her streaks. We, and by we i’m referring to silicon valley, have become so good at being able to engineer addictions and its not even really that hard, whether its getting to choose an automobile, or watch a show on netflix, we’ve gotten really good at manipulating human behaviors and influencing people’s choices. So I think the two things I see as the biggest promise going forward are using some of the same knowledge to reverse engineer this. If we know we can create an addiction, can we take what we’ve learned and figure out how to break it. And then obviously the other possibility to replace a bad addiction with a good addiction. Anyways, I think there is unlimited promise for being able to use technology to help tackle these problems.

Q: You mention active use vs passive trackers. Where do you find each to be useful and which format do you think has more promise to solve the problem?

Dr. Weiss: I think we’re still learning a lot. However, one of the things that seems to be clear is that people are busy and distracted. The more we ask people to do, the less we’re gonna get back in terms of quality. So I think if you can find a way to collect information with as little effort and thought from individuals, that should probably be a principle that is guiding. That doesn’t mean you can’t ask people to do anything. But the idea that you ask someone to photograph every meal, or enter the caloric content of every meal. I just don’t think that is realistic that we are goign to get big groups of people to do that. But you can through GPS and other technological tools you can figure out when someone is in a restaurant, or had a transaction. Then you can loop together more data passively. You can probably get someone to step on a scale every day, or if not every day at least a couple times a week. You can definity capture activity. And then there are a whole group of people developing devices that may or may not be useful. For example, there is a device that i’ve been looking at that I think is really interesting. It measures breath acetone, which is a surogate for ketosis. There might be some use in getting people to blow into this device with some frequency. To me this feels like this is something you could get peop;le to do, kind of like brushing your teeth. Vs getting someone to input in all the nutritional information of every meal is not realistic. It’s just not going to happen.

Q: Does your lab do clinical based trials based on these apps?

Dr. Weiss: Yes. Health eHeart is a big digital based clinical trial program that was launched by my colelgues here at UCSF. The elevator pitch is that it is a smartphone based version of the framinham heart study. Everybody enrolls throught their phone, which is the poitn of interaction. We’re using them to do a small focused trial on meal timing. We’re gonna do 16 hour fasts with 8 hour feeds. And we’re gonna use the phone, connected scale, and breath acetone device, and we’ll compare that to a more traditional 3 meals a day eating pattern in a prospective randomized control trial. We’re launching that pretty soon.

It’s a 100 person trial, we’re goign to do 50 people here in San Francisco, and for those 50 people we are gonna have them come in and do really detailed phenotyping. Body composition, dexa scans, total energy expenditure using double interval water, and a whole host of labs. And 50 people we’re gonna do remote. So 50 people will be anywhere in the country and we’ll just send them a scale and a few other devices, and we’ll never see them.

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