Technology Components as Adjuncts to Family-Based Pediatric Obesity Treatment in Low-Income Minority Youth.

BACKGROUND Strategies to treat pediatric obesity are needed, especially among high-need populations. Technology is an innovative approach; however, data on technology as adjuncts to in-person treatment programs are limited. METHODS A total of 64 children [body mass index (BMI) ≥85th percentile, mean age = 9.6 ± 3.1 years, 32.8% female, 84.4% Hispanic] were recruited to participate in one of three cohorts of a family-based behavioral group (FBBG) treatment program: FBBG only, TECH1, and TECH2. Rolling, nonrandomized recruitment was used to enroll participants into three cohorts from May 2014 to February 2015. FBBG began in May 2014 and received the standard, in-person 12-week treatment only (n = 21); TECH1 began in September 2014 and received FBBG plus a digital tablet equipped with a fitness app (FITNET) (n = 20); TECH2 began in February 2015 and received FBBG and FITNET, plus five individually tailored TeleMed health-coaching sessions delivered via Skype (n = 23). Child BMI z-score (BMI-z) was assessed at baseline and postintervention. Secondary aims examined weekly FBBG attendance, feasibility/acceptability of FITNET and Skype, and the effect of technology engagement on BMI-z. RESULTS FBBG and TECH1 participants did not show significant reductions in BMI-z postintervention [FBBG: β = -0.05(0.04), p = 0.25; TECH1: β = -0.006(0.06), p = 0.92], but TECH2 participants did [β = -0.09(0.02), p < 0.001] and TeleMed session participation was significantly associated with BMI-z reduction [β = -0.04(0.01), p = 0.01]. FITNET use and FBBG attendance were not associated with BMI-z in any cohort. Overall, participants rated the technology as highly acceptable. CONCLUSIONS Technology adjuncts are feasible, used by hard-to-reach participants, and show promise for improving child weight status in obesity treatment programs.

[1]  Leonard H Epstein,et al.  Family-based obesity treatment, then and now: twenty-five years of pediatric obesity treatment. , 2007, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[2]  Steven L Gortmaker,et al.  United States Adolescents' Television, Computer, Videogame, Smartphone, and Tablet Use: Associations with Sugary Drinks, Sleep, Physical Activity, and Obesity , 2017, The Journal of pediatrics.

[3]  B. Wansink,et al.  Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps A Scientific Statement From the American Heart Association , 2011, Circulation.

[4]  Penny Gordon-Larsen,et al.  Five-year obesity incidence in the transition period between adolescence and adulthood: the National Longitudinal Study of Adolescent Health. , 2004, The American journal of clinical nutrition.

[5]  C. K. F. Wen,et al.  Prevention and treatment of pediatric obesity using mobile and wireless technologies: a systematic review , 2015, Pediatric obesity.

[6]  S. Patton,et al.  Using Videoconferencing to Deliver Individual Therapy and Pediatric Psychology Interventions with Children and Adolescents. , 2016, Journal of child and adolescent psychopharmacology.

[7]  M. DavisAnn,et al.  Outcomes from an urban pediatric obesity program targeting minority youth: the Healthy Hawks program. , 2013 .

[8]  T. Jones,et al.  High incidence of obesity co‐morbidities in young children: A cross‐sectional study , 2011, Journal of paediatrics and child health.

[9]  V. Montori,et al.  Clinical review: treatment of pediatric obesity: a systematic review and meta-analysis of randomized trials. , 2008, The Journal of clinical endocrinology and metabolism.

[10]  D. Spruijt-Metz,et al.  mHealth approaches to child obesity prevention: successes, unique challenges, and next directions , 2013, Translational behavioral medicine.

[11]  Lisa K Militello,et al.  Correlates of Healthy Lifestyle Beliefs and Behaviors in Parents of Overweight or Obese Preschool Children Before and After a Cognitive Behavioral Therapy Intervention With Text Messaging. , 2016, Journal of pediatric health care : official publication of National Association of Pediatric Nurse Associates & Practitioners.

[12]  Brian E. Saelens,et al.  Recommendations for Treatment of Child and Adolescent Overweight and Obesity , 2007, Pediatrics.

[13]  D. Ward,et al.  Recruitment and retention in obesity prevention and treatment trials targeting minority or low-income children: a review of the clinical trials registration database , 2015, Trials.

[14]  J. Carroll,et al.  A New Dimension of Health Care: Systematic Review of the Uses, Benefits, and Limitations of Social Media for Health Communication , 2013, Journal of medical Internet research.

[15]  L. Baur,et al.  Two-year outcomes of an adjunctive telephone coaching and electronic contact intervention for adolescent weight-loss maintenance: the Loozit randomized controlled trial , 2013, International Journal of Obesity.

[16]  Felipe Montes,et al.  The implications of megatrends in information and communication technology and transportation for changes in global physical activity , 2012, The Lancet.

[17]  Lester R Curtin,et al.  Centers for Disease Control and Prevention 2000 growth charts for the United States: improvements to the 1977 National Center for Health Statistics version. , 2002, Pediatrics.

[18]  S. Barlow,et al.  Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. , 2007, Pediatrics.

[19]  R. Jones,et al.  Multi-site randomized controlled trial of a child-centered physical activity program, a parent-centered dietary-modification program, or both in overweight children: the HIKCUPS study. , 2010, The Journal of pediatrics.

[20]  Tracy Burrows,et al.  Nutrition Interventions for Prevention and Management of Childhood Obesity: What Do Parents Want from an eHealth Program? , 2015, Nutrients.

[21]  S. Christiansen,et al.  Web-based family intervention for overweight children: a pilot study. , 2013, Childhood obesity.

[22]  Geraldine Naughton,et al.  Smartphone Interventions for Weight Treatment and Behavioral Change in Pediatric Obesity: A Systematic Review. , 2015, Telemedicine journal and e-health : the official journal of the American Telemedicine Association.

[23]  Christine A Pellegrini,et al.  The Comparison of a Technology‐Based System and an In‐Person Behavioral Weight Loss Intervention , 2010, Obesity.

[24]  R. Steele,et al.  Systematic review and meta-analysis of comprehensive behavioral family lifestyle interventions addressing pediatric obesity. , 2014, Journal of pediatric psychology.

[25]  K. Bierman,et al.  Technology-assisted Interventions for Parents of Young Children: Emerging Practices, Current Research, and Future Directions. , 2015, Early childhood research quarterly.

[26]  Denise E. Wilfley,et al.  Evidence Update on the Treatment of Overweight and Obesity in Children and Adolescents , 2015, Journal of clinical child and adolescent psychology : the official journal for the Society of Clinical Child and Adolescent Psychology, American Psychological Association, Division 53.