An apple a day keeps the doctor away. Granted, 19th-century proverb writers were talking about the fruit, but Tim Cook helped give new meaning to the adage with the release of the very first Apple Watch. In fact, I’d argue that when he hands the reins to John Ternus in September, it won’t be iPhones, Macs, AirPods, or the Vision Pro that defines Cook’s legacy. It’ll be how the Apple Watch set the course for modern health tech.

You don’t have to take my word for it. In 2019, Cook himself told told Mad Money host Jim Cramer, “…If you zoom out into the future, and you look back, and you ask the question, ‘What was Apple’s greatest contribution to mankind?’, it will be about health.”

The Apple Watch was the first new Apple product in the post-Steve Jobs era and the first developed without his input — though Cook was adamant that his predecessor’s influence could be seen and felt within the device. Consequently, it served as a barometer for Cook’s leadership and whether Apple could continue to innovate without Jobs’ singular vision. 

It was a shaky start. Apple’s early gambit on the Watch as a high-end fashion piece didn’t stick. But looking back, the gadget has defined the modern wearable industry. FDA-cleared digital health screening features weren’t a thing before the Series 4. Now, wearable devices across the industry can detect atrial fibrillation, hypertension, and sleep apnea. They can call emergency services if you get into a car crash or take a nasty fall. Each year, before a new Watch is announced, Apple rolls a clip of “Dear Tim” letters where users express how the gadget saved their lives. (It’s a moment Cook also called out yesterday in his letter to Apple fans.) We’ve written at The Verge about how these ads can feel like subtle fearmongering, but it’s an undeniable fact that there are real-life people who owe their lives to the device. 

Cook was among the first tech CEOs to characterize wearables as democratizing healthcare and science. Launching the inaugural Apple Heart Study and the Apple Research app has opened several doors for clinical researchers. The Apple Heart Study, for example, had 400,000 participants, an unprecedented number in 2017. A few short years later, during the covid-19 pandemic, researchers used an array of wearable devices to study whether the devices could detect early signs of infectious illnesses. One study found that the Apple Watch, could in fact, detect covid-19 up to a week early. But the research precedent wasn’t limited to Apple’s devices. Major sporting organizations ended up using the Oura Ring as part of their covid-19 reintegration plans once vaccines became more widely available. Since then, Oura has also launched a feature called Symptom Radar to detect early health changes. 

This idea is one we’ve seen adopted by politicians as well. Current Health Secretary Robert F. Kennedy Jr. has also been an outspoken proponent of “taking control of your health” with wearable tech. RFK Jr. has gone as far as saying he believes wearable tech to be a pillar of the Make America Healthy Again movement. Regardless of how you view MAHA or RFK Jr.’s wellness beliefs, none of that would’ve been possible without the blueprint Apple set with its Apple Watch.

It might be tempting to downplay Cook’s role in Apple’s pivot to health. After all, Jony Ive often gets credited with dreaming up the Apple Watch and its iconic design. Steve Jobs’ healthcare experiences while battling pancreatic cancer have also been cited as the “true” reason behind the Apple Watch’s creation. But I’d argue you can’t fully separate Tim Cook the man from Apple’s approach to health tech.

For one, I must point to Slate’s investigation into whether Tim Cook is secretly swole. (Spoiler: Yes, he is.) Numerous profiles have also pointed to Cook’s strict daily routine, which starts at 4AM and includes a roughly hourlong workout at Apple’s corporate gyms. In a podcast with Outside magazine, Cook also described himself as an outdoor nerd and that exercise as a key to a good quality of life. To Fortune, Cook called himself a “fitness nut.” Cook has also previously said using the Apple Watch helped him lose 30 pounds and fine-tune his exercise routines. You can see aspects of this within Apple’s Fitness Plus service, breathing reminders, and the hiking navigation features on the Apple Watch Ultra. 

It’s a bit harder to say how John Ternus, Cook’s successor, will approach health when he takes over in September. As a product guy, Ternus was behind the Apple Watch Ultra 3’s 3D-printed titanium and improved repairability. (He was a collegiate swimming champ, so perhaps we’ll see expanded features in that arena too.) Apple reportedly still hasn’t given up on noninvasive glucose monitoring. And in a recent interview, Apple told me that it plans to extend health features to other devices — something it’s already done with the AirPods Pro, which offer both heart-rate monitoring and hearing tests. The company is also in the middle of an open-ended, five-year-long clinical research study to help develop future health features. 

Cook has set a strong foundation and lead, but the gap is closing. Oura and Whoop, in particular, continue to barrel forward in setting new wearable health tech trends. But, 30 years from now, when we’re all wearing glucose monitors and possibly getting illness alerts from our earbuds, we’ll be able to point back to Cook’s tenure and say this is when it all started.

Daily life is different when you’re tracking glucose. A little over a year ago, I was on my way to a conference. My bags were packed, the Uber was on its way, but there was one last thing to do before I could head to the airport. Tearing open a small isopropyl alcohol wipe, I cleaned the skin on the back of my arm. After that, I applied a small applicator to the clean skin, doing my best to ignore the visible needle inside. I squeezed my eyes shut and pressed a button. It made a ka-thunk. I repeated the process on the other arm. 

In my right arm, I now had a Dexcom Stelo. In the left, an Abbott Lingo. Both were over-the-counter continuous glucose monitors (CGM) that would monitor the rise and fall of my glucose levels. Opening my phone, I checked both the Dexcom and Abbott apps to make sure the CGMs were transmitting data. I made a mental note to check how high altitudes might impact readings. It crossed my mind that, to my surprise, I’d felt zero pain. 

There was no urgent medical reason why I needed to track my glucose. I’m not a diabetic. My A1C levels — the metric that measures long-term blood sugar — have always been good. But glucose tracking isn’t just for diabetics anymore. On social media, you can see doctors, wellness influencers, biohackers, and athletes talking about CGM use. I just happen to test health tech, so I thought I’d give it a whirl for a few weeks and see if there was any benefit for a non-diabetic like myself using this tech. 

Instead, I ended up spending over a year testing the devices, reading up on studies, speaking with researchers, and falling down rabbit holes. I bounced from doctor to doctor trying to figure out if there was actually something wrong with me — or the devices I was using.

The first “professional use” CGM was cleared by the Food and Drug Administration in 1999. Most people think these devices are used to track blood sugar, but that’s not entirely correct. Technically, they provide real-time glucose measurements from the interstitial fluid between your cells, just underneath your skin. Compared to traditional finger-stick tests, which directly measure blood sugar, CGMs can track glucose trends over an extended period of time. 

Until 2024, CGMs required a prescription and were devices primarily used by Type 1 diabetics — people who produce little to no insulin. Now, both Dexcom and Abbott sell CGMs targeted at non-diabetics, prediabetics, and Type 2 diabetics who don’t rely on insulin. To differentiate, sometimes you’ll see companies market over-the-counter devices as “glucose biosensors.” 

The benefits of using CGMs for prediabetics and Type 2 diabetics are clear. Unlike Type 1 diabetes, prediabetes and Type 2 tend to develop over time as the body becomes more resistant to insulin. If caught early enough, it can be “reversed” with lifestyle interventions like changes to diet and exercise. People with pre- and Type 2 diabetes also make up the overwhelming majority of cases in the US. According to the American Diabetes Association, as of 2021, Type 2 diabetics make up about 95 percent — or roughly 36 million — of the estimated 38.4 million Americans with diabetes. Meanwhile, about 98 million were estimated to have prediabetes. Put all that together, and a significant number of people could potentially learn a lot from using CGMs about how their dietary habits impact a legitimate metabolic condition.

Less clear is whether this technology is useful for non-diabetics. But that hasn’t stopped the push for this tech, from both the CGM makers and the government. If Health Secretary RFK Jr. has his way, in four years, everyone might be wearing one of these. Underscoring this, President Donald Trump’s controversial surgeon general nominee Casey Means is also the cofounder of Levels, a CGM startup aimed at non-diabetics. In her book Good Energy, she calls out the technology as a useful tool in fixing metabolic dysfunction — something she claims is at the root of every possible chronic ailment today. However, several medical experts have publicly questioned this logic, stating the evidence for non-diabetics simply isn’t there. 

But we’ve now entered a new era where wearable technology offers a tantalizing promise. It’s not just about flagging potential illnesses. It’s about optimizing your body’s biometric data to live the longest, healthiest life possible. In the context of the US’s terribly flawed healthcare system, this tech has often been positioned as giving back a degree of control to the average person. Wear this device, track your health, learn more about yourself, and subsequently make better choices. 

Optimization of metabolic health has been a rising trend for years. Most commonly, this has come in the form of food logging. However, CGM-related metabolism tracking has gained traction due to the extra layer of data it provides. January AI was originally a CGM startup that then pivoted to providing glucose spike prediction within a meal logging app based on the data it collected. Meanwhile, Oura has since partnered with Dexcom to provide glucose readings, meal logging, and AI interpretations inside its own smart ring app. Abbott also recently partnered with Withings, another wearables maker, for a similar integration. When you factor in that GLP-1 use is increasing, alongside the return of 2000s-era, ultra-skinny diet culture, it seems like CGM use is being positioned as the next evolution of fitness tracking.

“It’s predicted one in two Americans will have obesity by the year 2030,” says Dr. Thomas Grace, a diabetes clinician with Type 1 diabetes who consulted with Dexcom on the Stelo CGM. “I think the most exciting thing for myself, for my patients, and for people using Stelo is the instant reward they get from understanding how food, activity, stress, and sleep affect their overall glucose health.” 

I’m the exact sort of non-diabetic that Dexcom, Abbott, and other CGM startups are targeting. I’ve got a family history of Type 2 diabetes and high cholesterol. I’ve been diagnosed with polycystic ovary syndrome (PCOS) — a chronic condition that numerous doctors have told me means I likely either have insulin resistance or chronic inflammation that makes me predisposed to diabetes. As a runner, I’ve struggled with energy levels while training for long-distance races despite following standard fueling practices and carb loading. Why not try biohacking my nutrition to manage my diabetes risk, gain insight into PCOS, and be a better athlete? 

Wearing a CGM 24/7 is invisible until it isn’t. I went days without remembering they were in my arms. Then, they’d inevitably snag on my shirt sleeve, or I’d brush into a doorframe, the contact popping the CGM out of my arm. Now, even when I don’t wear CGMs, I’m aware of the back of my arms and the cut of all my shirts. That hypervigilance comes with being constantly monitored — even if you’re the one doing the monitoring. 

At first, I’d review my data every morning, after each workout, and a few hours after each meal. Most of what I saw was pretty normal. A bowl of pasta? Glucose spike. Roasted salmon and a side salad? Minimal increase. Carb loading before a long run? Mondo spike, followed by a sharp decrease. (I found CGM use too cumbersome for mid-run fueling, as there’s a five-minute delay between readings.)

Nevertheless, reviewing my data multiple times a day began spiking my anxiety. Both Dexcom and Abbott’s apps have educational articles about what the ideal glucose range is for healthy nondiabetics — 70 to 140mg/dL. Fasting glucose levels — like when you’re sleeping — ought to sit in the range of 70 to 99mg/dL. Those first few months, I woke up well beyond 100mg/dL every day, even without late-night snacks. Sometimes, I’d wake up to see the Dexcom app had alerted me to glucose spikes while I slept. (Abbott doesn’t send spike notifications for Lingo.) 

A year prior, I had tested Nutrisense — which also makes use of CGMs — for two weeks and never had elevated morning glucose levels. Clearly, diabetes had finally come for me.

Elevated morning glucose is a concern because of the Dawn Phenomenon. To help prepare your body to wake up, you produce hormones like cortisol and growth hormone. That signals to your liver to release glucose, giving you energy for the day. In diabetics and insulin-resistant people, however, it leads to overly high blood sugar levels during the morning. Something, perhaps, like what I was seeing. 

Cue anxiety, scheduling a flurry of doctors’ appointments, and hyperfixating on my diet and exercise. At the doctor’s office, I got shrugs, quizzical brow raises, and a reluctant acquiescence to run blood tests. (“Do they really have non-diabetics wearing those?” a nurse asked while taking my blood pressure.) My A1C, a gauge for your average glucose levels over two to three months, was perfectly normal. No diabetes here. I did, however, have elevated liver enzymes and cholesterol levels. 

Out of an abundance of caution, my doctor ordered an ultrasound. I had to wait several weeks for an appointment. Later, once the goo was slathered over my abdomen, I watched nervously out of the corner of my eye as an ultrasound technician muttered to herself. After another few days, I got a call from the doctor. I was diagnosed with a “nothing to worry about right now” case of non-alcoholic fatty liver — a condition that commonly occurs alongside PCOS. Maybe, my doctor suggested, I should cut out all alcohol (I rarely drink) and lose body fat (I’ve been trying for 10 years). Come back in about a year, they said, and we’ll see where you’re at. 

Read one way, this could be a success story for CGMs. The devices flagged something had changed, and though it wasn’t diabetes, I had at least one new official diagnosis. Glass half full: Control over my health had been handed back to me. 

A more skeptical take is that elevated liver enzymes and high cholesterol had been present in previous blood work. A former doctor had also suspected fatty liver disease, but said an ultrasound wasn’t necessary unless my levels worsened. Were my levels worse at this CGM-inspired blood test? Not particularly. The advice I’d been given was the same as it had been in years past. Glass half empty: I learned nothing new. 

It wasn’t until much later, after consulting with Dexcom and Abbott, that I learned side sleeping could lead to inaccurate overnight glucose readings. When you’re on your side, the CGM can get compressed. That, in turn, could lead to readings lower or higher than your actual glucose levels. I tried swapping arms for the Lingo and Stelo to test for this, but it was impossible to account for how I shifted positions each night. Either way, I continued getting high overnight and morning glucose readings from both sensors for months. 

The worst part was that I couldn’t tell whether the data was inaccurate or my doctor had missed something. 

I started running into issues after the first month of continuous wear. For starters, it can be pricey. Dexcom and Abbott both gave me several test units, but for the average person, it can cost around $100 a month. A single sensor lasts about 15 days if everything goes well. Sometimes, they malfunction or get ripped out after getting caught on clothing and other objects. The adhesive also leaves stubborn residue that takes weeks of showering to fully remove. Partly to stretch out my supply, partly to give my skin a break, I started testing two weeks of every month. After six months, I pared down to once a quarter. 

But regardless of how often a person uses CGMs, every body is different. Foods that cause a spike for me may do nothing for you. The only way to know for sure is through diligent logging and experimentation. The conundrum is that this creates a mountain of data, and as I learned, interpreting that data without adequate context can lead to unnecessary anxiety.

Compounding the issue? CGM makers have differing approaches on how to present that data. The Dexcom Stelo app, for example, will give you spike alerts after about an hour or two. Abbott’s Lingo CGM eschews such alerts altogether. Instead, Abbott opts for a Lingo Score that tries to simplify raw data into a digestible number that signifies how well you did on average at keeping your glucose within a healthy range of 70 to 140mg/dL. 

Using a CGM to stay within that range sounds relatively simple and easy. In reality, it’s complicated.

“The one study that did look at follow-up outcomes found that people who spent more time above that range were more likely to get diabetes, but this was in a pretty small population,” says Nicole Spartano, assistant professor at Boston University’s Chobanian and Avedisian School of Medicine. “They may have already had prediabetes and are sort of on their way already. I think we’re really at a point where we don’t have a lot of information from a research standpoint.” 

For example, Spartano notes that there’s often a lack of context for how CGM numbers could relate to an individual’s health. On the one hand, doctors often see a fasting blood glucose level of over 100mg/dL as a cause for concern. CGMs, however, do not measure blood glucose. They measure interstitial glucose, which can, at times, be higher than blood glucose. Spartano says more research is needed to determine what the differences between blood and interstitial glucose could be, both broadly and on an individual level. 

“We assume that they’re completely accurate, but they’re not exactly accurate. There’s a certain level of accuracy that the FDA requires, but that still leaves some wiggle room,” says Dr. David Klonoff, medical director at the Diabetes Research Institute at Mills-Peninsula Medical Center and editor-in-chief of the Journal of Diabetes Science and Technology. 

Basically, if you wear two CGMs simultaneously, as I did, it’s possible to get different numbers and not know which one is truly correct. And while most people would only wear one at a time, there could also be a difference between one CGM you wear and the next, based on whether they were applied correctly and several other factors. 

But say everything is assumed to be accurate. What is the best way to interpret CGM data for non-diabetics? To try and find out, Spartano ran a clinical study in which 18 endocrinologists were asked to evaluate data from non-diabetics. 

“We gave them 20 different glucose monitor reports and asked them, ‘If someone came in with this report, would you suggest they have a follow-up screening for this?’” says Spartano. She says some experts viewed peaks as a normal part of physiology. Others saw elevated levels as a sign someone might need further testing. 

“Essentially, there was no consensus. Even clinicians who read CGM data all day, every day don’t know what to do with this data,” says Spartano.

“One of the problems is we don’t have an ideal way of analyzing the information yet. We know if someone is doing really poorly or completely normally, but the people that seem to be headed for trouble? We can only say, ‘It doesn’t look normal, but it’s not abnormal. It’s something in the middle,’” agrees Klonoff.

According to Klonoff and Spartano, there isn’t a reference set of data that’s been vetted and agreed upon by a group of experts. The data that’s coming in from different subgroups of people using over-the-counter CGMs is all so new that it’ll take years before that’s even possible. 

So, say you, a non-diabetic, needed help interpreting your CGM data. It’s very possible that if you were to present your data to 10 different doctors, you might get 10 different recommendations. 

During my research, multiple doctors and diabetes experts told me I was fine given that my A1C remained optimal and my CGM data — for the most part — stayed within a healthy range. Spikes, they assured me, are a normal part of my metabolism functioning as it should.

However, that’s technically not optimizing. Take Means. While her credentials are questionable (she thinks you can prevent cancer with “good energy” habits), in her New York Times bestseller Good Energy, she advises, “We want to minimize spikes because they are associated with worse outcomes.” She advocates for stricter criteria. Post-meal glucose levels shouldn’t rise above 115mg/dL, no spike should be above 30mg/dL, and “optimal” morning fasting glucose should be between 75 and 80mg/dL. I’ve seen other influencers recommend similar advice, albeit with slightly different numbers.

By those standards, you could be in a healthy range 100 percent of the time but still have a “suboptimal” metabolism. Never mind that experts have said there’s not enough consensus to define what warrants “good” or “bad” CGM data in non-diabetics. Many CGM apps will give you scores and additional metrics to aim for. If you’re a perfectionist like me, that can be a recipe for disaster.

The longer I wore CGMs, the more obsessed I became with the food on my plate. A slice of pizza at a gathering would make me break out in a cold sweat. Common sense says a single slice of pizza once in a while is not the end of the world. But the thought of a spike alert or a bad score was enough to convince me that I should forgo eating meals or snacks entirely, even if my stomach was growling. Likewise, I began overexercising. I’d feel good if my fasting glucose was below 85mg/dL, and stressed if it was anything over 100 — even if there was a logical, temporary, good reason for that. I began to feel stressed about being stressed. At a certain point, I became incapable of enjoying social events and started avoiding them. The worst moment came early on in testing at a family Thanksgiving dinner. I started negotiating with myself about what I could eat based on how it was showing up in a CGM app. After six months, it became bad enough that people close to me felt the need to intervene. I had been too fixated on successfully “optimizing my metabolism” to notice.

This is often forgotten in the narrative to optimize metabolism. Studies have found that it’s difficult to conclude that wearables, diet, or fitness apps have a definitive link to disordered eating or eating disorders — though the risk is there, and they have been associated with exacerbating symptoms in those who already have experienced them. For some people, CGM use won’t come with this kind of dark side. For me, it absolutely did. 

I now opt to use CGMs only to test new features. 

After about a year, I decided to conduct one final test. Once again, my data was wonky. Morning glucose was elevated. Post-meal spikes were prolonged. And my daily average glucose was higher than it’d ever been. I was consistently exhausted. I kept gaining weight despite vigilantly monitoring my nutrition and exercise. I found a new doctor and got some more blood work done. Still no diabetes or prediabetes. But my bad cholesterol had worsened, and two liver enzymes had more than tripled from the previous year. An ultrasound showed my fatty liver had progressed from mild to moderate. For the first time, I had my insulin resistance tested and was found to be on the “high side of normal.” 

My new doctor concluded that my non-medicated efforts to rein in my chaotic metabolism, while admirable, weren’t cutting it. Prescriptions were written, a plan was formed, and four months into treatment, my CGM data and blood work have dramatically improved. For the first time in a decade, my bad cholesterol is normal. I’ve lost 15 of the 25 pounds I gained, and my liver enzymes have dropped by roughly 65 percent. My morning glucose levels are no longer elevated.

Proponents of non-diabetic CGM use might frame this as an outright win. In many ways, it is. Even so, I’m hesitant to characterize it that way. I was often stumped by my data, anxious when consulting doctors, and for a time, wrecked my hard-fought relationship with food and exercise. Overall, it took 13 months from starting CGM testing to finding a satisfactory treatment for my metabolic issues and 17 months to finally see improvement. Along the way, I shed many tears of frustration, and I’m still adjusting to the side effects of my new medications.

I’m grateful to see my health improve. My long-term testing of CGMs undeniably played a role in that. But arguably, medication — not CGM use and definitely not “taking control of my health” through lifestyle changes alone — is what’s ultimately helping me feel better. I’m all for non-diabetics having access to these sensors, so long as they’re aware of the limitations. What I’m not for is framing CGMs as a silver bullet for demystifying and optimizing your metabolism. 

This is Optimizer, a weekly newsletter sent every Friday from Verge senior reviewer Victoria Song that dissects and discusses the latest gizmos and potions that swear they’re going to change your life. Opt in for Optimizer here.

You can trace the state of health tech today to a single gadget: the Apple Watch Series 4. 

Back in 2018, smartwatches and fitness bands focused on a handful of things: step count, heart rate, some light sleep monitoring, and activity logging. As a result, they were much more focused on fitness rather than overall health. Handy if you were trying to increase activity levels or lose a few pounds, but not a device that could “save your life.” That all changed with the Series 4, which introduced FDA-cleared atrial fibrillation detection — something that had never been done before on any consumer wearable. Not everyone was a fan of the feature. Critics cautioned that it wasn’t as accurate as a traditional 12-lead EKG, and many doctors weren’t sure how to interpret such novel wearable data. 

Nevertheless, this sort of FDA-cleared digital screening feature is now the hallmark of what’s considered advanced consumer health tech. Every year, there are several stories of how Apple Watches have improved or saved lives — something that spurred rivals to pursue similar features on their own devices. Eight years after the Series 4 debuted, wearables can send an array of notifications relating to illness, sleep apnea, hypertension, and even fertility windows. And though there’s debate about such features causing health anxiety, wearable makers are racing to discover relationships between new biomarkers and enhanced longevity — hence why so many newer devices are zeroing in on recovery metrics, metabolism, and, for some reason, bodily fluids. 

Given that The Verge is spending this entire week reflecting on 50 years of Apple products, we’d be remiss if we didn’t look at Apple’s role in defining this space — and what’s evolved in its wake. So, I sat down with Deidre Caldbeck, senior director of Apple Watch and health product marketing, to talk about how the company approaches developing health features and what that means for the Apple Watch’s future.

Back in 2016, my first Apple Watch was the Series 2. As a wearables reviewer, I’ve tested every single iteration since. One thing has always been crystal clear about Apple’s approach in this space. The Watch isn’t meant to be a niche object for a small group of health nuts. The vision is a health gadget that works for everyone. (So long as you have an iPhone.)

“We really wanted to make the features on Apple Watch as inclusive and intuitive as possible. Of course, technologies have advanced, and people’s interest in health and fitness has changed over the years, but we’ve really tried to maintain that primary objective: building features that can really impact as many people as possible,” says Caldbeck. 

According to Caldbeck, while the Apple Watch has always had an optical heart rate sensor, it was primarily used to track workouts. But as more people started wearing the Watch, Caldbeck says the company got feedback from users saying they wanted more context into their heart health that would perhaps explain some anomalies in their measurements. With the Series 3, the company delivered high and low heart rate notifications. But the major shift, she says, really came with the Series 4. That was when the Apple Watch got its first significant redesign, with a bigger display and a revamped, more modern UI. The addition of the EKG then helped to shift the device toward being a more holistic health tool than simply a fitness tracker.

“We started to hear more from people that they were getting insights into heart rate recovery and we thought, ‘Okay, well, maybe we invest more in things like low-cardio fitness,’” she says, referring to how the company presents the VO2 max metric. “And of course, aFib notifications were there, but should we do more with aFib history once you’ve been diagnosed with aFib? So that sort of kicked off this acceleration into more of these heart health features.”

Apple’s focus on developing big, broadly impactful health features often feels at odds with the current, overarching theme in health and wearable tech right now: AI-powered personalization. Right now, Apple’s rivals are going full speed ahead in integrating AI for an increasingly customized experience. Garmin, Google / Fitbit, Samsung, Oura, Whoop, Strava, Withings, Peloton — you name it, they’re all stuffing AI into their platforms to deliver highly individualized experiences. (Spoiler: They’re generally godawful.) 

In the past few years, these companies have also been quick to incorporate wellness trends into their products. For instance, with the popularity of GLP-1 medications, metabolic health tracking and AI nutrition features are a hot commodity. Garmin just launched its take on the feature in January. Even Meta announced this week that it’s getting into AI nutrition logging via its smart glasses later this summer.

Conversely, Apple has been late to the AI game (and criticized for it). Take Workout Buddy. Released last year, the AI-powered feature isn’t truly an AI coach. Instead, it’s meant to be a more motivational feature, surfacing historical milestones or highlighting your progress toward achieving daily goals. Notably, it doesn’t tell you what to do, generate workouts, or provide guidance — something that many people have come to expect from AI fitness features. 

All this, Caldbeck says, is intentional.

“We want to deliver meaningful insights without very specific recommendations,” she explains. “We have, to date, designed our features to be a little more discreet, to sort of fade in the background and meet you where you are. Of course, we want to notify you if there’s something that you should pay attention to and give you the right information to make the right decisions or to maybe have a conversation with your doctor.” 

Caldbeck notes that Apple has implemented AI in developing several features, such as heart rate monitoring, fall detection, and hypertension notifications. That said, the guiding principle is to use AI to primarily “unlock health insights and empower people with information that they can then take action on.” And another key distinction is that every health feature must align with consensus-based, established scientific literature.

“What’s consistent is our commitment to providing features with actionable insights that are grounded in science and built with privacy at the core,” Dr. Sumbul Desai, Apple’s vice president of health and fitness, tells me over email. 

Caldbeck admits that from a product perspective, it’s tempting to hop on buzzy wellness trends. However, she says Apple requires that its data be validated across a large population because its products have such a large global reach. Case in point, its inaugural Apple Heart Study had over 400,000 participants — an unheard-of number at the time. Concepts like specificity and sensitivity — which measure whether a test delivers more accuracy on true positives or true negatives — are often weighed when developing a feature. 

“Frankly, we’re careful when we roll out these new features because we want to make sure we’re not getting ahead of the science,” says Caldbeck. “Sometimes, we wait a year or two. It does mean that others may be ahead of us in some areas that we know users care about, but it takes discipline, and we’re going to continue to do that.” 

To be clear, many health tech companies pay a lot of lip service to being science-backed. But Apple isn’t bluffing about the patience and competitive sacrifice this approach requires. Last year, I got the chance to speak with Desai regarding the Apple Health Study. The unique thing about this particular study is that it had no specific goal and would encompass activity, aging, cardiovascular health, circulatory health, cognition, hearing, menstrual health, metabolic health, mobility, neurological health, respiratory health, and sleep. The study is set to last five years, and could be extended further. It’s not guaranteed that groundbreaking insights or features will be discovered. Meaning it could be a long, long time before we see what comes from research at this scale and scope.

Hypertension notifications, which were launched last year, are another example. Although it was a feature that Apple had been keen on for a long time, Caldbeck says the company chose to wait until it could deliver reliable, validated results for a global population and successfully go through the regulatory clearance process. Apple also published a validation paper based on data from 100,000 study participants, detailing the tech and how the feature was developed. Sleep score, a feature that has been available for several years on other devices, is another example. Apple didn’t roll out its version of the feature until 2025, Caldbeck says, because it prioritized scientific consistency. And while Apple could have incorporated biometrics into the feature, it instead emphasizes factors that users can actually control. 

But even if it’s a while before we see the next groundbreaking health feature, Caldbeck and Desai say that users can expect to see Apple incorporate health tech into its other gadgets, too. 

“We’re focused on creating innovative, intelligent features that deliver personal insights through products like Apple Watch, AirPods, and iPhone, fundamentally evolving the concept of prevention by democratizing access to health information,” says Desai. 

“If you think about what we’ve done with hearing health with AirPods, and even what we did years ago with using your iPhone to track mobility metrics, there’s a lot that we can still do with devices that are with you every day,” adds Caldbeck. “That’s going to be a place that we’ll continue to invest in to bring more impact to more people across more of our products.”

In Optimizer, I often lament how, in recent years, wellness trends seem to be influencing health tech in a less-than-ideal way. The increasingly blurry line between wellness and medical tech genuinely keeps me up at night, especially as health tech companies begin to lobby Washington for relaxed wearable regulations. As a reviewer, I’ve also written my fair share of how Apple Watch and health updates can feel iterative, especially if other tech companies “got there first.” As I watch this space, I’m not sure which approach will ultimately win. Apple’s slower, broader, but scientifically rigorous approach — or the startups chasing emerging wellness trends, banking on AI-powered personalization to usher in a new era of health tech. But if there’s one thing I’m certain of, it’s that Apple is the rare company that can afford to take its time.