Abstract
BackgroundTechnology has provided a new way of life for the adolescent population. Indeed, strategies aimed at improving health-related behaviors through digital platforms can offer promising results. However, since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents.ObjectiveThe purpose of this study was to assess the effectiveness of an eHealth app in an adolescent population in terms of improvements in their age- and sex-adjusted BMI percentiles. Other goals of the study were to examine the social relationships of adolescents pre- and postintervention, and to identify the group leaders and study their profiles, eating and physical activity habits, and use of the web app.MethodsThe BMI percentiles were calculated in accordance with the reference guidelines of the World Health Organization. Participants’ diets and levels of physical activity were assessed using the Mediterranean Diet Quality Index (KIDMED) questionnaire and the Physical Activity Questionnaire for Adolescents (PAQ-A), respectively. The variables related to social networks were analyzed using the social network analysis (SNA) methodology. In this respect, peer relationships that were considered reciprocal friendships were used to compute the “degree” measure, which was used as an indicative parameter of centrality.ResultsThe sample population comprised 210 individuals in the intervention group (IG) and 91 individuals in the control group (CG). A participation rate of 60.1% (301/501) was obtained. After checking for homogeneity between the IG and the CG, it was found that adolescents in the IG at BMI percentiles both below and above the 50th percentile (P50) modified their BMI to approach this reference value (with a significance of P<.001 among individuals with an initial BMI below the P50 and P=.04 for those with an initial BMI above the P50). The diet was also improved in the IG compared with the CG (P<.001). After verifying that the social network had increased postintervention, it was seen that the group leaders (according to the degree SNA measure) were also leaders in physical activity performed (P=.002) and use of the app.ConclusionsThe eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise. Digital interventions in the adolescent population, based on the improvement in behaviors related to healthy habits and optimizing the social network, can offer promising results that help in the fight against obesity.
Highlights
The current trend toward rising BMIs among children and adolescents reflects a standstill in high-income countries and an increase in cases of overweight and obesity in lower-middle-income countries [1]
After verifying that the social network had increased postintervention, it was seen that the group leaders were leaders in physical activity performed (P=.002) and use of the app
The eHealth app was able to modify behaviors related to P50 compliance and exert a positive influence in relation to diet and physical exercise
Summary
The current trend toward rising BMIs among children and adolescents reflects a standstill in high-income countries and an increase in cases of overweight and obesity in lower-middle-income countries [1]. The World Health Organization (WHO) recognizes that social changes have modified factors related to diet and physical exercise, resulting in an energy imbalance that leads to overweight and obesity [3]. Among all the determining factors that can influence diet and physical activity in the adolescent population, peers can encourage healthy or unhealthy behaviors [4]. In Spain, for example, recent studies have shown that 64.3% of children between ages 6 and 17 years have low or medium adherence to the Mediterranean diet [9]. Since it has been shown that peers are capable of modifying behaviors related to food and physical exercise, it is important to study whether digital interventions based on peer influence are capable of improving the weight status of adolescents
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