Episode 25: Whole Health Research with Key Opinion Leader Tiffany Stewart

You're listening to Bio from the Bayou, featuring stories and industry insights from experts in the bustling biotech scene of New Orleans. The entire Gulf Coast region is buzzing with expertise and excitement. We're here to bring you frontline access to this vibrant ecosystem direct from NOLA, a city that provides a little lagniappe with everything we do. Where people come for the science and stay for the food, festivals, and resilient culture. Today's guest is Dr. Tiffany Stewart. She is a professor at Pennington Biomedical and the director of the Behavior Technology Laboratory focusing on health performance and resilience. Welcome to the show.

Thank you for having me.

Absolutely. Thanks for being with us. And so I briefly mentioned in the intro, you're the founder and director of the Behavior Technology Laboratory at Pennington Biomedical Research Center in Baton Rouge. The lab is focused on health, performance, and resilience. How is what you do different than simply encouraging potentially unhealthy people to engage in diet and exercise?

Great question. I am a clinical psychologist by training, and that means that I'm a scientist practitioner. I see patients and help train teams of people to work with individuals to change habits, but I also conduct large-scale research trials on Things that we believe can optimize our performance in daily life or in high-performance environments like athletes and our military. One of the things that we fundamentally do different in our work when we're looking at health habits and the whole picture of health, we're handing people not just the what, but we're handing them the how. And what I mean by that is the world is made up of a lot of health information. that we receive in a lot of different ways, whether that's a pamphlet, whether it's a billboard, handing people information, even at the doctor's office, that describes a problem that you might have and why you need to solve that problem. But oftentimes the practical guidance on how to go about solving that problem is left out. So what we call this information is more of an awareness campaign or awareness building or education even. But not practical skills training. So we are taking this a step further in our efforts, whether it's a digital therapeutic or a comprehensive program. We're individualizing care and individualizing tools with, with multiple layers. And you'll see a lot of this coming with precision medicine and precision nutrition in the conversation right now, trying to train individuals in the tailored habits that they need to improve health. This goes well beyond— so to your original question about diet and exercise, this goes well beyond health habits people typically think of, like nutrition and fitness. It's what I like to call whole health, or looking at the whole human. And when we think of whole health, what does that really mean? We think of health in popular culture. Everybody immediately goes to these core components like weight, fitness, and nutrition. And we largely do live in a diet culture and also a culture that very much values appearance. Few mention sleep in this sort of trifecta of health components, but that's emerging. Conversations on sleep have been emerging for a while. But what we know is if you don't work on the mental part, like stress management and stress reduction and gaining broader perspective and working with things like mood and anxiety, it makes it really hard to do health behaviors that might impact your physical health as well. So to add these more physical components, we need to focus on our healthy minds, like sleep, mindfulness, anxiety. In healthcare, we tend to focus on treating disease states and consequences when they happen. But part of prevention is habit building. Part of prevention is heading things off before they become clinical. And the way that we do that is also working with our minds, with our whole human self in a more comprehensive way to approach tailored care.

Got it. Well, that's pretty interesting. I can say for sure that stress impacts my health and wellness frequently. So how can we help shift the public's focus from, say, you know, the popular culture and appearance and weight loss to one of this whole health perspective?

You know, I think we need a fundamental cultural paradigm shift in our thinking about what health really is. In our culture, over the years, we've been made to believe that all of our health behaviors are essentially weight-loss behaviors and that thinner is healthier. But we know through the science that is not exactly true. We also know that everybody, every shape and size on the continuum, benefit from health behavior, whether it's drinking water for hydration or eating nutrient-rich foods or moving every day, benefits us in many ways. It— moving, for example, helps reduce stress and helps our brains to function optimally and reduce things like dementia. We often don't hear these health benefits of health behaviors because they're so promoted around the weight management argument. And so we end up thinking about health in terms of nutrition and fitness, which is great. Those are 2 very big components. But as I mentioned before, other components— sleep and mental health— are very important. So we really need to drop the appearance narrative of our culture as the center point and look at the health goals that keeps our bodies functioning in a way that affords us the things we want to do in our lives and longevity and quality of life. Whole health and quality of life are multidimensional. It takes focus on many areas to cultivate whole health. So if we're not taking an approach that aligns all of these components— eating, sleep, exercise, stress reduction— and we are too focused on one component, for example, people engage in extreme approaches to dieting, for example.

Right.

And the outcomes of this and this type of thing does not lead us to long-term health. It doesn't yield long-term positive outcomes. So as we age, we really need to look at health as a multidimensional concept where appearance is not the center.

Got it. And as the name implies, I'm sure you're deploying a lot of technology and digital health tools in the Behavior Technology Laboratory. So how can these help individuals monitor and improve their whole health?

Digital health tools are great. And deliver data that shows us many dimensions of the what. As I mentioned, with our apps and tools, we use that data to then tailor plans and show individuals the how, not only of using the data as benchmarks of change, but what is meaningful change and how do we get there in very small increments of effort. It's important to also note that many of the trackers that we're using are better utilized to observe progress or change over time. But in one instant, that data across many different tracker platforms— so not singling anything out at all— are not super accurate. And that's from a variety of reasons, whether it's user error, whether it's the tracker is not sitting exactly right on the wrist, whatever it is. So there's a lot of variance and error in this data. We use the data to look at trends over time, taking the data into the context of everything going on in somebody's life and looking at it and comparing it over time is much more meaningful than taking that literal data. Many people have wearables now but don't necessarily know how to interpret that data or what it means or how to deploy it in a practical way. And so a lot of the digital therapeutics that we have developed We have a, a program that we developed for the military. We're developing tech for athletes for mental health. And our newest digital therapeutic, Zig, really looks at incremental change over time and pulls that data through the app, no matter what wearable you have, to give you very practical information about what that data means and how to tailor it into your habits.

Besides being in peak physical shape, what makes the members of our military and military families and collegiate and professional athletes compelling study subjects?

Studying high-performance populations allow us to see what health behaviors look like from the lens of high stress and high-performance demands. And these demands span survival, like in the case of our soldiers, And it goes to our athletes who are stepping up onto the podium for competition. So a range of obviously stressful experiences. And in these groups, we can learn a lot about performance under pressure, but also the physical and mental training and focus that has to take place in order for that performance to happen or the mission to be successful. Studying these groups teach us a lot about our own physical and mental potential to handle challenges before us. in health or otherwise. And we can take cues about habits, schedules, mental techniques to optimize our own performance. We do a lot of research in looking at these physical pieces and the mental pieces. We're starting to look at mental resilience in athletes and mental resilience in soldiers. There's a host of science in this area that makes us believe. People tend to think of resilience as some kind of magical quality, either you have it or you don't. But this science makes us believe that resilience could be cultivated in individuals by training of certain skills. Certain psychological practices and skills can make us more durable to stress and cope better in difficult situations and bounce back from difficult situations in really endure over the long haul. So we are looking at a lot of those things now in high-performance populations to take cues about what we can do in our lives to also stand up to stress and, and become healthier.

So many people struggle with setting and maintaining realistic health goals. How can individuals set achievable, sustainable goals that contribute to their whole health?

What I would say to that is 3 words— meaningful incremental change. We like to set big long-range goals, and that's great. But if we only look at a goal every day, that big long-range goal, it won't get us through the step-by-step we need to take every day to get to that longer-range goal. There is a whole science behind SMART incremental goal setting that works. And when we master a new habit, no matter how small, and feel good about that progress, we are likely to keep going, stick with it, and then add other new habits along the way. Habit building and habit change is, is really its own area of psychology, honestly, whether you're looking at cultivating physical goals, like, I'm going to get up and go to the gym every day, ranging to doing things like mindfulness practice or walking in nature or deep breathing or restorative rest when you need it. So all of those things count as small, incremental habits that we build for our whole health. Maybe getting to sleep earlier at night is factored into your plan. But we have to build these incrementally over time in a meaningful way, or Not only do they not stick, but it's, it's nearly impossible if we don't build it incrementally.

So in addition to your research, you've founded companies in the past and would certainly be considered an entrepreneur. What challenges do you see in whole health for entrepreneurs that want to be successful in this space?

Well, my laboratory conducts what we call translational science, which is science essentially that's translated from the bench meaning in the lab, evolved into tools you can hand to everyone to use, or called the bedside. So from bench to bedside, we want to see science into the hands of everybody who needs it. The biggest challenge that I have found over the years with commercializing tools for whether it's mental health, physical health, whether it's digital tools, whether it's in-person, treatment programs is, I would say, running into conversations where in order to commercialize something or bring it to the broader market, there's a lot of challenges to the integrity of the science, if that makes sense. So is— I think the biggest challenge is keeping the integrity of the science as part of those commercial usable tools that people would be engaged with. So I know that science sometimes seems more basic or less inviting. And so there's a lot of things you see the media do with outcomes of studies and headlines that the conclusion of the study is not exactly what that headline is saying. What I have found over the years is working with people to try to bring things to the broader market is we have those conversations about, okay, how can we take this scientific tool and make it very exciting and have people use it. And so making claims maybe beyond what the science has shown or things like that, overinflating results or morphing the tool itself into something that can cater to big headlines, it's commercialization of science output, whether it's results, whether it's a product, is a balance between scientific integrity and commercial appeal. And I think that People sitting in this space, to do this well takes a lot of thought and a lot of work.

Well, I'm going to jump in here with, and this was not planned, but a shameless plug for a digital solution that you've developed over the years with working with our military members and others called Zig. And on the surface, people might compare it to the Weight Watchers app or Noom or something else. Could you tell us a little bit about Zig and why it is different from those other solutions?

What I would say is, so the 2 apps that you mentioned really came out of the gate with a weight-loss focus. That is the mission, that is the published elevator speech and pitch and tagline. And both of these tools and programs are viable. They have studies that have been done and operate from a an evidence-based perspective from what we can tell. So they're very weight-focused. That is the center of the model. And there's a lot of habits that are targeted to change as a function of trying to lose weight. Our apps and our digital therapeutics that we have built for our special populations, in particular the military and athletes, have basically evolved in ways that we have been able to translate them for the general public. And the— I would say the main difference in what we've brought to the market is the whole health model. So what you're going to see with some of the apps on the market that are targeting weight loss is they're starting to add a few extra components like stress reduction or something like that, or maybe a mood assessment. But it's not really a comprehensive incremental habit-building tool that's looking at a bunch of habits at once. It's very focused on that weight loss goal. I would say that our products that we have delivered to our populations really weigh equally to some degree the outcomes of the physical and the mental and what we're trying to shift as a whole.

Could you discuss the importance of a holistic approach to healthcare where physical, mental, and emotional well-being are integrated into a person's healthcare plan?

Again, I think it's that whole health picture. We can't be expected to adhere to health behaviors if we don't understand how to do them. And there's so little bandwidth in clinicians' offices and in our healthcare system. It's a very expedient process and can be discouraging. The healthcare system is not really set up for this right now as it currently is set up. Mental health is seen still as a one-off to the main healthcare treatments. There's been a lot of good work that's been done in this area to bring mental health into the forefront and get support for treatments. But it's still not as integrated as it needs to be. It's also still stigmatized. And people don't have enough benefits to receive care. Mental health professionals aren't embedded in larger medical systems. And because it's still considered extra, it's hard to get that integration for whole health care when it's really fundamental to any physical health issues that we encounter. All physical health issues require behaviors and the right mindset to either do the treatments or engage in habits to overcome the condition. Why aren't we helping people with the how of behaviors and tackling challenges that prevent them from being successful? It's a complicated landscape of giving— getting evidence-based tools into the hands of people who really need it, including our underserved. And finally, treatment in these areas needs to be better. But you know what's better than good treatment is good prevention and heading things off before they become clinical problems. So that's what we're trying to do with our digital therapeutics.

Well, thanks so much, Tiffany. We look forward to following your research and programs focused on whole health in the future. I know I've learned a lot, and I hope our audience has as well. As always, we will have Dr. Stewart's contact info and informational links posted in our show notes. Make sure you check them out to learn more. Once again, thank you for joining us, Tiffany.

Thank you so much for having me.

Thanks for joining us for Bio from the Bayou, and we hope you'll join us again. If you'd like to learn more about the emerging biotech scene in New Orleans and the Gulf Coast region, visit us at biofromthebayou.com, where we have more info on who we are, how to get involved and connected in biotech in New Orleans, and the industry events we'll be hosting where you can meet with us in person. And we'd be remiss if we didn't give a special thanks to the Accelerator Network for providing funding for this podcast. Learn more about them in our show notes. We'll catch you on our next episode of Bio from the Bayou.