The ETIOBE Project: A Supporting System for Children Obesity

1. CYBETHERAPY 2008 SAN DIEGO The ETIOBE Project: A Supporting System for Children Obesity Rosa Baños, Cristina Botella Alvaro Frías, Mariano Alcañiz Ausias Cebolla, Ernestina Etchemendy Soledad Quero, Sabrina Andreu

2. Research team FROM 1996 CLINICAL TECHNICAL

3. TEAM COMPOSITION Universidad Jaume I Prof. Cristina Botella Prof. Azucena García-Palacios Prof. Soledad Quero Sabrina Andreu Berenice Serrano Diana Castilla Ernestina Etchemendy Dr Ausias Cebolla Universidad Politécnica de Valencia Prof. Mariano Alcañiz Dr. José Antonio Lozano Irene Zaragoza Jaime Guixeres Dr Beatrriz Rey Universidad de Valencia Prof. Rosa Baños Prof. Conxa Perpiñá Álvaro Frías

4. VIRTUAL REALITY, AUGMENTED REALITY Treatment of anxiety disorders Treatment of eating disorders

5. TELEPSYCHOLOGY Animal phobia Fear of public speaking Self-administered programs

6. TREATMENT OF OBESITY ETIOBE PROJECT: TREATMENT OF OBESITY IN CHILDREN SUPPORTED BY NEW TECHNOLOGIES (VIRTUAL REALITY, TELEPSYCHOLOGY). Instituto de Salud Carlos III: CIBER Obesidad y Nutrición

7. Treatment of Obesity • CBT: change in behavior, cognitive, and emotional patterns that maintain obesity. • CBT + medical treatment: efficacy in reducing body weight. • Unfortunately, results are not so good with respect to maintaining treatment outcomes.

8. The problem of maintenance After a CBT program patients gain around 30-35% during the first year. 100% after 5 years. Main problem in outcome maintenance is motivational component. Motivation and self-control good predictors of treatment efficacy. Obesity is a chronic medical condition requiring a continuous and suitable supervision.

9. The treatment of Obesity To increase the efficacy of obesity treatment: To design techniques and strategies that help patients to monitor eating habits and energy consumption. Personalize the intervention adding supporting strategies to help the patient persevere and defend him/herself from negative stimuli (advertisement, fast food, etc.). New technologies could help in this task: tele-health and e-health. The use of new technologies means a change in the ways we can provide health care.

10. E-TIOBE • What is E-TIOBE? • e-therapy system that uses innovative strategies to enhance motivation and treatment adherence, personalizing the treatment considering the patient’s physical, mental, and contextual state. • Which is E-TIOBE’s aim? Offer personalized supervision, support and help to the patient 24 hours a day, 7 days a week and in real time.

11. Goals of E-TIOBE • Increase motivation • Enhance treatment adherence • Enhance self-control • Weight loss maintenance • Relapse prevention promoting healthy habits • Including everybody involved in the problem

12. Process that allows communication of users who are in different locations (patients and clinicians) Three types of services: prevention, personalized treatment (including assessment and follow-up), and providing information about the problem (feedback). Four technology concepts: Ambient intelligence, pervasive computing, ubiquitous computing, and virtual therapy. Prevention Personalized treatment Feedback e-health systems

13. Ambient Intelligence • Electronic environments sensitive and responsive to people’s needs. • Network and intelligent sensors: physiological, psychological, and contextual information from the user. • Several sensorization technologies to monitor physical activity: i.e. GPS

14. Using computers to change attitudes and behaviors. Generate contents with the aim of change and/or reinforce the user’s behaviors. Pervasive Computing

15. Ubiquitous Computing The user/patient can have access to the system from everywhere and whenever he needs to. Mobile services and ubiquitous platforms that give the patient support and orientation regarding the treatment. The system can integrate inmediately the data generated by the different devices.

16. Virtual Therapy Virtual reality, augmented reality, virtual agents, and natural interfaces.

17. Applications of E-TIOBE • Clinician supporting application. The therapist can design a personalized assessment, treatment and follow-up, according to the specific characteristics of each patient. • Home supporting application. The system presents the patient contents and strategies that help him/her in the therapy process. It also allows the communication between the patient, the family, and the therapist and make possible the recording and processing of data throughout the whole process. • Mobile supporting application. It makes possible communication in real time and in different contexts. Help of the virtual agent.

18. e-TI – scenarios

19. e-TI – Clinician supporting application • 4 modules: • Data input • Treatment • Personalized treatment • Treatment Protocol • Patient Manual • Family Manual • Alarms Editor

20. e-TI – Home supporting application • Treatment View • Virtual agent (personalized) • 2D/3D games • Augmented reality games • Biometric monitoring

21. e-TI – Mobile supporting application • Self-monitoring • Virtual agent • Alarm view • Motivation/reinforcement messages

22. e-TI – Monitorization Physical health Physiological variables Monitoring What is he doing?, who is s/he with? Where is s/he? Geolocalization in and out Actions at home Physical activity How motivated is he? Treatment adherence Motivational level Positive psychology

23. Firstelementdevelopedby TIN (TherapyIntelligent Network), an open sensorizationplatformtodevelopintelligentenvironmentsorientedtothepatient. TIPS conectsthepatientwiththe e-therapyenvironmentstogetfeedback of thepatient’sstates. TIPS can get: Contextinformation: Geolocalization, physicalactivity. Physiologicalinformation: heartrate, skinconductance, breathingrate. TIPS can communicatewith: Mobile devices: PDA, cellphone. Computer TIS: (TherapyIntelligent Sensor) in theenvironment TIPS Module

24. TIPS Tamaño 7 x 5cm

25. Módulo TIPS Intelligentmodule: Digitalizes and processesthe sensor signals. Implementthecommunicationprotocol and managesthecommunications. Tamaño 7 x 5cm

26. Módulo TIPS Communications module : transmitsthesignalsvia Bluetooth orZigbee Tamaño 7 x 5cm

27. Módulo TIPS Physiological module: processes and treatsanalogicsignalsfromthesensors. Tamaño 7 x 5cm

28. Módulo TIPS Physicalactivity module: Detection of postures, physicalactivity and caloriesconsumption. Tamaño 7 x 5cm

29. Módulo TIPS Geolocalization module : outdoorlocalizationwith GPS Tamaño 7 x 5cm

30. Geolocalization Module xmlmessages are senttothe server Data can beviewed in real time viaInternet. Therapists can set actionpoints. PDA receivesthesignal and interactswiththepatient.

31. Physical Activity Module • It’sabletodetect: • Position • Level of physicalactivity • Frequency of steps • - Caloriesused

32. Physiological Module It captures physiologicalsignalsfromthepatienttodetectphysical and emotionalstates. Heartrate Skinconductance. Breathingrate Integrationwithintelligenttee-shirt

33. E-TIOBE: Hypothesis • CBT + medical treatment + new technologies systems (E-TIOBE): • Higher treatment motivation. • Higher treatment adherencia. • Maintenance of weight loss at mid- and long-term.

34. THE FUTURE • To conduct a clinical trial to test the efficacy of ETIOBE • To improve the efficacy and efficiency of current treatments for obesity. Thanks very much for your attention