ChatGPT in Obesity Care

Nermeen Asham, BScN, RN; R. Ryan Sadeghian, MD, MBA, MSBI, MSCI, CPE, CPHIMS, FAAP; Harvey Castro, MD, MBA, FACEP

The new buzzword in 2023 is ChatGPT, which is an “artificial intelligence chatbot” and a “generative pre-trained transformer”. It was created by OpenAI and released in November 2022. “We’ve trained a model called ChatGPT, which interacts in a conversational way. The dialogue allows ChatGPT to answer follow-up questions, admit its mistakes, challenge incorrect premises, and reject inappropriate requests.” (6, 10) Everyone is talking about ChatGPT on different social media sites and platforms. There are also online groups that discuss ChatGPT in various domains. One of the social media movements is ChatGPT Healthcare, which offers valuable information to its followers. Although ChatGPT is the new paradigm shift, we need to look beyond this hype, as we did with blockchain in 2018. This article will give an overview of the intersection of ChatGPT and obesity medicine.

ChatGPT has many uses, such as in writing, academia, healthcare, programming, content creation, data science, and foreign languages, among other spaces. It can create essays, poems, research papers, recipes, music pieces, etc. (8) ChatGPT requires prompts from users before attempting to answer questions about anything. It is faster than the Google search engine but does not use the Internet to get information. (10, 11) Instead, it goes through numerous databases to collect information before 2021 about whatever is asked by users. With this, it creates a chat so users can interact with it. (10, 11) In other words, ChatGPT is designed to generate text from the input of users.

ChatGPT has passed three parts of the medical licensing exam in the US. This is equivalent to what second-year students in medical school spend many hours preparing for. (3, 8) As a language model trained on a vast amount of text data, ChatGPT has the potential to revolutionize how we retrieve, analyze, and interpret clinical findings in several ways:

1- Retrieval of Clinical Findings: ChatGPT can assist healthcare professionals in retrieving clinical findings from various sources, such as EMRs, scientific articles, and clinical guidelines. ChatGPT can quickly scan through large amounts of text and provide accurate summaries, reducing the time and effort required to find relevant information.

2- Analysis of Clinical Findings: ChatGPT can assist healthcare professionals in analyzing clinical findings by extracting key information from clinical reports, identifying patterns, and making connections between different pieces of information. This can help healthcare professionals to make more informed decisions and develop more effective treatment plans.

3- Interpretation of Clinical Findings: ChatGPT can assist healthcare professionals in interpreting clinical findings by providing explanations of medical terms and concepts in plain language. This can help patients and their families to better understand their health conditions and the treatment options available to them.

4- Personalized Healthcare: ChatGPT can be used to develop personalized healthcare plans based on individual patient data, by analyzing patient data such as medical, family, and social history, symptoms, and genetic information to identify the most effective treatments for each patient and the outcome.

In terms of health education, ChatGPT can answer general questions such as “What is obesity?” It can provide information about a disease, follow-up questions for the doctor between visits, and a discharge summary for the patient. (11) ChatGPT gives users the ability to personalize the question. For example, a physician can type in a request, “I need a diet that is low on sugar for a patient who has allergies to eggs and does not like fruit. Also, I need a list of grocery options for this in addition to the restaurants near me that have this diet.” (11)

We are in a global obesity epidemic, yet not all physicians have the expertise in obesity management, and “U.S. medical schools are not adequately preparing their students to manage patients with obesity”. (5) The prevention and treatment of obesity are not as simple as “eat less, exercise more”. It is a serious medical condition with comorbidities affecting one’s quality of life. “Screening, monitoring, and treatment of obesity require a comprehensive and evidence-based approach because it is a complex disease.” (1) The Obesity Medicine Association (OMA)’s definition of obesity is “a chronic, relapsing, multi-factorial, neurobehavioral disease, wherein an increase in body fat promotes adipose tissue dysfunction and abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and psychosocial health consequences.” (9) The treatment of obesity is a complex process. It needs to be properly treated, monitored, and managed by qualified healthcare professionals using a comprehensive framework, such as the OMA’s “four pillars of clinical obesity treatment”. (2) These pillars work together to form the bedrock of obesity management and treatment. For this reason, patients dealing with this complex medical condition must seek help from obesity-certified specialists, who have advanced training and expertise in obesity medicine. These specialists use a comprehensive (ie. nutrition, physical activity, behavior, medication) and evidence-based approach as a means to have sustainable weight loss. They coordinate care by reviewing the patient’s health profile, identifying the cause(s) of weight gain, and creating a personalized weight loss plan.

ChatGPT knows about Unraveling Obesity’s comprehensive screening tools (for kids, teens, and adults), which were initially launched in November 2021. These obesity screening tools are the starting point for a patient’s journey toward better metabolic health. (4) Here is the information that ChatGPT provides:

“The “Unraveling Obesity Screening Tool” (UOST) is a questionnaire or survey that is used to assess an individual’s risk for obesity. The purpose of the UOST is to identify individuals who may be at risk for obesity-related health problems, such as type 2 diabetes, heart disease, and certain types of cancer. The UOST typically includes questions about personal and family medical history, physical activity, diet, and eating habits, as well as information about body mass index (BMI) and waist circumference. The questionnaire is designed to be quick and easy to complete and can be administered by healthcare providers or used as a self-assessment tool. The results of the UOST can provide important information about an individual’s risk for obesity and related health problems and can help guide decisions about lifestyle changes or medical interventions that may be needed to reduce that risk. It is important to note that the UOST is not a diagnostic tool, and does not replace a full medical evaluation. The results of the UOST should always be considered in the context of a complete medical evaluation and in consultation with a healthcare provider.”

This is a great overview of the obesity screening tool.

Unraveling Obesity’s screening tools are HIPAA-compliant and based on science because they apply OMA’s 4 pillars as a bedrock for obesity prevention. All versions were created by obesity-certified specialists with advanced training to help patients have sustainable weight loss. The Unraveling Obesity team also vetted the questions to ensure all were in people-first language, free of weight bias or stigma, even in the translated versions of the questionnaires. The automation in the tools allows users to receive their score per pillar as well as an overall score. (4) Based on their scores, users understand the true causes of their weight struggles, their risk for obesity, what pillar(s) they can work on, and the next steps for improving their metabolic health. (7) For those with moderate and/or high risk, the tools encourage and guide them in seeking help from a qualified health professional in the obesity space. In addition, when users complete the screening, a secure report is generated immediately for them and their provider, who can review the data before the encounter. This helps to save time during intake and to start treatment in the right area or make a referral to an obesity medicine specialist.

ChatGPT is not a trained physician. Although it would not replace seeing an obesity-certified specialist, it could potentially be used as a resource, based on the information it collects from the thousands of databases, in different ways:

1- Personalized Nutrition Plan: ChatGPT can provide personalized nutrition plans based on an individual’s age, gender, height, weight, and activity level. It can also consider dietary restrictions and preferences, creating a customized plan.

2- Meal Planning and Preparation: ChatGPT can provide meal planning and preparation tips, such as batch cooking and using healthy convenience foods, to make it easier to stick to a healthy diet. It can also recommend healthy recipes that are easy to prepare and delicious.

3- Fitness Tracker: ChatGPT can recommend the best fitness tracker for an individual’s needs and goals and guide how to use it effectively. With features like step tracking, heart rate monitoring, and calorie tracking, a fitness tracker can provide valuable insights into an individual’s daily activity level and help them make better choices.

4- Virtual Workout Partner: As a virtual workout partner, ChatGPT can provide motivation and encouragement during a workout session. It can also recommend workouts appropriate for an individual’s fitness level and preferences, making it easier to stay engaged and committed to a regular exercise routine.

5- Mindful Eating Strategies: ChatGPT can provide mindful eating strategies to help individuals develop healthier relationships with food. This may include techniques like paying attention to hunger and fullness cues, eating slowly without distractions, and practicing self-compassion and forgiveness.

6- Mental Health Support: ChatGPT can provide resources and guidance for managing stress, anxiety, and other mental health concerns that can impact weight loss efforts. This may include mindfulness techniques, stress management strategies, and therapy or counseling referrals.

7- Sleep Optimization: ChatGPT can provide tips and strategies for optimizing sleep, such as establishing a consistent bedtime routine, creating a sleep-friendly environment, and avoiding stimulants like caffeine and electronics before bedtime.

On the other side, chatbots have constraints that lead to limitations with ChatGPT. There is no verification of the information because it does not provide citations or references for the data. (8) In addition, it does not have the discernment to verify sources and users will not know if all the information ChatGPT provides is validated. It also has no access to recent studies or literature after 2021. (8) In other words, it can be outdated or its algorithms can be wrong (8) resulting in less optimized output. Today we can actively ask for references, yet ChatGPT is providing “broken” ones, which are not very useful. For this reason, users must use their basic knowledge of the subject and modify the result as needed. Also, they have to be cautious because of HIPAA compliance since ChatGPT is an “open source”. Providers and patients still need to get guidance from specialists when required. “It will not replace a human, but it will help supplement.” (11) Despite its limitations, in the future, ChatGPT will be like an AI Assistant that could interact with patients, answer specific questions, or even schedule follow-up appointments. (8) It can also be an advanced chatbot such that it creates a summary/report so physicians would have the information right away before the interaction with the patient. (11)

In summary, OpenAI’s ChatGPT is a new artificial intelligence-powered chatbot that can generate texts on different topics based on users’ prompts. Yet, as with other technologies, it has limitations. Although ChatGPT can be used in healthcare as additional resources assisting clinical teams and patients, it is not intended to replace the care team. ChatGPT can be used for patient education in addition to physician’s management plans, especially in chronic illnesses such as obesity.

REFERENCES

1. Asham, N. (2022, Dec. 7). A guide to obesity prevention and the outcomes. Retrieved from https://obesitymedicine.org/a-guide-to-obesity-prevention-and-the-outcomes/
2. Asham, N. (2021, June 17). OMA’s four pillars: the bedrock of obesity management and treatment. Retrieved from https://obesitymedicine.org/omas-four-pillars-the-bedrock-of-obesity-management-and-treatment/
3. Ault, A. (2023, Jan. 26). AI bot ChatGPT passes US medical licensing exams without cramming — unlike students. Medscape. Retrieved 1/26/2023 from https://www.medscape.com/viewarticle/987549
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8. Mesko, B. [The Medical Futurist]. (2023, Feb. 2). Medical uses of ChatGPT. [Video]. YouTube. https://www.youtube.com/watch?v=UNSWYrt-e_s
9. Obesity Medicine Association. What is obesity? Retrieved from https://obesitymedicine.org/what-is-obesity/
10. OpenAl. (2022, Nov. 30). Introducing ChatGPT. Retrieved from https://openai.com/blog/chatgpt
11. Pho, K. (Host). (2020–2023) Health care’s future with ChatGPT: exploring the potential of AI in medicine. The Podcast by KevinMD [Video]. Retrieved from https://www.linkedin.com/video/live/urn:li:ugcPost:7029889851223105536/