The National Science Foundation (NSF) and the National Institutes of Health (NIH) recently awarded a new multi-year multi-million dollar grant to myself and Michael Youngblood under a new Smart and Connected Health inter-agency program. This is a multi-organizational collaborative project with Dr. Joy Zhang at Carnegie Mellon University Silicon-Valley and Dr. Peggy Latare from Kaiser Permanente Hawaii (KPH). The project will involve fundamental research to support the development and testing of a smartphone-based system called Fittle+ to help people achieve and maintain healthy behavior changes in diet and physical activity.

This is a problem of national concern (or maybe even a crisis): Healthcare costs to the U.S. economy will be staggering, and major drivers of these increases are unhealthy behaviors such as physical inactivity, increased food intake, and unhealthful food choices. Obesity, for instance, could cost an estimated $900 billion in US health expenditures (17% of the total) by 2030. (1) We believe this is a project that could result in disruptive innovation in health and wellness.

Fittle+ Technology

The technology for the Fittle+ project builds on PARC’s current mobile behavior change platform, called Fittle, and CMU’s smartphone-based activity analysis. Fittle provides support for individuals and teams to progress through lifestyle challenges, helping people to master one health-improving habit after another, in a way that builds on previous achievements. Users can choose from a variety of third-party health challenges to accomplish goals via an intelligent coaching agent and personalized, engaging user experiences. These challenges are either conversions of existing behavior-change programs that have been developed over the years or new programs, all currently created by professionals.

For instance, one of the featured beginner-level challenges is an eight-week program developed in collaboration with two certified experts in personal training and nutrition that promotes better diet and increased physical activity. The challenge includes a set of goals and related content for eating slowly, eating more vegetables, adding small healthy meals, and a progression of walking and exercise goals.

Fittle incorporates a number of theoretically motivated or evidence-based techniques in a way that can be delivered at low cost because the scaffolding for individual success is either automated or provided through peer support. The NSF-NIH funded Fittle+ system will build on this work, and integrate and apply theory and methods from mobile sensing, intelligent computer-based tutoring, and evidence-based social design to solve the problem of providing social support and personalized intelligent coaching.

The Problem: Scaling up and Prolonging Successful Health Behavior Change

We are fortunate to be collaborating with Dr. Peggy Latare who runs the highly successful KPH Weight Management Program. Despite the general trends in physical inactivity and poor diet, KPH has several clinical programs that are effective in producing behavior change and desirable health outcomes. However, these programs (like many other successful weight programs) typically have bottlenecks in providing sufficient numbers of expert counselors and personalized day-to-day support to a large population for a long period of time.

Weight loss is a particularly tough problem because people who participate in even these effective programs tend to revert back to old habits and regain weight after they leave the programs. There is a pressing need to extend the reach of existing health behavior change techniques in areas such as diet and fitness and to intensify and prolong their impact. Smartphones provide an obvious platform for rapid dissemination of successful behavior-change techniques, with projections of 160 million users in the U.S in 2014.

The first years of the NSF-NIH project will involve working with the KPH Weight Management Program to integrate Fittle+ into their group-based programs. The idea is to support the counselor-run groups over the course of 20 weeks, and then continue to provide Fittle+ personalized coaching group support with minimal counselor intervention after 20 weeks. The final years of the NSF-NIH Fittle+ project will be devoted to running a Randomized Controlled Trial to test the efficacy of Fittle+ over a 12 month period at KPH.

Our NSF-NIH project with CMU and KPH is just one step towards the goal of helping people weave together the small changes in everyday behavior that lead to big changes in lifestyle and health. We continue to look for opportunities to work with partners and end-users in the spirit of open innovation to build and test evidence-based solutions to address the major challenges of healthcare. If interested, please visit fittle.org or email us at contact@fittle.org.

(1) Writing Group M, Roger VL, Go AS, et al. Heart Disease and Stroke Statistics — 2012 Update: A Report From the American Heart Association. Circulation. January 3, 2012 2012;125(1):e2-e220.

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PARC’s Nudg Research Platform will be used to test and deploy the Fittle+ smartphone-based Ecological Momentary intervention system. Fittle+ will integrate: 1) CMU MobiSens, a mobile sensing and behavior modeling system using accelerometers, GPS, WiFi signal, Blue Tooth, shuffled sound clips etc., 2) an intelligent coaching system delivering personalized interventions in optimal contexts and 3) online social interaction mechanisms to support motivation, commitment, and learning. A Kaiser Permanente weight loss program will be used to shape challenges, behavioral goals, supporting content, and provide the real-world testbed.