A novel interactive mobile health support system for pediatric obesity treatment: a randomized controlled feasibility trial

Linnea Johansson, Emilia Hagman, Pernilla Danielsson, Linnea Johansson, Emilia Hagman, Pernilla Danielsson

Abstract

Background: In order to achieve improved weight status, behavioral pediatric obesity treatment is resource intensive. Mobile Health (mHealth) is more accessible than standard care but effective approaches are scarce. Therefore, the aim of this feasibility trial was to study trial design, mHealth usage, compliance, and acceptability of a novel mHealth approach in pediatric obesity treatment.

Methods: This six-month parallel two-arm feasibility trial took place at three pediatric outpatient clinics in Stockholm, Sweden. Participants, 5-12 years, starting obesity treatment were randomized to using an mHealth support system as an addition to standard care (intervention) or to standard care alone (control). The intervention included daily self-monitoring of weight transferred to a mobile application (app) used by parents, a website in which clinicians could track treatment progress, prespecified treatment goals for change in degree of obesity shown in the app and on the website, and text message interactions between clinicians and parents. The main outcome was description of feasibility. Height and weight were measured at baseline, three, and 6 months to explore changes in body mass index standard deviation score (BMI SDS).

Results: Of 40 children eligible for inclusion, 28 agreed to participate (54% girls) and were randomized to intervention (n = 15) or control (n = 13). Weight was measured at home regularly throughout the entire trial period by 12/15 children in the intervention group. Attendance at appointments were better in the intervention group (p = 0.024). Both parents and clinicians had a positive experience and found the mHealth support system accessible. At 6 months the intervention group had a greater reduction of 0.24 units in BMI SDS than standard care (- 0.23 vs. 0.01, p = 0.002).

Conclusions: The mHealth support system was a feasible and innovative treatment approach which, in addition to standard care, generated better treatment results than standard care alone. Future research should evaluate the treatment effects over a longer follow-up time in a larger study sample.

Trial registration: This trial was retrospectively registered at ClinicalTrials.gov , ID: NCT03380598 , on November 8, 2017.

Keywords: Feasibility; Mobile health; Obesity treatment; Pediatric obesity; Self-monitoring.

Conflict of interest statement

Professor Claude Marcus, one of the founders and shareholders of Health Support Sweden AB—which developed Provement—is a mentor who has no formal authority over the research group to which the authors belong. The authors have not received any funding from Health Support Sweden AB for this research, nor for any other work.

Figures

Fig. 1
Fig. 1
Illustration of the mHealth support system. Layout by Love Marcus. *BMI SDS = Body mass index standard deviation score
Fig. 2
Fig. 2
Participant flow chart for allocation and received treatment. Completers and non-completers for baseline and each follow-up are presented together with measured anthropometrics (height and weight) and parents’ response frequency to the questionnaires about their expectations and treatment experience. *BMI SDS = Body mass index standard deviation score
Fig. 3
Fig. 3
The weekly number of weights per month, for study completers using the mHealth support system (N = 12). The box illustrates the mean value(x) and the median (line) with the first and third quartile. The whiskers show the minimum and maximum values
Fig. 4
Fig. 4
Changes in BMI SDS from baseline to follow-up at three and 6 months for all study subjects (intervention n = 15, control n = 13).¤ Mean change in BMI SDS, with 95% confidence interval. *A p-value of < 0.05 was statistically significant. P-values are based on Student’s t-test

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