Health wearables have moved past step counting. They now offer personalized coaching, advanced health monitoring, and 24/7 conversational support. The technology is advancing faster than the answers to the questions it raises: whether the data is reliable, who can afford the devices, and whether doctors want the information at all.

Modern devices now track complex health metrics including electrocardiograms to detect irregular heart rhythms, blood oxygen levels, skin temperature, heart rate variability, and stress levels. That is far beyond the basic step counting of earlier generations. "Wearables, of course, have been around for a while, but they're really having a moment this year," said our analyst Rajiv Leventhal on a recent episode of "Behind the Numbers."

Wearables have outgrown the gym. More Americans now have fitness trackers or wearables (26%) than gym memberships (24%), per KPMG data, and over half own a wearable or connected device that tracks at least one health metric, according to Vox.

AI coaching is the new frontier

AI coaching is the biggest shift in the wearable space. Most major players, including Oura, Whoop, Samsung, Fitbit, and Garmin, now offer AI assistants that analyze user data to provide personalized recommendations.

These AI coaches can answer questions like "Why is my recovery low?" or "How hard should I train today?" by combining wearable data with imported medical records, creating comprehensive health profiles. The systems offer tailored workout and sleep recommendations, customized meal planning, and conversational support similar to ChatGPT, but with the added layer of continuous health tracking.

"The AI coaching is able to answer those questions in a more personalized way that wasn't possible before," Leventhal said.

Users may no longer need to schedule doctor appointments to interpret their wearable data, because AI assistants can supply relevant information on-demand. That matters most for people who can't access healthcare regularly, and it is exactly where the clinical reliability of these insights is least tested.

The data overload problem

Wearables generate more health data every year. Doctors do not want most of it in the exam room. The challenge: Most wearable data isn't actionable for clinical decision-making.

"If you take a diagnostic test at your doctor's office or at a lab, it might say that you have an infection, and the doctor knows exactly what to do next," Leventhal explained. "But if a patient's heart rate variability declines modestly or increases modestly, it's really unclear what that change means to the doctor and if they should do anything to address it."

Patients are already pushing wearable data into the exam room. Some 23% seek guidance on using it to manage their health, 21% ask physicians to review and interpret it, and 16% schedule visits because of what it shows, according to research from the American Medical Association.

The proliferation of health data creates a time crunch for physicians who typically have only 15 to 20 minutes per patient visit. "A doctor only has 15 minutes, 20 minutes to see a patient, and now the patient is bringing all of this wearable data in as well," EMARKETER Senior Analyst Beth Snyder Bulik noted.

The wellness vs. medical device divide is blurring

Continuous glucose monitors (CGMs) exemplify how medical devices are crossing into wellness territory. Long used by people with diabetes to track blood sugar, CGMs are now available over-the-counter (OTC) for general wellness tracking.

But this shift brings risks. People without diabetes may misinterpret normal blood sugar spikes after eating as dangerous, creating unnecessary anxiety. "While there's inherent value in being able to track all those things, there's also a little bit of caution," Bulik said.

The line between wellness and medical devices is dissolving. The distinction has centered on purpose: wellness devices promote general health for consumers, while medical devices address specific health conditions and often require prescriptions.

Cost remains the biggest barrier

Wearables remain out of reach for many of the people who could benefit most. Devices typically cost $200 to $500, plus monthly or annual subscription fees for advanced features like AI coaching.

Only 18% of people who self-report their health status as poor or very poor own a health wearable, compared with about 25% of all US consumers, according to EMARKETER data. Similarly, just 18% of lower-income consumers own these devices.

"The people who need them the most aren't the ones getting them," Leventhal said. Wearable companies market their products as lifestyle devices to affluent consumers. Oura partners with American Express Platinum to offer discounts to cardholders who pay $800 annually for their credit card.

Cost is the top reason US adults have never considered using digital health tools, cited by 24% of respondents, ahead of not being tech-oriented (21%), per data from Merge.

The wearable market is creating a health data divide. Wealthy consumers gain access to continuous health monitoring and AI coaching, while lower-income populations, who often have greater health needs, are priced out.

Listen to the full episode.

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