The New York Academy of Sciences
Big Data, Consumer Technology, and the Obesity Epidemic: Emerging Science and Ethical Considerations
Posted January 26, 2017
From smart phone applications to electronic medical records, sophisticated means for tracking our health have never been more accessible. But with all this new technology, comes new challenges—not the least of which being researchers and physicians confronted with the daunting task of processing an unprecedented trove of new information. On September 16, 2016, The Sackler Institute for Nutrition Science presented Big Data, Consumer Technology, and the Obesity Epidemic: Emerging Science and Ethical Considerations to address the uses, benefits, difficulties, and ethical implications associated with Big Data.
The day's first session focused on three innovative uses of Big Data. Electronic health records (EHR) document millions of events each day, representing novel opportunities to cull new observations in realms such as disease biology and pharmacology. Nicholas Tatonetti of Columbia University uses data mining, to better understand and predict drug–drug interactions (DDI) in hopes of improving prescribing practices. DDI are responsible for up to 30% of adverse drug reactions, yet according to Tatonetti, are relatively understudied, with the FDA and clinical trials not requiring the analysis of such interactions. Instead, the FDA maintains an adverse event reporting system for healthcare professionals and patients to voluntarily report the adverse outcome experienced, the drugs taken and the diseases being treated for.
Still, even with access to these reports, determining which of the drugs, if any, are actually causing the adverse effect is an arduous task. In response, Tatonetti developed an algorithm to infer DDI for two drugs. As proof-of-concept, Tatonetti looked for adverse events related to type 2 diabetes. Applying the algorithm, he identified two drugs frequently taken together: paroxetine, an antidepressant, and pravastatin, a cholesterol-lowering drug. Using EHR to compare the blood glucose values for patients on these two drugs, patients on both drugs had a 60 mg/dL increase in blood glucose levels compared to the control. Conversely, patients on either of these drugs individually had no change in blood glucose values. These results were validated in a mouse model: mice on both drugs had a blood glucose value 60 mg/dL higher than the control. This example demonstrates how data mining of EHR can be used to discover and validate new DDI to improve prescribing practices, and how EHR might predict experimental outcomes.
Tooraj Mirshahi of the Geisinger Clinic discussed the use of EHR to predict the outcomes of bariatric surgery. Patients seek various forms of bariatric surgery to promote weight loss and to improve their co-morbidities, such as diabetes and cardiovascular disease (CVD). Using EHR, Mirshahi matched 1750 bariatric patients with non-surgery control patients according to BMI, age, gender, and co-morbidities. Mirshahi found that gastric bypass is effective at reducing BMI, mortality and CVD. But although many do improve post-surgery, there is a high degree of variability among patients. Using the Geisinger Clinic's data, Mirshahi set out to better understand what factors can be used to predict bariatric surgery outcomes.
Mirshahi found that a high pre-surgery BMI was one of several conditions that were predictors of less weight loss post-surgery. However, patients with a BMI below 50 were more susceptible to the presence of four common genetic obesity markers controlling their weight loss progress, whereas patients with a BMI above 50 were unaffected by genetics. To predict the probability of diabetic remission post-surgery, Mirshahi developed a DiaRem scoring system, calculated from the patient's age, HbA1c, prescribed diabetes drugs, and insulin use. After validating in multiple cohorts, patients with a low DiaRem score correlated with a higher probability of diabetes remission. The Get 2 Goal mobile app, available for patients and providers, calculates a post-surgery DiaRem score and weight loss prediction to help motivate patients and track their progress.
In an effort to curb the obesity epidemic in the U.S., a provision under the Affordable Care Act requires chain restaurants to post calorie counts on their menus. While there is evidence for the effectiveness of calorie labels on weight loss, the reasons are not well understood. Michael K. Price of Georgia State University is using Big Data to understand this initiative's success and link the effects with social welfare.
Price found that people from areas with local mandates already in place—like New York City—have a reduction in average BMI, even in people at healthy weight, indicating that the consumer was previously inattentive to calories and is now making more informed, healthier choices. However, people also reported a reduction in life satisfaction. Although these people end up consuming healthier foods and fewer calories, they are left with a feeling of guilt for wanting to choose the higher calorie option. Going forward, Price plans to collect more data following the federal mandate, for example, by analyzing people's restaurant visits and food choices before and after the mandate. Those feeling guilty in response to calorie postings may change where they eat to avoid restaurants that post calories. Conversely, people who want to be more informed may switch to restaurants that do post calories. Ultimately, a better understanding of how people are affected by the mandates can allow improvement in policies going forward.
The second session focused on new implications for obesity intervention. Ruth E. Patterson of the University of California San Diego discussed maintaining a healthy weight by practicing time restricted feeding (TRF), which focuses on when subjects eat, rather than the amount of calories. Studies in rodent models have indicated that TRF improves body weight, fat mass, glucose tolerance, fatty liver, and lifespan, and can reduce the risk of cancer. However, there is very little data on the effect of TRF in humans. Using Big Data from 24-hour dietary recalls, Patterson looked at the effect of prolonged nightly fasting among women. Analysis revealed that increasing nightly fast duration from the typical 10 hours to the prolonged 13 hours reduced the risk of elevated HbA1c by almost 20%. Additionally, breast cancer survivors with a nighttime fasting of less than 13 hours per evening were 40% more likely to have more breast cancer events sooner, and about 20% more likely to die from breast cancer than survivors that followed prolonged fasting.
Despite its apparent effectiveness, is prolonged nightly fasting a feasible public health recommendation? To test this, Patterson performed a one-month pilot study, in which 20 female participants were told to fast for at least 12 hours and were given a mobile app to record their meal time and remind them when to stop eating. The study showed modest weight loss among the women, and 90% of the participants found the fast to be easy and somewhat pleasant.
Satchidananda Panda of the Salk Institute performed a similar feasibility pilot study with eight overweight participants with a baseline eating duration greater than 14 hours. Over 16 weeks, participants were asked to decrease their eating duration to any 10–11 hour window they choose, with no other dietary changes. TRF resulted in sustained weight loss for at least one year after intervention, and an improvement in sleep quality. There was also a 20% reduction in calorie intake, so TRF may also be an effective method of caloric restriction. Together, data presented by Patterson and Panda indicates the effectiveness and feasibility of limiting eating duration for weight management.
One possible mechanism for the effectiveness of TRF is by syncing with the body's internal circadian clock, eating during the daylight hours when we are most active. However, Panda found that more calories are consumed at night between 6 pm – 9 pm, than during the daylight hours of 4 am – 12 pm. Circadian clocks regulate many aspects of human health and disruption of the clock through lifestyle may be the cause of many diseases, particularly those associated with obesity.
Barbara E. Millen, founder and president of Millennium Prevention, Inc., discussed the importance of personalized prevention and early intervention when addressing patient health and wellness. Millennium looked at bodyweight change and obesity development in 4000 men and women over a 28-year period. These studies showed the importance of early intervention, as many women continued for a full decade in developing obesity. Additionally, more than half of the foods consumed by both men and women were nutritious, thus a complete overhaul of their current dietary patterns would not necessarily be effective. Millennium developed the HealthMain website, a platform for personalized medicine. After completing several brief surveys, evidence-based assessment tools benchmark the individual against current expert guidelines and suggest lifestyle changes that complement the healthful decisions the patient already makes. Six-month follow-up data from participants showed high engagement and impact on lifestyle changes.
The final session of the day discussed the use of Big Data in public health, with a discussion of equity and ethical considerations. David S. Siscovick of the New York Academy of Medicine, discussed Health Data for New York City (HD4NYC), a platform using data sharing and collaboration to improve public health research by connecting researchers and datasets from the Department of Health and Mental Hygiene (DOHMH) with other institutions. Charon Gwynn of the DOHMH discussed the use of Big Data to implement and promote public health initiatives, such as Take Care New York (TCNY) 2020. Using baseline numbers for obesity, sugary drink consumption and physical activity, they set goals to curb obesity in all New Yorkers and priority populations in NYC by 2020. The DOHMH has outlined projects towards their 2020 goals including collaboration with Department of Transportation to identify additional areas for bike lanes in Brooklyn and East New York, and an initiative to bring food trucks with fresh produce to areas with limited access to healthy foods. Gary Bennett of Duke University advocated the use of digital approaches to improve equity and narrow racial disparities in obesity, since medically vulnerable populations are now tuned into mobile devices.
Lori Andrews of Chicago–Kent College of Law discussed ethical considerations surrounding Big Data. Much of the health information we share through email, social media, and medical apps is collected by data aggregators and sold to employers, insurers, and advertisers. For example, a teenager discussing in an online chat forum their plans for suicide using a certain chemical may result in being targeted with ads for the same chemical.
Use the tabs above to find multimedia from this event.
Presentations available from:
Satchidananda Panda, PhD (SALK Institute)
Lori B. Andrews, JD (Chicago-Kent College of Law, Illinois Institute of Technology)
Gary Bennett, PhD (Duke University)
Charon Gwynn, PhD (New York City Department of Health and Mental Hygiene)
Barbara E. Millen, DrPH, RD, FADA (Millennium Prevention, Inc.)
Ruth E. Patterson, PhD (University of California San Diego)
Michael K. Price, PhD (Georgia State University)
Karandeep Singh, MD, MMSc (University of Michigan)
David Siscovick, MD, MPH (The New York Academy of Medicine)
Nicholas Tatonetti, PhD (Columbia University)
How to cite this eBriefing
The New York Academy of Sciences. Big Data, Consumer Technology, and the Obesity Epidemic: Emerging Science and Ethical Considerations. Academy eBriefings. 2016. Available at: www.nyas.org/ObesityTech-eB
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Jason Block, MD, MPH
Jason Block is an assistant professor and associate director of the Obesity Prevention Program of the Department of Population Medicine at Harvard Medical School/Harvard Pilgrim Health Care Institute. He completed an internal medicine residency and chief residency at Brigham and Women's Hospital and was a Robert Wood Johnson Foundation Health and Society Scholar. Block's primary research interests are in neighborhood-level determinants of weight gain and obesity and the evaluation of governmental and institutional policies and other novel interventions to improve diet. He is a primary care physician at Brigham and Women's Hospital in Boston and a clinician in the Brigham and Women's Weight Management Clinic.
Matthew Harding, PhD
Matthew Harding is an economist and data scientist who uses Big Data to answer economic questions related to individual consumption and choices in areas such as health, energy, and transportation. He is an associate professor of economics and statistics and UC Irvine. He holds a PhD in economics from MIT and an MPhil in economics from Oxford University. As a data scientist, he develops cutting edge econometric methods for the analysis of "deep data," large and information-rich data sets derived from many, seemingly unrelated sources to provide novel economic insights. He is particularly interested in the role of technology and automation to induce behavior change and help individuals live happier and healthier lives. At the same time, his research emphasizes solutions for achieving triple-win strategies. These are solutions that not only benefit individual consumers, but are profitable for firms, and have a positive impact on society at large.
John G. Kral, MD, PhD
After earning his master's in psychology, John Kral attended medical school at the University of Göteborg, Sweden, specializing in surgery and medicine, completing PhD studies and initiating the obesity surgery program there. In 1981, he started the Division of Surgical Metabolism, St. Luke's–Roosevelt Hospital, Columbia University, and in 1983 co-founded the American Society for Bariatric Surgery. Kral initiated and co-organized the 1991 NIH Consensus Development Conference on gastrointestinal surgery for severe obesity. Focusing on studies of body composition, adipose tissue receptors and lipid and carbohydrate metabolism, his current interests include ingestive behavior, determinants of metabolic obesity, effects of gestational stress on urban health, the importance of the intrauterine environment and epigenetics. In 2012, the Obesity Society awarded Kral the AJ Stunkard Lifetime Achievement Award. He is past chair of the Sackler Institute for Nutrition Science working group Obesity, Diabetes and Nutrition-Related Diseases at the New York Academy of Sciences.
Kristina H. Lewis, MD, MPH, SM
Kristina H. Lewis is an assistant professor in the Division of Public Health Sciences at Wake Forest Baptist Medical Center. She is an internal medicine physician practicing in the field of bariatrics. Lewis's research focuses on developing and evaluating interventions for obesity and related comorbidities. This work ranges from comparative effectiveness studies of bariatric surgical procedures, to trials of novel behavioral interventions for diet, to studies of policy interventions for improving diet at the population-level. Lewis currently serves as chair for the Health Services Research Section of the Obesity Society, and chair of the Obesity, Diabetes and Nutrition-Related Diseases working group for the Sackler Institute for Nutrition Science.
Satchidananda Panda, PhD
Satchin Panda's circadian rhythm research has discovered that light and meal time have profound health impact. He found a new light sensor in our eye measures blue light to tune brain functions ranging from falling asleep to throbbing migraine pain in a sunny day. This simple discovery has triggered a new field of light therapeutics. Panda also discovered that the number of hours between our breakfast and dinner may be as important as day's calorie counts. Eating all food within 8–12 hours every day can sustain the primordial circadian rhythm and prevent obesity, diabetes, heart diseases, cancer, poor sleep. Panda grew up in India, did his doctoral research at the Scripps Research Institute, and postdoctoral training at Novartis before starting his independent research lab at the Salk Institute, La Jolla. He is a Pew Scholar in Biomedical Research, and an American Federation of Aging Research mid-career scientist.
Gilles Bergeron, PhD
The Sackler Institute for Nutrition Science
Gilles Bergeron has worked in international nutrition for more than 25 years. He has extensive experience in nutrition in the life cycle, food security, agriculture/nutrition linkages and monitoring and evaluation. A founding member and deputy director of the Food and Nutrition Technical Assistance (FANTA) project, he spent 18 years overseeing FANTA's work in policies and programs; nutrition and infectious diseases; maternal and child nutrition; agriculture/nutrition linkages and emergency nutrition response. Prior to joining FANTA, he spent six years as Research Fellow with the International Food Policy Research Institute and three years with the Institute of Nutrition for Central America and Panama in Guatemala. He has operated in Africa, Latin America and Asia, and his work has been published in scientific journals such as The Lancet, Advances in Nutrition, World Development, the Journal of Development Studies, and Food and Nutrition Bulletin. He received his PhD in development sociology from Cornell University in 1994.
Mireille Mclean, MA, MPH
The Sackler Institute for Nutrition Science
Mireille Seneclauze Mclean joined the Sackler Institute for Nutrition Science at the New York Academy of Sciences in 2011. Her activities include managing the growing pool of research grants issues through the Institute's Research Funds, organizing multi-disciplinary workshops and symposia in the field of nutrition, and supporting the dissemination of research. Previously, she spent over ten years doing fieldwork for international NGOs intervening in crisis situations. In that role, Mclean defined and directed the implementation of programs in nutrition, health, food security and sanitation for vulnerable population groups in South East Asia, Africa and the Middle East; managed large grant programs for displaced populations and conducted a number of participatory research assessments and nutritional surveys. She also worked as a program coordinator at the Bureau of Public Health in Paris, France. Mclean's work focuses on highlighting the importance of implementation, delivery systems, and partnerships to translate science into better outcomes. She holds an MA in Development Economics and International Development from the University of Sussex and a Master of Public Health from the Liverpool Faculty of Medicine.
Lori B. Andrews, JD
Lori Andrews is a law professor and director of the Institute for Science, Law and Technology at Chicago–Kent College of Law. She has authored 11 non-fiction books, including I Know Who You Are and I Saw What You Did: Social Networks and the Death of Privacy; more than 150 articles on health care policy, biotechnology, and digital technologies; and several mystery novels. Andrews chaired the federal advisory committee to the Human Genome Project and has advised governments and professional groups ranging from the G8 science ministers to the U.S. Centers for Disease Control. She has received grants from NIH, NSF, U.S. Department of Energy, Robert Wood Johnson Foundation, M.D. Anderson Foundation, and others. Andrews has been a visiting professor at Princeton and at Case Western. She received her BA summa cum laude from Yale College and her JD from Yale Law School. The National Law Journal listed her as one of the 100 Most Influential Lawyers in America.
Gary Bennett, PhD
Gary G. Bennett is the Bishop-MacDermott Family Professor of Psychology & Neuroscience, Global Health and Medicine at Duke University. He directs the Duke Global Digital Health Science Center and the Duke Obesity Prevention Program, is president-elect of the Society of Behavioral Medicine, and has authored more than 125 scientific papers. Bennett developed the interactive obesity treatment approach (iOTA), which has been evaluated in trials both domestically and abroad. His recent work demonstrates the effectiveness of coach-led, digital health obesity interventions (delivered via text, smartphone, and interactive voice response) for medically vulnerable patients. Bennett has served on numerous National Institutes of Health committees, grant review panels, editorial boards, and guidelines councils. He co-founded two digital health startups: Crimson Health Solutions (acquired by Health Dialog in 2007) and Scale Down. Bennett has degrees from Morehouse College and Duke University; before joining Duke in 2009, he served on the faculties of the Harvard School of Public Health and the Dana-Farber Cancer Institute.
Charon Gwynn, PhD
Charon Gwynn is deputy commissioner for the Division of Epidemiology at the New York City Department of Health and Mental Hygiene (DOHMH), where she oversees efforts to gather, analyze and disseminate information about New Yorkers' health. Prior to joining DOHMH, Gwynn served as deputy director of the Strategic Information Unit at ICAP, Columbia University, where she provided technical assistance and capacity-building support for routine monitoring and evaluation, surveillance, and electronic health information systems in the context of U.S. government-funded HIV programs in Sub-Saharan Africa, and Central Asia. Previously, as a research scientist at the New York City Department of Health, she participated in the design, planning, implementation and publication of results from the first community-level Health and Nutrition Examination Survey in NYC. As an epidemic intelligence service (EIS) officer with CDC-Atlanta, Gwynn worked to evaluate and analyze data from the Behavioral Risk Factor Surveillance System. Gwynn received her PhD in Environmental Health Sciences from New York University in 1999.
Barbara E. Millen, DrPH, RD, FADA
Barbara E. Millen is president of the academic consulting firm Boston Nutrition Foundation, Inc. (BNF), and Millennium Prevention, Inc. (MP), which conducts translational research and offers web and mobile platforms under the trademark HealthMain. Previously, Millen was professor of family medicine and graduate medical sciences at the Boston University School of Medicine, where she served as founding chair of the graduate programs in medical nutrition sciences and director of nutrition research at the Framingham Heart Study. Millen earned her master's and PhD in public health from the Harvard University School of Public Health. Recently, she served on the National Institutes of Health expert committees that developed guidelines for the management of overweight and obesity in adults and lifestyle management to reduce cardiovascular disease risk. She chaired the 2015 U.S. Dietary Guidelines Advisory Committee, which informed its 2015–2020 dietary guidelines. She has authored four books and received the Elaine Monsen Award of the Academy of Nutrition and Dietetics Foundation.
Tooraj Mirshahi, PhD
Tooraj Mirshahi received his PhD in pharmacology from Virginia Commonwealth University. After a post-doctoral fellowship at Mt. Sinai School of Medicine, he joined the faculty at Geisinger, where he is an associate professor at the Weis Center for Research. Mirshahi is a member of the Geisinger Obesity Institute. His current work is funded by grants from the NIH, as well as a collaboration with Regeneron Pharmaceutical. Mirshahi's training is in cell biology and signal transduction, and a major interest has been signaling in the leptin-melanocortin pathway that controls feeding, satiety and energy expenditure. Geisinger has collected genetic data both genotyping and whole exome sequencing from over 60,000 patients, and Mirshahi has combined his understanding of cellular and molecular basis of obesity with available genetics data to look at factors that play critical roles in obesity as well as outcomes after bariatric surgery.
Ruth E. Patterson, PhD
Ruth E. Patterson is a professor in the UCSD Department of Family Medicine & Public Health, as well as associate director of population sciences and leader of the cancer prevention program at the Moores Cancer Center. She spent 12 years at Fred Hutchinson Cancer Research Center, where she was co-principle investigator of the Coordinating Center for the Women's Health Initiative nationwide study of postmenopausal women. Patterson also served as co-PI in a study of Washington State residents examining vitamin supplement use and cancer risk. At UCSD, Patterson was awarded funding for a NCI-designated Transdisciplinary Center on Energetics and Cancer (TREC). UCSD's TREC Center is designed to assemble transdisciplinary scientific collaborators to address questions regarding insulin resistance and inflammation underlying the association of energetics with breast cancer carcinogenesis, from the cell to the community. Her current research interests focus on the hypothesis that prolonged nightly fasting can reduce risk of chronic diseases, including some cancers, by improving multiple metabolic parameters.
Michael K. Price, PhD
Michael Price is an associate professor of economics in the Andrew Young School of Policy Studies at Georgia State University and a research associate at the National Bureau of Economic Research. His interests include experimental and behavioral economics, the economics of charity, environmental economics and health economics. His research focuses on the use of experimental methods, in particular, the use of field experiments to test economic theories and understand factors that influence individual decision-making. To collect data for his research, he has partnered with various utilities, government organizations, private firms, and non-profit organizations to implement large-scale field experiments.
Karandeep Singh, MD, MMSc
Karandeep Singh is a physician, researcher, and educator interested in studying learning health systems, making new discoveries about disease, and improving patient care through technology. His research areas include natural language processing of clinical notes, risk prediction using high-dimensional data, mobile health apps, and wearable technologies. He is an assistant professor of learning health sciences in the Division of Learning and Knowledge Systems and an assistant professor of medicine in the Division of Nephrology at the University of Michigan Medical School. Singh completed his internal medicine residency at UCLA Medical Center, where he served as chief resident, and a nephrology fellowship at Brigham and Women's Hospital in Boston. He completed his medical education at the University of Michigan Medical School and holds a master's degree in medical sciences in biomedical informatics from Harvard Medical School.
David Siscovick, MD, MPH
David Siscovick is senior vice president for research at the New York Academy of Medicine. A professor emeritus of medicine and epidemiology at the University of Washington in Seattle, Washington, he was formerly co-director of the university's cardiovascular health research unit and director of its cardiovascular epidemiology training program. For more than three decades, he was a practicing general internist and clinical epidemiologist with a focus on bridging clinical medicine and public health. Siscovick has authored more than 650 peer-reviewed publications and won multiple grants from the National Institutes of Health. His research has focused broadly on the epidemiology and prevention of cardiovascular disease across the lifespan. He has led interdisciplinary teams and large-scale multi-institutional collaborations, and he has mentored young investigators from multiple institutions. He has been the principal investigator or a co-investigator on multiple NIH grants. He recently completed a two-year term as the chair of the American Heart Association Council on Epidemiology and Prevention.
Nicholas Tatonetti, PhD
Nicholas Tatonetti is assistant professor of biomedical informatics in the departments of biomedical informatics, systems biology, and medicine and is director of clinical informatics at the Herbert Irving Comprehensive Cancer Center at Columbia University. He received his PhD from Stanford University, where he focused on novel statistical and computational methods for observational data mining. He applied these methods to drug safety surveillance, discovering and validating new drug effects and interactions. At Columbia, his lab focuses on detecting, explaining, and validating drug effects and drug interactions from large-scale observational data. Widely published in both clinical and bioinformatics, Tatonetti is passionate about the integration of hospital data (stored in the electronic health records) and high-dimensional biological data (captured using next-generation sequencing, high-throughput screening, and other "omics" technologies). Tatonetti has been featured by the New York Times, Genome Web, and Science Careers. His work has been picked up by the mainstream and scientific media in hundreds of articles.
Elyssa Bernfeld holds a BS in Biochemistry from the University of Delaware and is currently pursuing a PhD in Biochemistry at Hunter College, City University of New York, researching cancer cell metabolism. She also enjoys writing to a broad audience to share scientific knowledge.