• Adam Tilton

Am I Healthy? I Hired a Team of Professionals and Tracked My Biometrics to Find Out

Recently, I shared my vision for the future of healthtech and what I wish to experience as a patient: Here's the vision for the future I have in my head: I'm in the doctor's office meeting my physician. It’s not our first meeting—she knows more about me and my life than anyone else. She is reading over the latest report of my key biometrics provided from my various connected health devices, commenting as she reads. "Keeping up with running since we last spoke, and your recovery looks good too... I see your sleep schedule was inconsistent for a while. How old are your kids now?" she asks. "My oldest just turned three," I reply, knowing she's wondering what I was doing in the middle of the night all of last year. "Looks like you might have had a temperature for a few days back in August, but overall, your heart, respiratory, blood pressure, and temperature reports look consistent with what the models predict. Just routine tests today and a quick exam," she says as she sets down my report. This is the experience I want. Informed by data, enriched with insights from the population, reviewed and interpreted by an expert, and provided to me with empathy and hope. We’re a long way off, but I was curious if I could get closer by combining the data I receive from wearables with a boutique healthcare experience. Would I be able to incorporate the data meaningfully? Would my healthcare providers track it with me? And would the experience lead to more sustainable outcomes and a healthier lifestyle? The Boutique Healthcare Experience I researched the boutique healthcare market and landed on SHIFT, a team of physicians, dietitians, fitness coaches, and physical therapists who share my enthusiasm for transforming our approach to primary care health.

I met my healthcare team for the first time at the SHIFT facility in downtown Chicago. It’s a palace of health. The entrance leads to a fitness studio and healthy food bar, and down a set of stairs you’ll find another fitness studio, physician’s offices, physical therapy offices, locker rooms, and everything else you might need to evaluate your health. The engagement with SHIFT started with an assessment and a battery of tests. The first hour was familiar to me, including an eye and ear exam, a blood draw for labs, blood pressure and blood oxygen content monitoring, and a weight measurement. The next six hours of tests, however, were unique, including a twelve-lead EKG, low-density X-ray scan, VO2 max testing, fitness exam, physical therapy assessment, nutrition consultation, and a review with my physician.

I received a comprehensive summary of the results which told me I have work to do. Across the medical, nutrition, fitness, physical therapy, and recovery assessments my grades were satisfactory. For example, I have slightly elevated blood pressure, higher bad cholesterol (LDL) than I should, and my bad fat (visceral adipose tissue or VAT) score was not great. While it doesn’t feel good to be analyzed in this way, I appreciated having a holistic view of my health and personalized recommendations across nutrition, exercise, and recovery to improve it—a stark difference to my annual 30 minute check-up. After the tests I met one-on-one with the nutritionist to discuss my eating habits, and I was feeling a bit uneasy. I love to cook and was prepared to admit to my sins. “I make crepes stuffed with nutella and pancakes doused in syrup, have been working to perfect smoked brisket, and sear ribeye steaks in bacon fat. Sometimes I eat salad.” The feedback was surprisingly mild, though. For the most part, she helped me draw my focus to balance, like eating an egg and fresh fruit with my nutella-packed crepes, and understanding the benefits of certain foods with respect to others, like choosing unrefined grains instead of refined grains. She also helped correct a few misconceptions I had, like I should only have a protein shake if I just went to the gym (but otherwise should only eat pancakes). Turns out, that is incorrect. I similarly met with a personal trainer to review my exercise habits, and a physical therapist to review my range of motion. Since I joined Nike I’ve been running quite a bit, and that showed up in my V02 max results. I have better than average stamina. But in certain joints I’m stiff and my muscle definition is best described as middle-aged-with-kids. The physical therapist assigned me exercises to improve my flexibility and joint strength, and the personal trainer suggested high intensity interval training (H.I.I.T) and resistance workout.

I left SHIFT feeling inspired and well-prepared for the changes I needed to make to meaningfully impact my health. I had a fresh set of resistance bands, detailed reference books for nutrition, and a set of simple workout routines to implement.

Wearables and Data Tracking Once I got home, I relied on a number of wearables to continue tracking key biometrics, including:

  • Withings Blood Pressure Monitor: My blood pressure reading was a bit high, so I chose this monitor to keep an eye on it. It’s easy enough to use and a reading takes a minute or so. What’s been more difficult is building the habit of consistently taking a measurement at the same time of day. I don’t really know what to do with the data, but I’m passing it along to my physician who does.

  • Withings Connected Scale: I have been keeping track of my weight using the Under Armour connected scale that launched with the HealthBox in 2017. I recently ordered the Body Cardio scale from Withings and look forward to seeing what’s evolved in the past five years. I do check my weight every morning, and over the last few months the changes have been substantial.

  • Apple Watch: I have been wearing my Apple Watch to track my runs and general activity, though I’ve found it’s most convenient for streaming music to my AirPods without needing my phone. The GPS tracking isn’t perfect (or so my Garmin friends tell me), and in any case I don’t really have a need for the running metrics. I just want an easy way to communicate to my healthcare team that I’ve been working out consistently, and provide some basic context around my workout, e.g. a run, H.I.I.T ride, etc. The other Apple Watch metrics, like resting heart rate and heart rate variability are neat, but I don’t know what to make of these numbers and so far no one has asked me for them.

  • Levels Continuous Glucose Monitor: The Levels Continuous Glucose Monitor (CGM) is minimally invasive, which means a bit of force and a needle are required to insert a thread under your skin to take the measurement. The sensor is also disposable, so the attachment procedure must be repeated every two weeks. The device is a pain to wear, and after removing the device I had a small scab as proof of my adherence. Once in place it provides a reading of your blood glucose, so long as you don’t forget to scan the sensor with your phone every 8 hours. The reading was also hard to interpret. Regardless of what was on the breakfast menu—avocado whole grain toast, kale and spinach smoothie, crepes, nothing but coffee—I had a glucose spike in the morning. The app tries to help make sense of the data for you with a simple score between 1 and 10. I received a score of 9 (which is good) for eating pizza and drinking beer, and a bad score of 3 (which is bad) for chicken cordon bleu with creamed spinach. I’m sure there’s some science that explains this, but I asked my healthcare team to help me make sense of this data, and their opinion was that it was unnecessary for me to be concerned. My glucose response is normal and healthy. I really wanted this device to be a glimpse of the exciting future of minimally invasive sensing, but it was a pain to wear, challenging to discern any value from, and irrelevant to the experts I trust.

  • Oura Ring: I’ve just started using this with the intention of better understanding my sleep and “daily readiness.” I’ll share more here soon.

  • Google Photos and Levels App: To build a conscious muscle for what I eat I started by tracking every bite and sip, and that was painful. I didn’t realize how often I reach for a beverage or snack. I started with a simple procedure of taking a photo of everything I eat and putting it in a shared Google Photos album. That worked, but it lacked context like time of day, and it was hard to add notes. The Levels app is actually a pretty good solution for meal tracking, and to share what I was capturing there I just shared screenshots of the log at the end of each day. This was enough for my nutritionist to provide useful feedback. Eventually I gave up on tracking, and instead aligned on simple heuristics I could use to guide decision-making. It sounds strange, but I think this is a great opportunity for AR glasses. I would wear a pair of connected glasses if every time I ate or drank a photo was logged.

I assumed going into this experience it would be up to me to aggregate and interpret the data, and that turned out to be correct. While I shared the data with my team during our monthly check-ins, they just didn’t have the infrastructure to track my data and respond in real-time (something I’m hoping more PCPs will be able to do soon). I’m still tinkering around with how to best do this. I use HeadsUp right now to bring all my data together into a dashboard, but that’s not really the problem I have. Most of the data is essentially useless to me. I’ve also been exploring what it would take to build something for myself, and have been impressed with the software utilities provided by Human API and Vitalic. More on that to come. The Results Overall, the experience is substantially better than the typical engagement with a primary care physician. I appreciated the extensive health snapshot I received on that initial day of tests and meetings. I also found it easier to incorporate the recommendations I got from the nutritionist, trainer, and physical therapist, knowing they were geared to my specific body and lifestyle. Exercise I found my exercise groove by continuing to run regularly but alternating other days with a H.I.I.T. workout on the Peloton, and doing my PT workouts before each. I’m still working on regular resistance training, but it's been a weird year and I have a good excuse for not wanting to be inside a gym. Let's check in on this point in a few months. Nutrition The changes I’ve made to my eating habits have been subtle but impactful (like buying a quality blender and starting each morning with a breakfast smoothie). I’ve reduced the amount of ice cream I eat, but not to zero, and have adopted a plan for smart and healthy snacking. At meal time, I still eat all the same foods but am more conscious about variety, balance, and ingredient selection. Lifestyle The lifestyle changes I’ve made in how I fuel and exercise have led to natural changes in how I recover. I sleep better, and I wake up with more energy. What started as a quest to understand my health has led to a very sustainable and rewarding routine. There’s a mindfulness I’ve developed around my health, and a sense of reward and achievement from my progress. In turn, this creates motivation to keep going, and has also led to more substantial (albeit unnecessary) changes like removing alcohol from my diet completely. I don’t feel the same level of satisfaction from drinking that I used to, and it interferes with these other interests. My sense of pleasure has adapted to things that align with a healthy lifestyle, all of which was born from this more in-depth health assessment.

With that said, there are a number of holes in the experience I’d like to see filled. First, as I mentioned, I’d like to see the data tracking and aggregation happen on the physician’s end. It was up to me to piece together the wearables, find the best aggregation and tracking tools, interpret the data and then feed that back to the team, most of which I was able to do only because of my extensive experience with wearables. Second, it’s expensive—not only for the boutique healthcare experience but also for the wearables, high quality ingredients, exercise equipment, etc. I’d like to see a model that makes an experience like this more accessible for more people. Finally, I’ve had to commit a lot of time and effort to make all of this work. If we believe that providing better healthcare to all will be achieved by preventing poor health outcomes from occurring in the first place, I believe we need elegant solutions for connecting key biometrics with expert healthcare teams to deliver personalized guidance.