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Massive Ideas for Health Innovation: How would you use data to improve health in your community?

“If you could do/build anything, what is one way that you would make use of data to improve health in your community?” That was the question posed at the recently concluded Massive Health + Massive Ideas for Health Innovation Contest. Organized by the good people at DC Health Innovation Week, we were impressed and very much inspired by the array of answers that came in. We thought we’d share a few snippets, but see the full list here:

“I’d like to make use of location data, and push little health challenges to participants at particular locations” “Integrate a map of my neighborhood, any neighborhood with calories burned by activity such that I can see if I travel from point A to point B by walking, pushing a stroller or riding a bike, I will burn so many calories. The map, or app applied to a map, can also show negative impacts if travel is done by car – calories NOT burned and carbon added to the environment.” “I’d take data from the We Eat in America (WWEIA), NHANES and US Census Current Population Survey datasets and create a series of “Hot Spot” maps – showing counties with the lowest fruit & vegetable intakes, with the highest incidence of obesity, highest periodontal disease, lowest occurrence of vaccinations, etc. I’d overlay it on neighborhood maps, showing the density of various categories of health, food & fitness businesses & services – flagging areas with poor access to low-cost/free space for physical activity, little access to fresh produce, no access to low-cost vaccinations, etc. THEN I’d overlay open/unused space. Do we see an area nearby with critically low average veggie intake? Let’s look at food access options and figure out the reason why — then community groups can either work with existing local businesses to improve veggie promotion… or spot an open lot to start a community garden.” "I’d like to build a data set out of the following information: My current biometrics (typical “know your numbers” stuff) + An assessment of my health risks (do I smoke? drink? have family history?) And use it to create a VISUAL, PREDICTIVE MODEL of my future health. To literally see … if I stay on this path, I’ll look like X and feel like Y in 10 years." That’s right, the possibilities are endless with data. Congratulations to the following individuals who were randomly selected to win Massive Health t-shirts for contributing their ideas:

PF Anderson Jessica Haufman Bridgette Collado Kristi Durazo Loran Stefani Maria Hayhow Suzanne Grubb Whitney Zatzkin Joyce Lee John Volock Do send an email to andre AT pulseandsignal DOT com to get in touch. We’re looking forward to DC Health Data and Innovation Week, where participants from all over the country come together to network and converse, applying useful data and ideas to transform health, and making better healthcare a reality.

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TEDMED Highlights: Here's to the future of health and medicine

After an invigorating three and a half days of TEDMED, we’re back. Intriguing talks. Brilliant People. Amazing conversations. And we can’t rave enough about it.

Me and Ryan from Pipette/RockHealth

Here’s some great highlights.

Healthcare is a long and winding road. It takes years and billions of dollars to find that wonder drug. Yet, a large proportion of drugs still get abandoned during the clinical trial phase, when they fail to be sufficiently effective for their indication. These drugs are stored in big pharma’s freezers, and forgotten. But if all goes according to plan, finding the holy grail could be significantly sped up. Francis Collins the Director of the National Institutes of Health shared how big pharma, academics and the NIH were discussing repurposing and rescue efforts for old and new drugs. Instead of discarding drugs that don’t make it pass clinical trials, these drugs would be tested for other indications. That’s a great example of how collaboration is advancing healthcare, allowing us to grow each other’s ideas and progress at a pace we wouldn’t be able to do ourselves. We’re excited to see what’s to come.

“The Obesity Crisis is centered around our culture, its part of our everyday lives. But to win, we have to lose” - John Hoffman

Obesity is a huge problem today. Swelling portions, an increased intake of unhealthy, over-processed foods. It’s become part of our culture. John Hoffman, HBO’s Executive Director gave a sneak preview to their much anticipated documentary “Weight of the Nation”, exploring the crux of our obesity problem today. Watch out for its premiere on May 14th and 15th.

As we move into an era of the Quantified Self, sophisticated technology is allowing us to collect better data so we can know ourselves even better than before. Meet Biostamp. Goodbye painful needles and clunky sensing devices. Hello sleek sexy smart-sensing skin. mc10's David Icke revealed how a thin, flexible seamless water-proof microelectronic device could record much better data in a way less invasive way. I hear they’ll be launching in the sports market first, and not healthcare per se. But still, it’s a glimpse of our future to come.

“Imagine owning and sharing our health data like how we share our lives on social networks.” - Dr Leslie Saxon.

The intersection between healthcare and technology was further explored when Dr Leslie Saxon shared her vision for how the Internet could change medicine. And that’s what she’s working towards at the USC Center For Body Computing. Together with her colleagues, she’s analyzed data from devices in more than 200,000 patients. By inputting this data and sharing them with healthcare professionals in the network, people are living longer. Diagnosing acute cardiac ischemia in a Nigerian gentleman in Mumbai from her home in Los Angeles by reviewing a 30-second ECG collected on an iPhone. That’s right. Just another example of leveraging expertise across the world. They’re using every day mobile phones to increase the health information flow and to create “Big Data” life analytics. It’ll allow us to study life patterns, identify disease, solve endemic health problems and most importantly give us more control over our health. Check out their everyheartbeat.org project which aims to build a platform to bridge the digital divide and connect more than 5 billion mobile phones in the world to the health ecosystem.

BIG DATA

At Massive Health, we're all about the power of big data. Our recent infographic drew some interesting trends and observations from the 7.68 million ratings of half a million foods by Eatery users from over 50 countries over a span of 5 months. Real data, collected from the real lives of people. We know that data is frozen knowledge, and useless unless we do something about it. That’s why we’re ardent supporters of the Data Health Initiative. The Data Health Initiative, as Todd Park, Chief Technology Officer of the United States shared, takes vast reservoirs of data in health, liberating it to people in the technology industry.

“We need to harness the power of data technology innovation to increase the returns for the people”- Todd Park, CTO.

Here’s to the future of health and medicine.

Till next year!

P.S. More TEDMED Photos here

HOW WE EAT: ANALYZING ½ A MILLION MEALS

“Data is ten times more powerful than algorithms.” – Peter Norvig1

The CDC says that today more than ⅓ of people are obese2. United Health predicts that 52% of Americans will be either diabetic or prediabetic by 20203. The interventions used to combat this crisis aren’t working. Meaningful large-scale data about how people eat in the real world is hard to come by: a ten thousand person study is often prohibitively expensive to run and the data is often collected using faulty after-the-fact questionnaires. Yet, it is that very data that we need to enable us to combat the crisis.

Today, we are happy to release the results of analyzing real-world eating of hundreds of thousands of people. And, to please your pixels, we’ve done it in infographic form. The data gives a never-before seen look into how people really eat.

The data was obtained from over 7.68 million food ratings of half-a-million foods by Eatery users from over 50 countries over a span of 5 months. As far as we know, this kind of data has never been available at this scale before. Did you know that San Francisco eats 4 times the amount of brussels sprouts as the rest of the US? Or that picking any specific diet (it doesn’t matter which) will, on average, improve your eating by roughly 20%? Or that poor eating is transmitted like a virus, with a transmission rate of 34.5% among friends?

We’ve been able to glean insight into how people think they eat, how they actually eat, where people eat, what they eat, when they eat, and with whom they eat. Each infographic tells a story regarding the effects of the who, what, when, where, and how on healthy eating. Click below to read them!

Veracity?

A quick note on the veracity of the data. We often get asked if crowd-sourced data can be trusted. We had a gut feel that the answer was “probably yes”.

Famously, one of the most accurate ways to guess the number of jellybeans in a jar is to average the guesses of everyone in the room4. The crowd-sourced method beats much more advanced algorithms. To test our hunch that the same applied in nutrition, we looked at the aggregate Eatery scores for all meals eaten in a city versus the published obesity level in that city5. It turns out there’s a strong correlation. Eatery data can accurately predict obesity levels of cities in the United States. That is, Eatery data strongly correlates with the healthiness of its users.

Furthermore, findings from the Eatery aligns with current scientific research. For example, the influence rate of food choices by friends matches closely with the obesity transmission rates6 described by Christakis and Fowler. Breakfast eating findings are also in line with research conducted on the effects of breakfast eating—that people who eat breakfast tend to eat smaller portions7,8,9,10,11 and healthier food throughout the day12,13. Additionally, as expected, controversial foods, such as coffee, diet soda, orange juice, and bacon are flagged with higher standard deviations from user ratings on the Eatery.

Data

If you are affiliated with a University and would like to use our anonymized data for research, please contact sylvia [at] massivehealth [dot] com.

References

Norvig, P. "The Unreasonable Effectiveness of Data." Internet: http://www.youtube.com/watch?v=yvDCzhbjYWs, Oct 11 2011 [Apr 19 2012].

“Nutrition, Physical Activity and Obesity.” Centers for Disease Control and Prevention. Internet: http://www.cdc.gov/Features/ObesityAndKids/, Oct 17, 2011 [Apr 18, 2012].

“The United States of Diabetes: New Report Shows Half the Country Could Have Diabetes or Prediabetes at a cost of $3.35 Trillion by 2020.” UnitedHealth Group. Internet: http://www.unitedhealthgroup.com/newsroom/news.aspx?id=36df663f-f24d-443f-9250-9dfdc97cedc5, Nov 23, 2012 [Apr 18, 2012].

Sunstein, CR. Group Judgements: Deliberation, Statistical Means, and Information Markets. U Chicago Law & Economics, Olin Working Paper No 219; U Chicago Public Law Working Paper No. 72. Aug 2004.

Christakis NA, Fowler JH. The Spread of Obesity in a Large Social Network over 32 Years. N Engl J Med. 2007; 357-370-9.

Clark CA, Gardiner J, McBurney MI, Anderson S, Weatherspoon LJ, Henry DN, Hord NG. Effects of breakfast meal composition on second meal metabolic responses in adults with type 2 diabetes mellitus. Eur J Clin Nutr. 2006;60:1122–9.

Liljeberg HG, Akerberg AK, Bjorck IM. Effect of the glycemic index and content of indigestible carbohydrates of cereal-based breakfast meals on glucose tolerance at lunch in healthy subjects. Am J Clin Nutr. 1999;69:647–55.

Nestler JE, Barlascini CO, Clore JN, Blackard WG. Absorption characteristic of breakfast determines insulin sensitivity and carbohydrate tolerance for lunch. Diabetes Care. 1988;11:755–60.

Pai S, Ghugre PS, Udipi SA. Satiety from rice-based, wheat-based and rice-pulse combination preparations. Appetite. 2005;44:263–71.

Pasman WJ, Blokdijk VM, Bertina FM, Hopman WP, Hendriks HF. Effect of two breakfasts, different in carbohydrate composition, on hunger and satiety and mood in healthy men. Int J Obes Relat Metab Disord. 2003;27:663–8.

Isaksson H, Sundberg B, Åman P, Fredriksson H, Olsson J. Whole grain rye porridge breakfast improves satiety compared to reﬁned wheat bread breakfast. Food Nutr Res. 2008; 52.

Levine AS, Tallman JR, Grace MK, Parker SA, Billington CJ, Levitt MD. Effect of Breakfast Cereals on Short-term Food Intake. Am J Clin Nutr. 1989;50: 1303-7.

A Tale of Two Meals: What's Really Making You Fat [Infographic]

Breakfast's really important to start your day right. Bacon and eggs or a bagel and cream cheese? Both tempting decisions. You opt for the less fattening option of bagel and ream cheese. But guess what? That's what's really making you fat.

Here are some references we used:

Hill, C. 2011. How does body absorb carbohydrates, fats and protein. Livestrong. July 10.

U.S. Department of Health and Human Services. 2008. Your digestive system and how it works. National Digestive Diseases Information Clearing House.

Collins, A. 2012. How fat is digested. Digestion of fats (Lipids).

Collins, A. 2012. Body fat explained. Guide to body fat (Adipose tissue)

Wertheimer, E and Shapiro, B. 1948. The physiology of adipose tissue. Physiol Rev. 28(4):451-464.

Shapiro, B. and Wertheimer, E. 1943. Phosphorolysis and synthesis of glycogen in animal tissues. Biochem J. 37(3):397-403.

You may find these references useful as well.

Rogers, CD. 2011. How long to digest pasta. Livestrong.

Sisson, M. 2007. The definitive guide to insulin, blood sugar and diabetes (and you'll understand it). Mark's Daily Apple.

Fitday. 2011. How carbohydrate metabolism affects weight.

Knepper, M. How carbohydrates, fats, proteins and hormones work to cause weight-loss or weight-gain. Annette Nay.

TEDMED: Imagining the future of health and medicine

Imagine a congregation of one thousand two hundred brilliant thinkers coming together. Now add phenomenal speakers from every kind of background into the mix. With a multitude of perspectives, they weave a rich tapestry of invigorating conversation about the future of medicine. All amidst the background of the picturesque John F. Kennedy Center for Performing Arts Opera House in Washington DC.  

That’s TEDMED. If there’s only one conference you can attend this year, this is it. And I’m thrilled to say that I’ll be there.

Besides meeting fantastic people and engaging in fresh and thought-invoking conversation with them, I’m excited to hear from a remarkably diverse group of thought leaders.

The talks all sound great, but I’m particularly psyched for these. On The Eatery, we’ve seen how users with diverse backgrounds and eating habits debate over the healthiness of foods, exchange recipes and get each other to eat healthier. Social’s really powerful. So I’m finding the talk “Do your proteins have their own social network” by Albert-László Barabási,- Director of the Center for Complex Network Research, Northeastern University, particularly interesting. It’s funny to think of proteins having their own social network, but when we distill our basic physiology to its core, we’re really a bunch of protein interactions. He also wrote the book Bursts which explores how we can predict human behavior as its not as random as we think.

Andrew (@carmandrew) and I attended a talk by Jane McGonigal (@avantgame) several weeks back on The Power of Gaming. It definitely shed a new light on gaming for me, how gamers could come together to figure out solutions to a world crisis, or how gaming could evoke positive emotion and make one feel happier and more confident about themselves. “Why is my joystick smarter than your stethoscope" (Seth Cooper, Creative Director, Center for Game Science, University of Washington) should be an intriguing follow up to this. I’m especially looking forward to getting more insight into the application of gaming in medicine.

Another thing I’ve observed on The Eatery is how users have encouraged each other to eat healthy, less processed foods. Unfortunately, we live in a world where the cheapest foods are the most processed and unhealthy ones. Hopefully, things will improve though. I’m interested to hear Joel’s take on this, with “Can real food from real farms lead to real health” (Joel Salatin, Beyond Organic Farmer and Author). We believe “health happens between doctor’s visits”. We have to take charge of our own health, we can’t be relying on our physician all the time. Yet, the products out there don’t allow us to do that easily right now. How can we make healthcare more consumer-friendly then? “Why don’t patients behave like consumers” (Jon Cohen, Senior Vice President, Chief Medical Officer and Director of Hospital Services, Quest Diagnostics) seems like an interesting talk to explore this topic.

Oh, and I almost forgot, but there’s even a talk by the Cookie Monster “Is ‘C’ for more than just cookie” (No, I’m not kidding).

 Then there’s the other highlight; TEDMED’s Great Challenges Program. It entails groups of scientists coming together to decide on the problems that we first need to solve, and where we should focus our efforts on. During the conference, 50 knowledgeable individuals will serve as advocates for 50 different proposed challenges. TEDMED Delegates then vote on the top 20 final Great Challenges, and in the months following each year’s TEDMED, a lively national dialog is generated. Our friends from Shape Up (Rajiv Kumar) “Inventing Wellness Programs that Work” and Start Up Health (Steven Krein) “Dealing With Medical Information Overload” as well as Rock Health’s Halle Tecco (Developing Tomorrow’s Medical Leaders) will be lobbying on the ground, so do find about the great stuff they’re working on.  

At Massive Health, we’re all about creating a design renaissance in healthcare. Our bodies aren’t the best feedback system and we want to fix that. We want to make beautiful products that aren’t just functional, but that people want and love to use. As part of the Massive team, its what I stand for as well. I’m also interested in how technology can be used for behavior change as well as the myriad of different initiatives and innovations working towards better healthcare for all. It’s fascinating. So come say Hi if you see me, I’d absolutely love to know what you’re up to.  

Won’t be able to attend TEDMED? You can always watch TEDLIVE simulcasts. You can stream from the official website, or perhaps a nearby school will be organizing one. Even better, you’ll be able to join in the conversations by submitting questions.  Will you be at TEDMED? Leave a comment or say Hi on Twitter (@cassandra_leong) - I’d love to catch up. And I might have a few snazzy Massive Health tees around too. What are you most passionate about in the future of healthcare and medicine?

How Much Is Too Much: 12 Strategies for Portion Control

We’ve all heard that portion control is really important for healthy eating. In fact, it may help enhance weight loss. But it’s hard. How do you measure a portion size anyway? It’s hard to tell how much one cup is. And even harder in this era of super-sized foods.

You could try visual aids.

But that's still a little difficult to remember.

We’ve made portion size really easy to track on The Eatery. First, tap on the portion icon. It'll bring you to the screen of a plate. See that irresistible white pulsing circle? Touch and drag it to indicate portion size. Rather than measuring in cups, its a lot easier to have a general indicator of portion size relative to the amount of food on your plate. Have you tried this function?

Tap on Portions

Touch and drag the white pulsing circle. But although its easy to track portions on The Eatery, I still find myself having an inordinate amount of food sometimes. So I’ve been looking for simple ways to practise portion control. Here's what I found. The best part? It’s really not that hard.

Small servings Try using smaller plates, bowls, forks and spoons for your meals. You think you’re eating more because your plate seems fuller.

See how plate size makes a difference?

I was surprised to discover that the yogurt in a cup had way less calories than the yogurt in a bowl, even though the latter seems like a much smaller portion.

Credits: SnackSense

Divide snacks into smaller portions. Portion that big bag of chips into 12 ZipLoc bags, so you won’t find yourself finishing an entire bag in one sitting.

Wait 20 minutes before getting seconds That's how long it takes to get full, so if you give yourself a “breather” you may realize you’re not so hungry for that second serving after all.

Leftovers? Divide them into small portions instead of one large container. It’s a lot easier to reheat the next time too.

Be a picky eater

Credits: Babble

Start your meal with a salad. It’ll keep you from overeating by curbing your appetite while giving you a sense of satiety sooner. Plus, all that nutrient goodness - fiber, vitamins and minerals in wholesome veggies.   

Make meat a side dish. By loading up on vegetables and healthy grains as the bulk of your meal, you’ll feel full sooner and get those extra nutrients.   

Eating out 

Order an appetizer as an entree or split an entree with your dining partner. Restaurants usually have large portions, so decide how much you will eat and only eat that amount.  

Separate half of the meal into a doggie bag. You’ll be less tempted, and you’ll get two meals for the price of one.  

Stay away from Supersizing. Don’t get carried away with bigger portion sizes just because its a good deal for your wallet; your waist and health will pay for it later.  

At work

 Don’t forget to eat. I know work can get crazy busy, but schedule meals and snacks so you don’t go hours without eating. You don’t want to put yourself at risk for overeating later.   Keep snacks a bit further away, like in your office pantry rather than on your desk. This reduces the likelihood of ‘desktop dining’, where you reach out for that snack every time you look over, even when you aren’t really hungry.

Always bring an afternoon snack with you. Prevent unhealthy temptations tempted, like donuts from the nearby cafe. Our recent satiety infographic suggests some easy snacking swaps that keep you fuelled throughout the day while being less likely to give you that dreaded energy crash later. Pro-tip: If you’re looking for a quick snack, grab an orange instead of that banana.

I know we promised a dozen, but here's a bonus.

  It’s okay to snack healthily. It can help control calorie intake and cravings. You don’t want to deprive yourself of food, that’s only going to trigger over-eating later.  

Any tips or tricks on controlling portion sizes? How does your workplace do it? Let us know in our comments section or on Twitter.

Recently we’ve been conducting quick chats to really understand our Eatery users better; what their health goals are, and what they like/don’t like about The Eatery. It’s been really exciting to learn how The Eatery plays a part in your lives. The feedback's been really useful so far, especially as the team continues to work on improving The Eatery. This post is also dedicated to Susan Robbins (@susanbdot)

who we got to know through another user, Jason Lesko (@RealSuperSized)

Thank you for the great conversation and multitude of new perspectives!

Interested in helping out? We love hearing from our users, so drop me a note at [email protected]

Friend Massive Health on facebook.

Follow @massivehealth on twitter.

Tracking your food isn't easy, but The Eatery app makes it a lot simpler.

Eating right is hard. We make it easier.

Lots of apps tell you what you ate. Only the Eatery can tell you how you eat.

Download the latest version of The Eatery here!

Taking Pictures of Your Food Makes You Healthier

Guest post by Lauren Abda. Lauren is a MS Candidate in Food Policy, Nutrition and Entrepreneurship at the Tufts Friedman School of Nutrition Science and Policy. She’ll be embarking on her fellowship at the World Health Organization soon.

At Massive, we do occasional brown bag lunches where we share the interesting things we’ve been involved in with the rest of the team. We invited Lauren to share with us how behavior change could be used to promote healthy eating - specifically, how merely tracking your food could help you eat healthier. We really wanted to share her talk with our Eatery users, so she’s kindly written a guest blog post for us. Enjoy!

Lauren at the Massive Health office Capturing Health, One Picture at a Time How documenting what you eat can improve your health Do you remember what you ate for lunch yesterday? How about two days ago? Chances are you were more concerned about satisfying your taste buds between meetings than maximizing your nutrition. Choosing what to eat has become a weighty decision influenced by friends, family, media, and the fit of your most recent shopping purchase. While these various influences can sway your immediate decision, they do not always contribute to lasting healthy behavior change.

Credits: 110pounds.com

A study published by the Kaiser Permanente Center for Health Research discovered that participants who kept food journals lost twice as much weight as those who did not. Documenting what you eat requires accountability, can reveal patterns, and allows you to establish realistic health goals. Whether you want to eat healthier, feel better, or lose weight, recording what you eat can help you achieve your objective.

Establishing accountability - Eating is akin to listening. Some information goes in one ear and out the other. In the case of food, some meals go in with little recognition or recollection. Food journals force you to consider what you are eating, how much, when, and where. Tracking your consumption can highlight patterns and habits that may have otherwise gone unnoticed. Identifying a problem - Repetition is often said to breed success. In the case of food, however repetition only breeds repetition. Before you know it, you’ve made a habit of eating a donut while reading through your emails every morning. This pattern may go unnoticed due to divided attention, deadlines, to-do lists, meetings, and deciding where to grab lunch. Recognizing such habits can reveal actionable health insights that you can begin to address. Achieving your goals - Identifying an unhealthy pattern is the first step in fixing it. While you might not have realize it, you developed a habit of buying a pastry with your morning coffee. However, when you brew coffee at home and bring it to work, you don’t eat a pastry. If you are trying to cut down on sweets, you might avoid buying a pastry, but you might avoid tempting yourself by purchasing coffee too. Making your morning cup at home can reduce your exposure to those tempting sweets and can help you stick to your ultimate goal of eating less sweets.

The Eatery app created by the team at Massive Health incorporates the components of lasting health behavior change. Along with a beautiful user interface, the app allows its users to access the benefits of journaling while eliminating the additional step of actually writing it down. With a simple picture, one can log what they are eating, when, where, how much, rate its healthiness, and get feedback from other users. With this app, a picture really can say a thousand words about your health.

Friend Massive Health on facebook.

Follow @massivehealth on twitter.

Tracking your food isn't easy, but The Eatery app makes it a lot simpler.

Eating right is hard. We make it easier.

Lots of apps tell you what you ate. Only the Eatery can tell you how you eat.

Download the latest version of The Eatery here!

Popcorn for Antioxidants and Chocolate for Weight Loss

In our recent infographic about the best snacks to fuel your day without giving you that dreaded sugar crash, we eschew potato chips for popcorn.

View the full infographic.

But even better, researchers at the University of Scranton in Pennsylvania have found that popcorn contains more antioxidants than other fruits and vegetables, per serving size. So yes, popcorn may just be the perfect snack food to keep you going.

They aren’t advocating that you replace all your fruit and vegetables, which are chock-full of other important nutrients, with popcorn. And obviously, drowning it in butter or sugary flavorings is going to offset the nutritional benefits. But it’s something to consider the next time you need a quick snack.

In other news, could chocolate have health benefits too? Yesterday, a New York Times Article cited a study showing that people who eat chocolate frequently had lower body mass indexes. While researchers could not explain why something loaded with sugar, fat and calories would have a beneficial effect on weight, they suspect that antioxidants and other compounds in chocolate may deliver a metabolic boost that can offset its caloric downside. Other studies have also found that regularly eating chocolate may lower blood pressure and cardiovascular risk, and improve cholesterol and insulin regulation. But don’t go crazy with chocolate overindulgence just yet. It seems like its the frequency of chocolate consumption and not the amount per serving that has a beneficial effect on BMI. Indeed, the study showed a small trend toward higher BMIs among those consuming larger amounts of chocolate per sitting.

What’s your favorite quick fix snack food? Chocolate-coated popcorn? Mmm. Let us know in your comments or on Twitter.

Friend Massive Health on facebook.

Follow @massivehealth on twitter.

Using The Eatery app is one of the best ways to eat healthier.

Eating right is hard. We make it easier.

Lots of apps tell you what you ate. Only the Eatery can tell you how you eat.

Download the latest version of The Eatery here!

Some Common Questions about the Cookies vs. Bananas (Satiety Index) Infographic

We’re thrilled about the great response from our infographic so far! Have you been choosing better snacks to keep you energized throughout the day? Some readers were curious and wanted to know more about the science behind the infographic, so we thought we’d share how we came to these conclusions and answer those burning questions you have.

Credits: TimeUnion.com

Could you tell me more about the glycemic index in the chart? Don't apples have a lower glycemic index than oranges? Why is this flipped?

In the Satiety Index experiment by Holt et al. (1995), a group of 11-13 participants were given various 1000kJ portions of test foods and their satiety response was then quantified to get a sense of how much a certain food filled you up.

As such, to accurately find the best foods to keep you full without that dreaded energy crash, we mapped the Satiety Index against the Glucose Score. The Glucose Score was the measure used in Holt et al’s (1997) study of the Insulin Index of Foods, and was obtained by the AUC for the 1000kJ test food divided by AUC for the 1000kJ white bread x 100%. While the glucose score indicates how quickly your blood glucose rises after consumption of a specific test food, it’s different from the glycemic index of food, which is traditionally calculated by the area under the 2 hour blood glucose response curve (AUC) following the ingestion of a fixed portion of carbohydrate (usually 50g), divided by the AUC of the reference food x 100%. Since Holt et al. (1995) used a standard 1000kJ portion of food rather than a specific weight of 50g to counter for the effect of certain foods being more energy-dense and hence having greater satiety than others in the calculation of the Satiety Index, we used Glucose Score as a more appropriate gauge of blood glucose increase. This is how the glycemic index for an apple (50±6%) appears to be higher than that of an orange (39±7%) in the infographic, and similarly for brown (68±10%) and white (46±10%) pasta. That said, using the traditional formula would demonstrate that apples have a lower glycemic index when calculated by the traditional formula, as some have pointed out. However, we thought it would be more appropriate to use the modified glucose formula instead to accurately reflect the use of a 1000kJ test food in the study.

Won't foods that require a larger serving size to provide the standard 1000kJ portion naturally make one fuller?

In the derivation of Satiety Index, a 1000kJ (240kcal) portion was chosen as a practical serving size to distinguish between the short-term satiating capacities of different foods. Fish was found to have a higher satiety index score (225±30%) compared to beef (176±50%). This probably seemed natural given that one would have to consume a bigger portion of fish as it was less energy-dense and hence participants would have felt full faster. Holt and colleagues did indeed find a strong correlation between the Satiety Index score and serving weight of food, despite food being given under a hood and pulled out in an attempt to minimize subjects’ preconceptions of the hedonic and satiating properties of the test food. However, this was due to differences in macronutrient breakdown rather than serving size. For example, fish had just 1.0g of fat out of a 333g serving (0.3%) compared to beef with 7.7g fat out of a 158g serving size (4.9%). As such, normalizing for calories rather than weight was deemed appropriate in this case.

The study had a small sample size, how accurate is this? While this study was conducted with a pool of 11-13 patients, it does provide a reasonable degree of power and precision, 80% power at a level of P<0.05 (two-tailed) for this purpose. Most studies of glycemic index have been derived from sample sizes of 10 patients because they provide useful results, and large improvements in power and precision would require two to three times more subjects and corresponding increases in time and resources (Brouns, Bjorck and Frayn et al. 2005).

How can you compare bananas to cookies? They contain all the good nutrients that cookies don't.

We’re not saying that bananas are as unhealthy as cookies. Because, yes, bananas are chock-full of good nutrients. However they give you the same amount of satiety, and then that sugar crash later on as cookies or french fries. So next time you’re feeling peckish and need that fuel to keep you going throughout a hectic day, don’t decide between a banana or a cookie, but grab an orange instead. We thought the story behind the infographic might interest you, and we’d love to hear your thoughts! Thanks again for reaching out and contributing to this engaging discussion!

References

Holt SH, Brand Miller JC and Petocz P. 1997. An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr. 66(5):1264-76.

Holt SH, Miller JC, Petocz P, Farmakalidis E. 1995. A satiety index of common foods. Eur J Clin Nutr. 1995. 49(9):675-90

Brouns F, Bjorck I and Frayn KN et al. 2005. Glycaemic Index Methodology. Nutrition Research Review. 18(1):145-71

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Using The Eatery app is one of the best ways to eat healthier.

Eating right is hard. We make it easier.

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Are Bananas Really as Bad for You as Cookies? [infographic]

Bananas may have more nutrients but they fill you up and give you the same sugar crash as a cookie.

Some foods fill you up and others leave you feeling hungry. There's a science to that: it's called satiety.

Three easy swaps to help you feel full throughout the day:

Replace breakfast cereal with all-bran for a 30% improvement

Replace bananas with oranges for a 71% improvement

Replace potato chips with popcorn for a 69% improvement

View the full infographic.

Learn more about the science of satiety and the glycemic index:

Holt SH, Brand Miller JC and Petocz P. 1997. An insulin index of foods: the insulin demand generated by 1000-kJ portions of common foods. Am J Clin Nutr. 66(5):1264-76.

Holt SH, Miller JC, Petocz P, Farmakalidis E. 1995. A satiety index of common foods. Eur J Clin Nutr. 1995. 49(9):675-90

Roberts SB. 2003. Glycemic Index and Satiety. Nutr Clin Care. 6(1):20-6

Anderson GH, Woodend D. 2003. Effect of glycemic carbohydrates on short-term satiety and food intake. Nutr Rev. 61(5 Pt 2):S17-26.

Jiménez-Cruz A, Manuel Loustaunau-López V, Bacardi-Gascón M. 2006. The use of low glycemic and high satiety index food dishes in Mexico: a low cost approach to prevent and control obesity and diabetes. Nutr Hosp. 21(3):353-6.

Tips on delicious recipes with a high satiety index:

Skarnulis L. 2012. Satiety: The New Diet Weapon. WebMD.

Thomas T. 2010. Eat less but still feel full. How you can shed pounds by playing tricks on your brain. The Daily Mail. 3 August.

Shape. 2009. The Feel-full Diet. May 7

Delicious Magazine. 2009. Foods to stop hunger pangs. June.

Kelly E. 2009. The 10 Most Filling Foods For Dieters. Examiner.com. May 4.

Health.com. 2012. 7 Foods That Fight Fat.

Friend Massive Health on facebook.

Follow @massivehealth on twitter.

Using The Eatery app is one of the best ways to eat healthier.

Eating right is hard. We make it easier.

Lots of apps tell you what you ate. Only the Eatery can tell you how you eat.

Download the latest version of The Eatery here!

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Massive Health heads to #SXSW - Six of the Best Health Tech Events

We're really thrilled to be at SXSW Interactive from March 9-13 this year! Exciting panels, inspiring talks and great conversations with others who care about the same things that we do, we’re looking forward to it!

Here’s our take on the things that we can't stop talking about:

This SXSW, we're psyched to be hosting the 2012 Interactive Health Happy Hour #sxswh #ihb3 in conjunction with HCBHealth, HealthTap and iTriage. We'd love for you to join us for an exclusive evening of food, drinks and fun (and of course, shenanigans) with other awesome SXSW attendees. Connect with the top influencers in healthcare, indulge in Neiliyo's tunes and dig in to great food. And engage in some fun photo-bombing with a FlipBook PhotoBooth! Apparently there's already 500 confirmed guests and a whopping 2000 on the waitlist. So if you haven't RSVPed, here's your chance. We hear the organizers may bring more tickets online. You really want to be there, because we promise it'll be a fantastic night. Psst, if you're on the waitlist, let us know why you'd like to join us and we'll try our best to get you on the guest list.

Aza (@azaaza), our co-founder will also be speaking at an intriguing SXSWi panel this year "Launching Companies In Regulated Industries". Comprising of Shamir Karkal, Adam Oliveri, Matt Harris and Jessica Scorpio, the panel will explore how startups can navigate the daunting regulations and competition, transforming industries and dramatically improving the status quo.

Here are our choice picks of other intriguing panels and conversations taking place.

The Future of Digital Health Monday, March 12, 11-12pm, AT&T Conference Hotel Classroom 204 At Massive, we're all about the intersection of health and technology. This panel will discuss the future of health information, apps, interactions and disruptive emerging trends in health. We’re excited to hear from our friends, Rock Health, Cake Health, HealthTap, Curious, and Wired Magazine. Crowdsourcing a Revolution: Can We Fix Healthcare? Saturday, March 10, 11-12pm, AT&T Conference Hotel Classroom 204 Challenges have spurred people to collaborate and create innovative apps and games to help solve problems in healthcare. Learn how we're doing so far, from Aman Bhandari, Senior Advisor to the CTO, US Department of Health & Human Services. Wireless Wellness: App-tastic or Just Fun & Games Friday March 9, 2-3pm, Austin Convention Center Ballroom D Join Ina Fried of All Things Digital and Aetna Chairman Mark Bertolini discuss how people are using mobile tech, to manage their health and make better decisions. Fit Together: How Fitness Goes High-Tech + Social Saturday, March 10, 5-6pm, Omni Downtown Capital Ballroom We’re intrigued with how tools like Nike Plus, Fitbit and RunKeeper enable people to track their fitness, and learn from peers and professionals. Get updated about these technologies and where they’re heading. We can't wait to attend these really unique and exciting events too, only at SXSW! Check out the Social Health Startup Bootcamp and learn more about up and coming healthcare startups at the Interactive Accelerator, including Pipette, Cellscope, Bodimojo, Jiff, Beyond Lucid and Simplee.

Seeking respite from the hustle and bustle of SXSW? We'll be chilling out and getting awesome massages at Rock Health’s Zen Den . You can check out the hottest health startups here as well from March 10-12 between 12-5pm.

Any other rocking events we should know about? Do leave a comment.

Will you be at SXSW? Drop us a note @massivehealth! We’d love to meet you. It’s my first SXSW conference and I’m really excited. I’d love to hang out, just ping me @cassandra_leong. That's me on the left, with Andrew Carman (@carmandrew). Another reason to say Hi, we're giving out awesome Massive Health tees! Aza (@azaaza) and Andrew (@andrewrosenthal) will be out and about too.

We're hiring for front-end, rails and iOS devs, data scientists, as well as UX/Product and visual designers. and we're especially looking forward to catching up with people who applied, or those thinking of coming onboard the Massive Health team in Austin!

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Top 3 Reasons to sign into The Eatery with Facebook

Why should you connect to Facebook?

1. Get the best feedback

Not sure how healthy your meal is? No idea why the crowd's rating your meal down (or up)? Start a conversation.

2. Backup your data

By connecting to Facebook, you’ll be able to access your previous data when you reconnect to Facebook even if you were to accidentally delete the app.

3. Become part of The Eatery community

It allows you to have a voice. See some tantalizing meal? Ask nicely and you might get a recipe. Home-made isn’t that hard. Running out of healthy meal ideas? Intrigued by what others are eating? Follow another Eatery user or your Facebook friends and see their meals in your feed. It’s like a constant treat of Fit or Fat.

P.S. No we don’t post stuff on your Facebook wall, we promise! The reason why we encourage you to connect your Eatery account to Facebook is because we want you to have an identity on The Eatery. Join the community!

P.P.S. If you’ve not connected your Eatery account to Facebook before, your previous anonymous data will be saved to your Facebook account.

Was this helpful? Let me know.

Or see our FAQs.

The Eatery gives you the big picture breakdown of your eating habits, strengths, weaknesses and the best place to start making a change. You can download it for free at the App Store.

If you have any questions/issues/thoughts, please drop me a note.

Opaque: Prototyping Clear App in a Day

Clear, a todo-list app by Realmac Software recently took the tech and design community by storm with its sexy new take on no-button, gestural interfaces. For those who haven't seen it, it's worth watching their intro video. It exudes class. We tip our collective Massive Health hats to Clear's great work.

In addition to the novelty of the gestural interface, Clear had an exceptional new visual metaphor for manipulating and adding todo items: simple paper-like folds. Being a fan of wonderful products that surprise and delight, we spent a day recreating some of Clear's primary user interactions and wanted to share what we learned (and our code) with the wider community.

Please don't take the code and just recreate Clear—that's not nice—but do use the techniques as a source of inspiration for your next project.

We implemented a number of the interactions: pull to create, pinch-open to unfold a new todo, pinch-close to fold away a todo, and of course a way to do it all programmatically. For the impatient, you can get the repo here. Here it is in action:

How Did You Do That?

To recreate Clear's effects, all it takes is some Core Animation layers, trigonometry, gesture recognition, and more trigonometry. Sitting comfortably? Here we go.

Clear has four different cell states which we've named fold back, pinch, fold up, and flat:

All four of these states don't need to be special cased in our code, although it may appear that way at first glace. If we lay the problem out correctly they can all be represented with the same five lines of code. We start by splitting the layer into two parts and defining two anchor points: at the bottom of the top half, and the top of the bottom half. Here's the code (we're taking advantage of Core Animation's 3D transforms):

What's going on? Each state can be constructed by translating the top or bottom layer by its anchor point by [z=h*sin(θ)] and rotating by angle [θ=cos-1(y/h)] where y = ½ the current cell height and h = ½ the original cell height.

In order to make the 3D projections line up properly and dramatically simplify the math, we change the anchor points of the layers to align with the center of our parent folding layer. For those of you following along at home, that's (0.5, 1) for the top layer and (0.5,0) for the bottom layer. If we don't transform anything we already have the flat layer.

One down, three to go.

As we shrink the height of our layer, we need to rotate the layers forward by the appropriate θ so their edges touch the front plane. You might be tempted to just skip the 3D and use 2D transforms to fake the effect. Trust us, that approach will end in tears. To get the pinch effect we rotate the top and bottom layers by the appropriate θ and -θ so the layer halves stay the same height. This puts the layers in front of the screen so we need to translate the layers back by z. That's 2 down. If we want to fold instead of pinch, translate the layers back by z and rotate both layers by θ or -θ and they will line up. As you can see above, that's just one CATransform3DMakeTranslation and one CATransform3DRotate per layer half and we're done.

What about pinching and stuff?

The use of contextually appropriate gestures are what make Clear really shine. For gesture management in iOS5 we can use UIPinchGestureRecognizer & UIPanGestureRecognizer. This example uses a full screen UIScrollView for bouncing and scrolling large lists and adds a bunch of our folding layers directly to the scrollview's layer. The approach is to create a new layer when a gesture begins, adjust the size of your layer when the gesture changes, and finalize/delete the layer when the gesture has ended. At the end of each gesture change state we relayout our layer frames. Thanks to Core Animation our layers will animate between states for you automatically.

Want more specifics? The nitty-gritty is all in the code.

Give me the code!

Want to do something like this in your project? Want to contribute? The source is hosted over here on github. We call it Opaque. Feel free to fork it and make it your own. Just submit a pull request if you've got something cool.

Read the source for a full understanding of how it works—this blog post talks about the most important parts, but clearly doesn't cover everything. The code is also just a prototype. If this were a production app, some obvious improvements would be:

Layers should track finger locations when pinching to create layers rather than using the pinch scale.

Use UIViews backed by custom CALayers instead of using raw layers in our view hierarchy.

Support arbitrary view hierarchies and avoid the two-text-field trick we used by rendering the cell contents into an image and using that as the layer contents while animating.

Create a MHFoldingTableView with a datasource and delegate and move our layer/cell layout into that view instead of the gesture recognizer.

Interested in building awesome software to save lives and change the world for the better? So are we, and we're hiring! Head over to our Jobs page and send us your resume.

Please send thoughts, feedback, improvements, ideas, haikus, hatemail, and suggestions to [email protected] and you can find me on Twitter at @yipe. Massive Health is not affiliated in any way with Realmac Software. We hope you take some of these ideas and build innovative new products with it!

A bit about the author: Michael recently ran a leading mobile agency producing award-winning iOS apps and mobile strategy for Fortune 500 brands. He also built AppleTV’s cinematic user experience, shipped beautiful apps for Apple’s Mac OS team for 6 years, and traveled Southeast Asia for a year with two cameras and a large unkempt beard. He’s excited to be back building products that matter.

Oops we accidentally posted this on Aza's Tumblr account - this post was written by our awesome engineer, Michael Margolis (@yipe) though.

Now presenting: The Eatery Awards

We love our users on The Eatery. Besides the insightful feedback that they’ve been giving, we’re learning so much from the great insight and conversations going on on The Eatery and the inspiring, healthy meal idea. So of course we had to say Thank you. We’ll be rolling out special Eatery badges of honor in the next few days (ahh like our very own Oscars), and since we’re all about good conversation, our first award is... *drumroll*

Chew On It Meals that get people talking. Yup, whether you’ve been exchanging recipes or debating over how healthy your coffee or tea is (see previous blog post), we love discussions like these.

Other tidbits we have in store...

The Out of This World Award The most interesting exotic meal. So far, ‘Tarama with Bread’ has got to be the winner for me.

According to Edouard, “it’s a typical meal : “mezze” ) from Greece and Turkey that we eat often in France, before the dinner itself (“aperitif”). It’s a mix of bread, oil, fish eggs and other spices.”

Love Lettered The meal that gets the most likes. See something interesting or pretty on the Eatery? Show some love. We’ve heard users mention that they’d like to see all their previously liked meals, we’ve shared your suggestions with the team!

Hello Delicious For those unbelievably pretty photos. Because gorgeously beautiful food porn makes people happy.

We heart healthy

Meals that give us inspiration, that push us to realize that hey, it's not that hard to eat healthy. And yummy.

Meanwhile, keep those recipes, tips and suggestions coming. We’re watching out for ya. Want to join our Eatery community? Just download The Eatery. It’s available for free on the App Store. If you’d like to join the conversation, connect your Eatery account to Facebook.

How we get our awesome Massive Health jackets, want one?

We’ve gotten lots of compliments on our snazzy Massive Health jackets.

It’s our identifying trait; that helps you spot us from afar at conferences, or on the streets of San Francisco! I love how they’re so warm and comfy. So we thought we’d share our little secret.

The jackets are actually from Patagonia: The Better Sweater BLK-155 Jacket. Pro-tip, nice savings if you order the jackets directly from Corporate Sales and not the local retail locations.

Want to get in touch? Drop us a note/tweet and we’ll pass you their contact.

Our beautiful embroidered logos are done by Jaron Logo (at 4th and Harrison in San Francisco, near our office). They’re open from 9am -5pm Mon- Fri. They’re great people, with really quick turnaround time. We’ve never had a problem. There’s a one-time set up fee for the embroidery at Jaron, in addition to the per-item fee. You can email them at [email protected]

Now you can show us your awesome jackets. You're welcome ;)

You may have seen some of our loyal users and friends wearing Massive Health t-shirts... but the only way to get a jawdropping Massive Health jacket is if you come work here. Interested in joining the team?

Check out our open positions: Front-end engineers, back-end engineers and visual designers.

Meeting Another User and Finding the Prettiest, Healthiest Fruit Tart

The Eatery’s all about showing the big-picture breakdown of our eating habits and identifying where you can start making changes.

Have you ever had conversations through The Eatery with other users? I certainly have!

I love it when I get involved in a fascinating conversation about healthy food with other Eatery users. Or get an inspiring wholesome idea or recipe from the meals appearing in my Feed or in Fit or Fat. I especially like how its just so easy to reach out to any Eatery user and ask about a delicious meal! I’ve always been interested in the raw food movement. It's intriguing how you can make great meals without any heating whatsoever. A few days back I saw that Vanessa (one of The Eatery users whom I follow) had posted a really pretty picture of a raw homemade ‘tart’ with coconut oil, vanilla, almond with organic fresh berries. How can you not resist that? Of course, I immediately commented and asked how she made it. She was so sweet about it, and gave me the recipe:

Super super easy! Take a few cups of raw walnuts and pecans, take about four raw dates and put into a food processor. Stop at the consistency you want the "dough" to be in (crunchy or smoother). Then form in a tart pan, refrigerate for an hour or so, add the filling and enjoy.

By the way, Vanessa's one of my favorite users on The Eatery and I'm always looking forward to seeing her meals in my feed because she does really creative variations of all kinds of health foods. She blogs here too, and incidentally just did a great post on this same dish (with raw fudge cacao fudge too).

An excerpt below:

Here is what you need:

1 cup of raw pecans

1 cup of raw walnuts

1 teaspoon of ground vanilla (click to see where I get mine) or vanilla extract

1 heaping tablespoon of raw coconut oil

1 pinch of pink sea salt

4-5 organic dates (honey or medjool)

Fresh berries, apples, coconut or whatever else that you would like to have for the filling

Thought I’d share the recipe here, enjoy!

Interested in coming onboard The Eatery? You can download it for free at the App Store. We also set up our FAQ page recently!

Why Eating Fat Doesn't Make You Fat: Sources

The politics of eating is a funny thing.

At Massive Health, we talk about the power of feedback loops to change behavior. The answer to why they work is nuanced. Boiled down, though, it's simple: our brains are wired to reward us for learning patterns. When there isn't a good feedback loop, we still draw conclusions, but they are much less likely to be the right ones. One of the reasons there are so many diets (yep, over 100 named ones) is that it's hard to figure out what works. The lag between eating a certain way and the way it affects your body is long.

There's a lot of research on eating both questionable and valid. One of the reasons we love building The Eatery is that, for the first time, it gives insight into the way people eat at massive scale. We hope to be able to start answering some of these questions with that big-data buzz word.

Yesterday, we released an infographic that got people talking. A lot. It has a bold claim: eating fat doesn't make you fat. With all the questionable data on eating, where did we get ours? A lot of it came from a book "Why We Get Fat" by Gary Taubes, which is a shorter version of his much longer literature-review book "Good Calories, Bad Calories". Both are great books (the first has 18 pages of sources) and we definitely recommend people read it. Those weren't the only sources, however. Here are the primary sources we used behind the infographic.

Sources and Resources

Gardner, C.D., A. Liazand, S. Alhassan, et al. 2007. “Comparison of the Atkins, Zone, Ornish, and LEARN Diets for Change in Weight and Related Risk Factors Among Overweight Premenopausal Women: The A TO Z Weight Loss Study, a Randomized Trial.” Journal of the American Medical Association. Mar 7;297(9):969-77.

Ernst, N. D., and R. I. Levy. 1984. “Diet and Cardiovascular Disease.” In Present Knowledge in Nutrition, 5th ed., ed. R. E. Olson, H. P. Broquist, C. O. Chichester, et al., pp. 724-39. Washington, D.C.: Nutrition Foundation.

U.S. Department of Agriculture (USDA). 2000. “Major Trends in U.S. Food Supply, 1909-99.” Food Review. Jan.-April; 23(1):8-15.

Jenkins, D. J., C. W. Kendall, L. S. Augustin, et al. 2002. “Glycemic Index: Overview of Implications in Health and Disease." American Journal of Clinical Nutrition. Jul; 76(1):266S-73S.

Johnson, R.K., L. J. Appel, M Brands, et al. 2009. "Dietary Sugars Intake and Cardiovascular Health: A Scientific Statement from the American Heart Association.” Circulation. Sep 15;120(11):1011-20."

Astwood, E.B. 1962. “The Heritage of Corpulence.” Endocrinology. Aug;71:337-41.

Wertheimer, E and Shapiro, B. 1948. The Physiology of Adipose Tissue. Physiological Reviews. Oct;28(4):451-64.

Mayer, J. 1968. Overweight: Causes, Cost, and Control. Englewood Cliffs, N.J.: Prentice-Hall.

Wilder, R. M., and W.L. Wilbur. 1938. “Diseases of Metabolism and Nutrition.” Archives of Internal Medicine. Feb; 61:297-65.

Frayn, K. N., F. Karpe, B. A. Fielding, I. A. Macdonald, and S. W. Coppack. 2003. “Integrative Physiology of Human Adipose Tissue.” International Journal of Obesity. Aug;27(8):875-88.

Berson, S.A., and R.S. Yalow. 1970. “Insulin ‘Antagonists’ and Insulin Resistance.” In Diabetes Mellitus: Theory and Practice, ed. M. Ellenberg and H. Rifkin, pp. 388-423. New York: McGraw-Hill.

Lustig R. 2006. The 'skinny' on childhood obesity: how our western environment starves kids' brains. Pediatric Annals. Dec;35(12):898-902, 905-7.

Lustig R., Sen S., and Soberman J.E. et al. 2004. Obesity, leptin resistance, and the effects of insulin reduction. International Journal of Obesity And Related Metabolic Disorders. Oct;28(10):1344-8.

#infographic

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