Obesity in the Digital Age

Published in May 2013 Issue             

Facebook says it now has 1.11 billion people using its social media site each month, slightly more than the 1.06 billion it reported 3 months earlier, and a far cry from the 1 million users it had at the end of 2004. Twitter's growth has been just as explosive. According to Twitter, which describes itself as a “real-time information network,” it took 3 years, 2 months and 1 day to go from the first Tweet to the billionth. In January, professional networking site LinkedIn had more than 200 million users.

So are you a friend on Facebook? LinkedIn to medical colleagues all over the world? Tweeting live from the operating room, as a Houston neurosurgeon did back in 2012? If you're not, it's time to go digital and get social, because that's where more and more of your patients are going to find out about obesity, diabetes, high blood pressure, the risks and benefits of metabolic and bariatric surgery and the latest information on new technologies and treatments. Put bariatric surgery into Google and you'll get more than 6.5 million results. Obesity gets more than 77 million and diabetes gets more than 166 million results.

Mark Fusco, MD, an ASMBS member and a bariatric surgeon in Melbourne, Florida says his patients drove him to the Internet. It was becoming commonplace for many of them to bring in articles they found online. He did a survey of his patients and found 83 percent of those who responded were on the web at least once a day.

“Health professionals need to be a part of the conversation, because if we're not putting out information, someone else will,” said Dr. Fusco, minimally invasive surgeon with the Health First Medical Group and the medical director of the Health First LifeShape Advanced Bariatric Center of Florida.

Dr. Fusco started with a website for LifeShape, which grew into a personalized experience for his bariatric patients. Patients were able to track their progress via the web and automated messages would go from the practice to the patient when certain milestones were hit like losing 50 pounds or achieving a BMI lower than 40.

The site now also includes the doctor's Facebook feed, where he recently congratulated New Jersey Governor Chris Christie “for talking the first steps in improving his health,” after he had gastric band surgery. He has another Facebook page where access is limited to post-operative patients and in 2009 he started a Twitter account.

Dr. Fusco does most of his social media updates himself. “I always wanted to do it…because patients want to engage with their actual doctor,” he said. He added, though, that other members of his team also post to Facebook. “Our dietitian posts recipes. Our trainers congratulate patients for accomplishments and produce fitness videos…and we have a wide variety of guest authors for our blog,” he said.

For Pam Davis who serves on the Integrated Health Executive Council for the ASMBS and is chairman of the board of the Obesity Action Coalition (OAC), social media has become a way of life. A certified bariatric nurse and the bariatric program director at TriStar Centennial Center for the Treatment of Obesity in  Nashville, Tennessee, Davis manages the program’s social media communities, which she has done since 2009, when she first created a Facebook page for the center after attending a seminar on social media at an ASMBS meeting.

“I quickly realized social media is one more way for patients to stay in touch and be engaged with their program – one more easily accessible resource, one more tool in their
bariatric toolbox.”

Davis knows all about the importance of engaging a surgery patient and providing emotional support. She had gastric bypass in 2001. “I had someone there for me,” she said. “But others may not be as fortunate as I was.”

On her center’s Facebook page, Davis frequently posts messages of support and encouragement. In an April Facebook post, for example, she shares a quote by Matt Hoover, “There’s something about pushing yourself beyond your limits that people need to do once in their life. They need to take the chance one time to see what they really can do. And once you do it, you’re never the same.”

While there is no replacement for in-person interaction, Davis said, “social media has made a huge impact in allowing people to make those lasting friendships and to support one another.” Davis noted that patients frequently comment on the center’s closed Facebook group to say “it is their only source of support due to the great distance they are from us and their lack of family support.” Davis says she spends between 2.5 and three hours per week in the social media world. “Time well spent,” she added.

“One of the really fun things” Davis said their program organized through social media was a bariatric patients’ cookbook, noting something social media participants can never seem to get enough of is recipes.. Through social media, the center solicited patient recipes and dieticians tested them. “Then we had a contest to name the cookbook, and the winner got a free autographed copy at an in-person cookbook launch. It was a good opportunity to engage your patient, online and in-person.”

Internal medicine physician  Kevin Pho, MD, has become a social media sensation since starting his blog KevinMD, about 10 years ago. It has grown to 100,000 subscribers and Forbes magazine hailed KevinMD.com, a “must-read blog,” and CNN named @KevinMD one of its five recommended health care Twitter feeds. Dr. Pho recently co-authored a social media guide for physicians and medical practices called Establishing, Managing, and Protecting Your Online Reputation.

“Social media has brought down some of the barriers. Five, 10 years ago, there was more of a wall, more of a paternalistic model where doctors would prescribe and patients would listen. Now, I think there’s more of a partnership between patients and doctors,” Dr. Pho said.

Dr. Pho says studies have shown that one-third of consumers are using social media for health-related issues and “social media is a platform for physicians to be heard,” particularly with obesity and bariatric surgery. “There is a lot of misinformation out there, so (social media is) a great way for bariatric surgeons to share what’s correct, to guide patients to reputable sources of
health information.”

Following NBC weatherman Al Roker’s admission earlier this year that he had a bathroom-related incident at the White House, the Huffington Post ran an article about bariatric surgery’s “Not-So-Glamorous-Side,” and some readers posted comments perpetuating several myths about surgery. One noted that “the mortality rate is 7 (percent) per 1,000 surgeries, nationwide, 30-60-90 days after the surgery.”

Clinical psychologist and ASMBS member Martin Binks, PhD, CEO Binks Behavioral Health PLLC, has been active in social media circles for years and uses his blog to “balance out the unhealthy messages” and believes more health care professionals should use social media to provide context in a 24/7 media environment.

“My point of view is, unless reputable (sources) are out there, patients will end up reading less reputable information,” Dr. Binks said. “In a way, patients are part of what I decide to post, because if a patient asks me a question, well 10 other patients probably had that same concern.”

There are some cautions for health professionals in the social media world. In 2010, the AMA released guidelines, “Professionalism in the Use of Social Media.” The guidelines state health professionals should carefully maintain standards of patient privacy and confidentiality, routinely monitor their own internet presence and keep appropriate boundaries with patients, possibly by separating personal and professional online content. The ASMBS has also released a policy for the Society’s social media interactions.

Dr. Pho said that ultimately he’d like to see a HIPAA-compliant social network. Programmers and developers however, are beginning to create applications and platforms that are designed to meet health care providers’ specific needs.Doximity is a social networking site, like Facebook, specifically for physicians to connect with each other, while MDConnectME is an application that allows professionals working in the OR to send updates to the patients’ loved ones.