In the first post in this series about whether apps, wearables, and other cool new tools are actually making an impact on our health, I examined the evidence from the real-world use of these tools. Unfortunately there has been a major gap between the promise of what these new tools can achieve and what has actually happened in the real-world. To our dismay, while the novelty of a new gadget can motivate people to engage in some new behaviors like walking more, journaling their food and making adjustments based on the patterns they observe, people seem to revert back to their old habits within a short amount of time. And, by short amount of time we’re not talking about months or years, we’re talking about weeks. In a report published by the IQIVIA Institute in late 2024 titled “Digital Health Trends 2024”, they examine the history and latest trends with the use of apps and wearables, as well as medical grade tools used for remote monitoring or digital therapeutics. It is clear that even though more than a million health apps have been released to date, most never get any downloads or are used more than a couple of times.
As you can see from the above figures, while a large number of apps have been released over time, a very small percentage account for most of the installs and this doesn’t even speak to how long they’re used after they’re installed. As mentioned, sticking with the long-term usage of these apps, even the most popular ones, has been spotty at best and at worst, most have less than a few weeks lifetime with consumers. Same has been observed with wearables where the novelty of a new gadget seems to engage the users for a few weeks but most don’t engage in long-term behavior change. We discussed the reasons for this in the last post but needless to say, a new cool gadget is no match for lifelong habits or a demanding life that leaves little room for new healthy habits.
While this is disappointing and warrants more work in designing apps, wearables, remote monitoring systems, and more health tools that can gain long-term adoption, there is also concern around the harmful effects of these devices. In a study published in the Mayo Clinic Proceedings, the issue of the safety of wearables and the potential health risks associated with their use is discussed. Among the issues that are discussed in this article are wearable-induced health anxiety, exacerbation of existing mental disorders and the recurrence of disorders, and sleep issues. For example, the data from a wearable can lead to rumination about sleep quality, which often leads to more severe sleep issues and reinforcement of negative beliefs about oneself. Other examples mentioned in the article include maladaptive health behaviors that can result from using wearables in medically healthy individuals such as overexercising, eating disorders, overuse and unjustified use of medical services and more.
This brings me back to my own story of using a wearable device a few years ago. Always in the search for better health and fitness, I decided to use a continuous glucose monitoring (CGM) device to optimize my eating and weight. In the early days of CGM devices becoming available over the counter to the general population, there was significant hype around using it in normal individuals to see what foods caused a spike in blood sugar. The promise was that by using that information, one could avoid only those foods and thus more easily shed pounds and maintain a healthy weight. Also, if you’re avoiding those foods that cause a high glucose spike, you can minimize the risk of pre- or diabetes. While I don’t have a family history of diabetes nor have I ever had any issues with being overweight or abnormal blood tests, I decided to “optimize” my health by learning which foods caused a spike in my blood sugar.
Over the next few months, abnormally high or low readings at various times significantly alarmed me and I decided to see an endocrinologist to see what was wrong. After having a battery of tests, which included HgA1C, glucose tolerance test, insulin level, etc, and learning that everything was normal, I asked the endocrinologist how he could explain the abnormal readings by the wearable device. He mentioned that these devices are new and we have no idea what “normal” levels are for non-diabetics and also we don’t know the appropriate levels for diabetics! Given that there’s no historical experience with these devices and large trials haven’t been done yet, trying to be proactive and slapping on a new toy to be even healthier is actually not a good idea. As you can see from this story, taking matters into our own hands and not following expert medical advice resulted in several months of confusion and anxiety, followed by unnecessary medical visits and testing. And, I’m a cardiologist!! The average person with no medical training can experience far more anxiety and be confused by numbers that they can’t interpret.
While I highlight the realities of our experience to date with health apps, wearables, and other digital health tools and some of it is not the rosy picture that is usually painted when discussing these emerging health tools, I want to emphasize that I’m optimistic about their long-term potential. Why? Since I ultimately know that improving health is about ongoing healthy habits such as eating less, exercising more, not smoking, sleeping well, and more. No matter how great healthcare is or will be in the future, it’s much better to maintain health and avoid getting sick. Or, if you have a chronic condition, getting it under control is about whether you adhere to the prescribed program of lifestyle adjustments, behavior modifications, medications, and more. Being able to monitor key health parameters and intervening in a timely manner will significantly improve the odds of success. We’ve seen some evidence of this in our early experience with these tools, even if those successes were short-term. As such, building on those lessons to create the next generation of tools that will have better adoption needs to be grounded in reality of our experience to date.
The next generation of these cool gadgets are already on their way and include ambient monitoring, AI integration, personalization of the readouts and the recommendations, and proactive management. They address some of the issues that have plagued the first generation of digital health tools. For example, ambient monitoring, where vitals or movements are monitored without using wearables or cameras, mitigate the issue of not actually wearing the device or losing it. AI integration can mean explanation of what the numbers mean in a language and literacy level appropriate for the individual. This could go a long way in improving people’s long-term adherence with these tools.
