Surveys indicate that many people who make New Year's resolutions to eat more healthily or exercise more frequently do not sustain the enthusiasm of January throughout the year.
But what if the burst of energy and good intentions could be maintained over a longer period, perhaps with the help of a coach? What kinds of health benefits would appear?
Since 2008, Emory faculty and staff have been participating in a study that could answer some of those questions. At the Center for Health Discovery and Well Being (CHDWB), volunteer study participants designed personalized improvement programs after having their health and risk factors thoroughly evaluated using a combination of traditional medical testing and cutting-edge measures.
"What we call 'precision phenotyping' was used to develop an action plan for each individual, and specially trained health partners were assigned to follow up with each participant regularly and help them meet their goals," says CHDWB director Greg Martin, MD, also associate professor of medicine (pulmonary, allergy and critical care) and associate division director for critical care.
The study was part of an effort by the Emory-Georgia Tech Predictive Health Institute to understand how advanced medical technologies, such as genomics, can be combined with individual feedback to help people who are now healthy identify risks and make changes that prevent or ameliorate any disease on their horizon.
Predictive health is a key element of the university's Strategic Plan, delving into new ways to define and optimize health and incorporated into undergraduate and graduate degree programs .
In 2013, the CHDWB moved from the Midtown Office Tower to Emory University Hospital, at the Atlanta Clinical & Translational Science Institute research site on the ground floor. About 500 participants in the initial study group continue to be followed through in-person annual visits. The Institute is planning to make its extensive CHDWB biomarker and survey data, as well as biological samples, available to investigators under the ACTSI umbrella in February.
Dozens of research papers and two books have emerged already, on topics such as the association between inflammation and cognitive function, how vitamin D affects vascular stiffness, and how self-perceived physical and mental wellness is measurable in cardiovascular function.
Improved health for study participants
Most recently, researchers from Emory and Georgia Tech published an analysis of the changes in the health profiles in 382 CHDWB participants in their first whole year of participation. The senior author of the Journal of Personalized Medicine paper is Georgia Tech biology professor Greg Gibson.
On average, the participants lost a small amount of weight (a few pounds) and saw their blood pressure and LDL-cholesterol go down significantly over the first year. They also reported lower scores for depression and anxiety.
"What do most people in developed countries need to do? Eat better, exercise more regularly and stress less," Gibson says. "It's unclear whether most of the impact comes from the interaction with partners, or simply from participation and goal-setting, but the overall effect is quite good."
However, Gibson notes, a close analysis shows that people who started with higher risk scores — because they were more overweight, for example — were responsible for most of the changes. View a more detailed summary of the analysis.
Paying for predictive health
Mining the data from CHDWB participants in another way, Gibson has also looked at whether a more intensive evaluation — whole genome sequencing — could inform predictive health efforts. In 2013, he and his team published a Genome Medicine paper examining eight individuals' health profiles and their genetic risk factors to show how a combination of genetic, clinical and family history data can be used to visualize individual risk of disease.
A more difficult question to answer is: could a predictive health program pay for itself, in terms of preventing expensive conditions like diabetes and heart disease? Although a formal cost analysis is ongoing, the Journal of Personalized Medicine paper estimates the annual cost of the CHDWB program, including health partner services and medical tests, at $1,000 per participant.
The medium term impact − how many people who lose weight will actually keep it off? – is emerging gradually, since enrollment was staggered and some of the group has yet to complete their five-years of follow-up visits.
Gibson and his co-authors argue that the majority of long-term savings over decades would come from the fraction of people (10-15 percent of study participants) with high cardiovascular risk factors. In terms of savings, obesity has been estimated to cost the U.S. health care system $5,000 per obese individual, but the CHDWB program does not eliminate obesity; rather, it softens it.
Mobile health monitoring
The "health partner" component of the CHDWB program has ended, and now CHDWB leaders are discussing whether comparable results could be attained with mobile applications and a more "do-it-yourself" patient-centered approach, Martin says. This has implications for scaling the CHDWB program for larger populations and how the findings may be applied to organizations outside Emory.
Several employers and insurance companies offer similar "health coach" services, but those programs are generally less extensive and personalized and most often focused only on chronic disease management.
"This was a 'high touch' program, involving regular communications with the health partner and thorough annual evaluations," Martin says. "There's been huge growth in the use of internet technology and smartphones to help you monitor your health, and those approaches as well can be used to lower the costs of personalized and predictive healthcare."