February 2, 2017

How can we use technology to support patients after bariatric surgery?


With funding from the Partnership for Innovation, GHRI is evaluating a new technology-based lifestyle program designed by Group Health bariatric surgeons.

Bariatric surgery is a potentially life-changing procedure that can help ward off chronic illnesses like diabetes and heart disease. But going through the surgery itself is only part of the journey. Achieving and maintaining a healthy weight after surgery usually depends on adopting healthier eating and physical activity habits in the long term.

We all know that’s easier said than done. But with the recent boom in mobile-health technologies such as activity trackers, lifestyle support for patients who’ve had bariatric surgery is moving in a whole new direction.

Helping lead the way is the Group Health BARI-FIT program, which launched as a pilot test last month in the Group Health Bariatric Surgery Program at Bellevue Medical Center. Funded by the Group Health Foundation’s Partnership for Innovation, BARI-FIT uses a mobile-health approach to support behavior change in patients who’ve had bariatric surgery.

In a world where mobile-health technologies abound, what makes BARI-FIT unique? It was designed by bariatric surgeons and researchers at Group Health to provide daily, personalized support that is integrated into patients’ clinical care.

High-touch, low-cost: The potential of mobile-health technology

Group Health performs about 350–400 bariatric surgery procedures each year for patients with severe obesity. While substantial weight loss occurs after surgery, some patients begin to experience weight regain within a year or two.

Research has shown that increasing physical activity, adopting healthier eating habits, and weighing oneself regularly can help people keep weight off after bariatric surgery.  So providers are looking for ways to best support patients in adopting these healthy behaviors.

“After someone has bariatric surgery, they often need a more intense level of lifestyle support than is possible in routine clinical care,” explains Group Health bariatric surgeon and BARI-FIT co-designer Jeff Landers, MD. “We need a practical but high-touch program—something that people can use at home as they initiate and maintain behavior changes.”

“Mobile devices and trackers hold great promise for delivering timely behavior change support at a cost that is far below what could be achieved through traditional phone or in-person programs,” adds program co-designer Anir Gupta, MD, also a bariatric surgeon at Group Health. “They have the potential to provide more practical and effective ways to help our patients keep moving toward their weight-loss goals.”

A step further: Daily, personalized support that’s integrated into clinical care

BARI-FIT uses mobile technology to encourage patients who’ve had bariatric surgery to track their physical activity and eating habits and to weigh themselves regularly. Patients who enroll in the pilot test will receive a Fitbit activity tracker and a smart scale, which syncs wirelessly to their Fitbit account.

“Mobile-health technologies like activity trackers and smart scales are widely available,” says Dr. Landers. “But, with BARI-FIT, we take it a step further by using the data from those tools in clinical reports we can review with our patients in their follow-up visits. This helps us identify the challenges they may be having with maintaining their weight loss and the steps we can take to help them reach their goals.”

Data from the activity tracker and smart scale will also inform daily personalized text messages from the patient’s care team. The messages will provide personalized activity goals and reinforce healthy habits like calorie counting, physical activity, healthy eating, and regular weighing.

“The idea is to use mobile-health tools to provide a level of personalized support that wouldn’t be possible otherwise,” explains Dr. Gupta. “And thanks to the Partnership for Innovation, we have an opportunity to implement that idea and see how well it works.”

Partnership for Innovation: Where frontline ideas meet rigorous evaluation

Administered by the Group health Foundation, the Partnership for Innovation is a donor-funded program that allows Group Health providers and staff to test innovations with the potential to improve care, lower costs, and boost patient satisfaction. Researchers from GHRI provide the scientific expertise needed to develop a rigorous proposal and evaluation plan—and to analyze the results.

Drs. Landers and Gupta worked with GHRI researchers Predrag (“Pedja”) Klasnja, PhD, David Arterburn, MD, MPH, to develop the BARI-FIT program and evaluation. Dr. Klasnja, the project’s lead researcher, is an expert in developing effective, user-friendly mobile-health technologies, while Dr. Arterburn has extensive experience studying bariatric surgery outcomes.

“Mobile-health technologies offer a new way to support healthy behaviors away from the clinic,” says Dr. Klasnja. “But it’s important that they be integrated with a patient’s clinical care.”

“That’s where the Partnership for Innovation comes in,” adds Dr. Arterburn. “It gives us a rare opportunity to design and rigorously evaluate an integrated solution that was designed by clinicians themselves.”

The project team is currently pilot testing the BARI-FIT program in about 50 Group Health patients who recently had bariatric surgery. The evaluation will look at the program’s impact on weight loss and a range of other outcomes, including patient satisfaction and quality of life. Results are expected in fall of 2017.

by Jessica Ridpath