Reigning in the Shocking Rise in Metabolic Disorders

By Brenda K. Wiederhold, Christina Valenti & Mark D. Wiederhold

With drastically increasing numbers of people dying from diseases such as diabetes, obesity and heart disease, it has become evident that metabolic disorders are a field in need of a large amount of attention and research. The term metabolic disorder describes any condition that disrupts the metabolic process or causes it to malfunction in any way. While some of these conditions are hereditary, many metabolic disorders today are developed as a byproduct of lifestyle and could be, idealistically, prevented. In addition, metabolic disorders stem from a multitude of factors, rather than a single gene or mutation, increasing the chances of developing more than one medical condition. This domino effect of comorbidity, along with the growing number of people exhibiting symptoms characteristic of developing a metabolic disorder, called metabolic syndrome, is forcing healthcare providers to make prevention as well as treatment a main priority.

Diabetes, just one of the many metabolic disorders common worldwide, demonstrates how crucial prevention is in trying to control the epidemic. According to the International Diabetes Federation, it was estimated that 285 million people, or 6.4% of the world’s adult population, suffered from diabetes in 2010, and in the next twenty years that number is projected to almost double to 438 million. Diabetes too, is not just an issue affluent countries are encountering, where meals consist of sugary foods packed with simple carbohydrates, but is affecting developing nations as well; India and China are the current leaders with the highest number of people diagnosed with diabetes. People are also beginning to develop an impaired glucose tolerance (IGT), or elevated levels of glucose, greatly increasing the risk of developing diabetes as well as cardiovascular disease. In addition, with the vast majority of cases of diabetes being Type 2, efficient and cost-effective ways of preventing and controlling the disease are a must.

Patient-centric care, based on providing patients with easy and convenient ways to monitor their own condition, will not only encourage people to take a more active role in their health, but will also help reduce healthcare costs. Small wearable devices, like the CommanderFlex, monitor important information needed to manage conditions such as diabetes, high blood pressure and cholesterol, chronic obstructive pulmonary disease (COPD), chronic kidney disease, and renal disease, by monitoring nutritional intake and physical activity. This information can then be wirelessly transmitted to healthcare providers. Also, a new form of mobile health is developing, as shown by the product created by Ford Motor Company and WellDoc, a company devoted to improving technology for managing chronic conditions. The two have recently teamed up to design the WellDoc DiabetesManager ® System: an in-car system that helps manage diabetes by allowing the driver access to their medical information, like vitals and medications, as well as wireless capabilities from their car, bringing constant care to patients as they drive.

Countries and research labs throughout the world are also teaming up to test the large-scale efficacy of telemedicine services. Renewing Health, a collaboration between nine European regions and the European Commission, is a project consisting of real-life trials that will evaluate personalized telemonitoring services for the management of chronic disorders like diabetes, COPD, and cardiovascular diseases. Large-scale implementation of telemonitoring systems could help the overall management and prevention of chronic diseases, as well as alleviate the burden of healthcare costs by facilitating access to care from remote locations.

A staggering number of related applications for smartphones are being developed as well, efficiently utilizing a device users carry everyday and adopting it into one that monitors medical conditions on-the-go. The Austrian Institute of Technology has developed a system, DiabMemory, that utilizes Keep in Touch (KIT) technology allowing users to access health-related information from different monitoring devices, like a glucose monitor, through an application on their smartphone. Patient in your Pocket, designed for healthcare professionals and developed by the Computer Science Corporation (CSC), is a mobile application for Black- Berry smartphones and PlayBooks that sends updates on patients in real-time to the device, and allows the user to update information as well as schedule and keep track of appointments. These and similar apps, like the WaveSense Diabetes Manager App for the iPhone, iPad, and iTouch, are available for only a few dollars or even free. Using everyday devices like smartphones helps users take small steps to take control over their condition.

Since prevention for these diseases is key, education about the role that obesity and overeating play in developing metabolic and other chronic disorders has become the focus of many prevention programs. Weight loss pills and workout regimens are not lacking by any means, but no universal method has been developed that will ensure lasting results. Part of the reason why losing weight and keeping it off is so hard to achieve, and why there is no one way that guarantees success, is because the factors that lead to weight gain are different for every individual. Genetics, lifestyle, money, environment, and psychological health intersect in infinite ways, and all need to be considered when assessing one’s condition. Personalized routines designed to fit each individual and thorough care are necessary to reducing one’s weight, rather than a one-size-fitsall workout or diet plan. In addition, obesity is more than just a physical condition; it is now being considered a psychological one as well. Biological science can tell us about the metabolic processes that contribute to weight gain, but psychologists have found that it can be a mental concern, as much as a biological one, when trying to devise methods of prevention and treatment, and modifying behavior is powered by the mind.

Cognitive behavioral therapy (CBT), which has been proven effective for treating substance abuse addictions and other psychological issues like anxiety, depression, and phobias, is now being applied to obesity by changing behavior gradually and modifying attitudes towards food and eating. The idea behind CBT for weight loss is that one’s eating habits are learned, and therefore can be re-taught through small shifts in one’s behavior that increase as progress is made. CBT programs start with an assessment by a physician of a patient’s overall condition and lifestyle, from medical history to daily routine, as well as the individual’s environment, to determine what factors trigger overeating. From there, gradual goals are set for the patient that are altered as therapy progresses increasing the likelihood of long-term sustainability, whereas drastic cuts in diet and rigorous exercise can be unhealthy and harder to maintain over extended periods of time. Support from healthcare professionals, as well as the people that surround an individual, is also emphasized in CBT, and patients are encouraged to join support groups. Mobile and wireless communications like IM and video chat also make support more accessible, further increasing chances of success.

Virtual Reality (VR) is being used in conjunction with CBT in an effort to modify behavior in a setting that reflects reality, yet one that is private. VR is increasingly being used in cases where psychological causes, for example, eating disorders like binge eating and purging, are associated with weight gain, body dysmorphia, and negative perceptions of self. VR works well alongside CBT because it too can easily be designed to fit the specific needs of a patient. By immersing patients in a life-like setting, VR aims to identify what cues contribute to one’s habits, help the patient identify how the cues make him or her feel, and then, with the help of a healthcare professional, develop self-efficacy by finding ways to overcome the triggers and negative emotions associated with them. New strategies are devised throughout the process to discover the best solution for the patient, and gradual modifications are made to one’s activity and diet. What gives VR its edge, though, is that it is done in a non-threatening environment, where the patient can cope with their issues away from public scrutiny. Despite initial startup investment, using VR in the short-term to produce long-term effects will outweigh the cost of a lifetime of suffering from a debilitating condition.

Prevention and management facilitated through the use of remote monitors, wireless technology and cell phone apps will encourage people to take action in their own health. In addition, CBT and VR therapy target the roots of harmful habits that inevitably cause people to develop life changing medical conditions. With the success of many current mainstream methods of treatment faltering, hope for rehabilitation lies in the development of new convenient telemonitoring devices and within the confines of virtual worlds. Together these innovations could bring people who suffer from metabolic and chronic disorders all over the world the relief they’ve been waiting for.

Brenda K. Wiederhold, Ph.D., MBA, BCIA                                                           Virtual Reality Medical Institute                                                                             Brussels, Belgium                                                                                                 b@vrphobia.eu

Christina Valenti                                                                                                    Interactive Media Institute                                                                                               San Diego, California

Mark D. Wiederhold, M.D., Ph.D., FACP                                                               Virtual Reality Medical Center                                                                                         San Diego, California                                                               mwiederhold@vrphobia.com                                                                   www.vrphobia.eu