Abstract
Pediatric obesity management strategies suffer from a high rate of dropout and persistence of weight excess, despite the use of new tools, such as automated mobile technology (MT). We aimed to compare the efficacy of two 6-month personalized MT protocols in terms of better engagement, adherence to follow-up visits and improved anthropometric and lifestyle parameters. MT contacts consisted of three personalized/not automated What’s App® self-monitoring or challenge messages per week. Messages, sent by a dedicated coach were inserted between three-monthly in-presence regular visits with (PediaFit 1.2) or without (PediaFit 1.1) monthly free-of charge short recall visits carried out by a specialized pediatric team. The sample included 103 children (mean age 10 years, range 6–14) recruited in the Pediatric Obesity Clinic between January 2017 and February 2019, randomized into Intervention group (IG) (n = 24 PediaFit 1.1; n = 30 PediaFit 1.2) and Control group (CG) (total n = 49). Controls received standard treatment only (indications for healthy nutrition and physical activity, and three months in presence regular visits). Overall, both IGs achieved significantly better results than the CGs for all considered parameters. Comparison of the two IGs at the sixth month in particular showed an IG 1.2 statistically significantly lower drop-out rate (10% vs. 62%, p = 0.00009), along with significantly improved BMI (p = 0.003), Screen Time (p = 0.04) and fruit and vegetables consumption (p = 0.02). The study suggests that the hybrid association of messaging through personalized/not automated MT plus monthly free-of charge recall visits may improve the prefixed outcomes of MT weight loss intervention programs.
Highlights
Childhood obesity is a major public health problem that increases the risk of medical comorbidities, health care costs and decreased quality of life
Children aged 6–14 years old, affected by obesity (Body Mass Index (BMI) > 95th percentile for age and sex according to the Centers for Disease Control and Prevention (CDC) 2000 growth curves for 2–20 years old) [25] were recruited between January 2017 and February 2019 for this study developed in the Pediatric Obesity Clinic of our University
83% and 60% in the Intervention group (IG) 1.2 group, respectively. Both the first and second recall visit were attended by 93% of IG 1.2 participants
Summary
Childhood obesity is a major public health problem that increases the risk of medical comorbidities, health care costs and decreased quality of life. Ethnicity, anthropometry, health service factors, and lack of treatment preparedness are likely predictors of dropout rates from weight management interventions, together with psychological distress and lower family functioning [3,4]. The latter aspect implies the importance of the household environment and of ongoing support for parents in an empathetic and personalized way rather than focusing on weight changes [3]. Intensity of the intervention and the frequency of visits are other factors which appear relevant in weight management interventions, as in adult participants they are inversely associated with cure abandonment [5]
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