Effectiveness of mobile health interventions targeting parents to prevent and treat childhood Obesity: Systematic review

Mobile- and Web-Based Interventions for Promoting Healthy Diets, Preventing Obesity, and Improving Health Behaviors in Children and Adolescents: Systematic Review of Randomized Controlled Trials

BACKGROUND

Childhood and adolescent obesity is a growing global health issue linked to noncommunicable diseases such as cardiovascular disease and type 2 diabetes. Digital health technologies, including mobile apps and web-based programs, offer scalable tools to improve health behaviors, but their effectiveness in young populations remains unclear.

OBJECTIVE

This systematic review aimed to evaluate the effectiveness of mobile and web-based digital interventions in promoting healthy diets, reducing obesity risk, increasing physical activity, and improving nutrition-related knowledge and attitudes among children and adolescents.

METHODS

A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar databases, along with hand-searching reference lists of key systematic reviews. The search encompassed records published up to September 30, 2024. Eligible studies were randomized controlled trials targeting dietary intake, anthropometric measurements, physical activity, or nutrition-related attitudes and knowledge among participants aged ≤18 years. Screening, full-text eligibility assessment, and data extraction were done partly in duplicate (20%; κ=0.86 for title or abstract screening, κ=0.71 for full-text eligibility assessment, and κ=0.78 data extraction). Risk of bias was evaluated using the Cochrane Risk-of-Bias tool (κ=0.71 for interrater reliability of 20% duplicate evaluation). Data were synthesized narratively.

RESULTS

From 300 records screened, a total of 37 articles (34 studies) were included. Interventions included games, (in 21/34 studies, 62%), mobile apps, web-based programs, and other digital tools. Among the 34 included studies, 23 (68%) studies reported positive outcomes for at least 1 measured variable. Fruit intake improved in 17 of 34 studies (50%) assessing fruit intake, while 7 of 34 studies (21%) targeting sugar-sweetened beverage consumption showed reductions. Improvements in nutrition knowledge were reported in 23 of 34 (68%) studies, but changes in anthropometric measures and physical activity outcomes showed no effect. Risk of bias was low for random sequence generation but high or unclear in other domains for many studies.

CONCLUSIONS

Mobile- and web-based interventions, particularly game-based tools, show promise for promoting healthy dietary behaviors and increasing nutrition knowledge in children and adolescents. However, the evidence for long-term sustainability and impact on anthropometric and physical activity outcomes remains limited. Future research should focus on understanding which digital features drive effectiveness, extending follow-up periods, and exploring the role of family involvement in interventions.

TRIAL REGISTRATION

PROSPERO CRD42023423512; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=423512.

Implementing an early-life nutrition intervention through primary healthcare: staff perspectives

BACKGROUND

Nutrition interventions targeting early childhood can be cost-effective and may provide lifelong, intergenerational benefits. From October 2022 to April 2023 the Nutrition Now (NN) e-learning resource was implemented within Early Childhood Education and Care centres and the Maternal and Child Healthcare Centre (MCHC) in a southern Norwegian municipality. As part of the NN project, the present study aims to explore the MCHC staff's experiences with implementing the NN resource, to gain insights into measures important to scale up digital early-life nutrition interventions.

METHODS

Three group interviews were conducted among public health nurses and midwives alongside one individual interview with the department leader of a MCHC in May 2023. An inductive thematic analysis, as described by Braun and Clarke, was conducted to generate the key themes and subthemes regarding the implementation process of NN within the MCHC.

RESULTS

Three main themes were generated: [1] Important resource but not always utilized; [2] Parents are interested but had issues with access; and [3] Staff and stakeholder buy-in and commitment needed from the start. Overall, the staff viewed the NN resource as a potential tool for promoting diet-related topics and believed it could support the guidance they were already providing parents. However, few staff members fully familiarized themselves with the resource. While staff perceived parents as positive when informed about NN, they believed issues such as access challenges, competing platforms, and time constraints reduced parental engagement. Lastly, staff suggested improvements for NN's implementation, including enhanced training, better planning, assigning champions, and lowering the threshold for access.

CONCLUSION

The findings of this study suggest that the real-world implementation of digital evidence-based health behaviour interventions is feasible but would be enhanced by employing strategies focusing on engagement and utilization.

TRIAL REGISTRATION

The main study is registered in the ISRCTN registry with ID ISRCTN10694967, https://doi.org/10.1186/ISRCTN10694967 . (Registration date: 19-06-2022).

Interventions to prevent obesity in the first 1000 days: scoping review

Introduction

The global prevalence of childhood obesity is a public health challenge. Early intervention, including during pregnancy, is essential to prevent this health problem.

Objective

Identify and characterize interventions during the first 1000 days of life that effectively prevent overweight and obesity.

Materials and Methods

A scoping review was carried out following the methodology proposed by Arksey and O'Malley. SCOPUS, EBSCOHost and PubMed databases were searched to select relevant articles. The analysis focused on articles published between January 2012 and December 2022.

Results

Fourteen articles with 10 interventions were included. These interventions were implemented in high-income countries and in racial and ethnic groups. Three interventions, involving 1013 women and their children, reported significant effects on preventing overweight and obesity at 18 and 24 months of the child's life.

Discussion

The interventions were characterized as multi-component, educational and based on theories of behavior change, parenting and sensory feeding. They addressed risk factors such as breastfeeding, complementary feeding, physical activity and sleep. There is an increasing use of digital technology in their delivery.

Conclusion

Promising results have been found for the prevention of obesity in the early years of life; therefore, implementation of interventions in low- and middle-income countries is of paramount importance.

Randomized Clinical Trial to Increase Self-Monitoring of Physical Activity and Eating Behaviors in Youth: A Feasibility Study

Introduction

Mobile health (mHealth) has the potential to reduce reliance on in-person healthcare visits, making monitoring of health, eating, and physical activity less burdensome. There is a great need to develop and test mHealth tools for pediatric weight loss programs to enhance clinical practice. This study aimed to test the feasibility of utilizing a tailored suite of mHealth components to augment an existing evidence-based in-person pediatric weight management program.

Method

Using a two-group randomized superiority trial design, participants who completed baseline measurement were randomized to Brenner Families in Training (Brenner FIT) or Brenner FIT + mHealth (Brenner mFIT)), and follow-up measures were completed at 3 and 6 months. Feasibility was assessed in terms of screening, recruitment, randomization, retention, and the assessment process. Acceptability was assessed in terms of program completion and implementation fidelity was assessed in terms of logging activity, frequency of self-monitoring, goal setting, and retention rate.

Results

Overall, 173 dyads were eligible for enrollment based on inclusion criteria. Twenty-five dyads consented to participate. Sixteen dyads completed baseline psychosocial questionnaires, eight dyads completed at least two 24-hour dietary recalls, and 20 (youth) participants returned accelerometers. Of the 14 dyads who completed enrollment, 7 dyads were each randomized into the intervention and control groups, with 10 and 5 dyads retained at three and six months, respectively. A total of four caregivers and two youth who utilized the website for goal setting set at least one goal, all seven youth linked their activity tracker, and most downloaded at least one video (two youth) or podcast (six caregivers).

Conclusions

Our results suggest that the assessment protocol was overly burdensome, the intervention had low acceptability, and the study as designed was not feasible to complete. Future studies should evaluate barriers and facilitators to the uptake of mHealth.

Effects of eHealth Interventions on 24-Hour Movement Behaviors Among Preschoolers: Systematic Review and Meta-Analysis

BACKGROUND

The high prevalence of unhealthy movement behaviors among young children remains a global public health issue. eHealth is considered a cost-effective approach that holds great promise for enhancing health and related behaviors. However, previous research on eHealth interventions aimed at promoting behavior change has primarily focused on adolescents and adults, leaving a limited body of evidence specifically pertaining to preschoolers.

OBJECTIVE

This review aims to examine the effectiveness of eHealth interventions in promoting 24-hour movement behaviors, specifically focusing on improving physical activity (PA) and sleep duration and reducing sedentary behavior among preschoolers. In addition, we assessed the moderating effects of various study characteristics on intervention effectiveness.

METHODS

We searched 6 electronic databases (PubMed, Ovid, SPORTDiscus, Scopus, Web of Science, and Cochrane Central Register of Controlled Trials) for experimental studies with a randomization procedure that examined the effectiveness of eHealth interventions on 24-hour movement behaviors among preschoolers aged 2 to 6 years in February 2023. The study outcomes included PA, sleep duration, and sedentary time. A meta-analysis was conducted to assess the pooled effect using a random-effects model, and subgroup analyses were conducted to explore the potential effects of moderating factors such as intervention duration, intervention type, and risk of bias (ROB). The included studies underwent a rigorous ROB assessment using the Cochrane ROB tool. Moreover, the certainty of evidence was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) assessment.

RESULTS

Of the 7191 identified records, 19 (0.26%) were included in the systematic review. The meta-analysis comprised a sample of 2971 preschoolers, which was derived from 13 included studies. Compared with the control group, eHealth interventions significantly increased moderate to vigorous PA (Hedges g=0.16, 95% CI 0.03-0.30; P=.02) and total PA (Hedges g=0.37, 95% CI 0.02-0.72; P=.04). In addition, eHealth interventions significantly reduced sedentary time (Hedges g=-0.15, 95% CI -0.27 to -0.02; P=.02) and increased sleep duration (Hedges g=0.47, 95% CI 0.18-0.75; P=.002) immediately after the intervention. However, no significant moderating effects were observed for any of the variables assessed (P>.05). The quality of evidence was rated as "moderate" for moderate to vigorous intensity PA and sedentary time outcomes and "low" for sleep outcomes.

CONCLUSIONS

eHealth interventions may be a promising strategy to increase PA, improve sleep, and reduce sedentary time among preschoolers. To effectively promote healthy behaviors in early childhood, it is imperative for future studies to prioritize the development of rigorous comparative trials with larger sample sizes. In addition, researchers should thoroughly examine the effects of potential moderators. There is also a pressing need to comprehensively explore the long-term effects resulting from these interventions.

TRIAL REGISTRATION

PROSPERO CRD42022365003; http://tinyurl.com/3nnfdwh3.

The social and environmental factors impacting the motivation of adolescents for weight control, why and how? A qualitative study

INTRODUCTION

Overweight and obesity are common problems among teenagers regardless of ethnicity, race, and socio-economic status. Therefore, this study aims to explore the social and environmental factors impacting adolescents motivation for weight control in Gilan province, Iran.

METHODOLOGY

Following a qualitative design, a content analysis approach was used to analyze the data. A total of 79 interviews were conducted with Adolescents (n = 23), Friends and Peers (n = 15), Parents (n = 12), Managers (n = 16), and Health care providers (n = 13), regarding adolescents obesity during 2019. MAXQDA V.10 software was used for our analysis.

FINDINGS

The main categories of environmental and social factors affecting adolescents motivation for weight control were external factors (the relative success of weight control intervention programs, the lack of environmental and social support, and the lack of family support for teenagers) that each one had some subcategories, and internal factors (competence, relatedness, and autonomy).

CONCLUSION

This study demonstrated the necessity of identifying environmental and social factors that are effective in reducing adolescents' motivation for weight loss. These factors are so influential that teenagers can't overcome them without receiving support from their environment and the government health-related policies. So, it seems that we need integrated multisectoral approaches and we suggest that health policymakers develop practical policies to control adolescents obesity by focusing on factors that have been mentioned in this study.

User-centered design and development of a web-based tool to support healthy feeding practices by parents of urban minority youth at risk for childhood obesity

Objectives

Technology, mobile health (mHealth), and "eHealth" are broadly used in childhood overweight and obesity interventions. However, the impact of technology-based interventions where parents or caregivers are involved is unclear. Thus, the objective of this manuscript is to provide valuable insights about the development of a parent-child web-based tool to promote healthy eating among preadolescents.

Methods

The tool development was an iterative process and comprised of two phases. In Phase 1, formative research (focus groups and interviews) were conducted with parents of children around the topics of dietary behaviors, technology use, and proposed intervention components. In Phase 2, a brief survey, focus groups, interviews, and user-centered approaches were used to confirm/finalize content, assess the website wireframe, and conduct usability testing.

Results

From the Phase 1 formative research, parents preferred reading/looking up health-related information on larger laptop/tablet screens, but preferred smartphones when reading "on-the-go." Suggestions for an online health tool included quick/easy/low-cost recipes, tips for healthy feeding and involving their children around healthy dietary-related behaviors, clear tool navigation, and using pictures/visuals. In Phase 2, when finalizing the tool wireframe and content, parents preferred a variety of motivational healthy feeding tips, local family-oriented community events, and a simple layout with minimal clicking to access links. During usability testing, parents responded positively to the content (healthy feeding tips, recipes, coupons, and free community events) and the clean layout.

Conclusions

Formative research and user-centered approaches with parents of preadolescents resulted in a web-based, mobile-friendly health promotion tool.

The Impact of the ENDORSE Digital Weight Management Program on the Metabolic Profile of Children and Adolescents with Overweight and Obesity and on Food Parenting Practices

Childhood obesity is a serious public health problem worldwide. The ENDORSE platform is an innovative software ecosystem based on Artificial Intelligence which consists of mobile applications for parents and health professionals, activity trackers, and mobile games for children. This study explores the impact of the ENDORSE platform on metabolic parameters associated with pediatric obesity and on the food parenting practices of the participating mothers. Therefore, the metabolic parameters of the 45 children (mean age: 10.42 years, 53% girls, 58% pubertal, mean baseline BMI z-score 2.83) who completed the ENDORSE study were evaluated. The Comprehensive Feeding Practices Questionnaire was used for the assessment of food parenting practices. Furthermore, regression analysis was used to investigate possible associations between BMI z-score changes and changes in metabolic parameters and food parenting practices. Overall, there was a statistically significant reduction in glycated hemoglobin (mean change = −0.10, p = 0.013), SGOT (mean change = −1.84, p = 0.011), and SGPT (mean change = −2.95, p = 0.022). Emotional feeding/food as reward decreased (mean change −0.21, p = 0.007) and healthy eating guidance increased (mean change = 0.11, p = 0.051). Linear regression analysis revealed that BMI z-score change had a robust and significant correlation with important metabolic parameters: HOMA-IR change (beta coefficient = 3.60, p-value = 0.046), SGPT change (beta coefficient = 11.90, p-value = 0.037), and cortisol change (beta coefficient = 9.96, p-value = 0.008). Furthermore, healthy eating guidance change had a robust negative relationship with BMI z-score change (beta coefficient = −0.29, p-value = 0.007). Conclusions: The Endorse digital weight management program improved several metabolic parameters and food parenting practices.

Process and effect evaluation of the app-based parenting program Samen Happie! on infant zBMI: A randomized controlled trial

Background

Although energy balance-related parenting practices are regarded critical components in the prevention of childhood obesity, most programs targeting parenting practices with respect to a wide range of energy balance-related behaviors were not aimed at high-risk families with a lower socioeconomic position (SEP).

Objective

The Samen Happie! app-based program aimed to stimulate healthy child weight development especially among families with a lower SEP, by encouraging healthy energy balance-related parenting practices.

Methods

A two-armed randomized controlled trial examined the process and effectiveness of the Samen Happie! program on child zBMI outcomes at 6- and 12-months follow-up. In total, 357 Dutch parents with infants aged 5-15 months old at baseline participated. Parents in the app condition (n = 179) received access to the Samen Happie! app and were compared to a waitlist-control condition (n = 178). Changes in zBMI were examined through linear mixed-effects models based on intention-to-treat and exploratory per-protocol principles.

Results

Process data showed low levels of sustained app use and moderate app acceptability. A general increase in child zBMI was observed in both conditions after 6 and 12 months. Intention-to-treat analyses using multiple imputations showed several statistically significant differences between conditions and high-risk subgroups. Specifically, at 6-months follow-up, zBMI increase was least pronounced in the app condition among children of parents with lower educational level. These findings were supported by exploratory per-protocol analyses including only frequent app users. In addition, per-protocol analyses showed benefits of app use at 6-months follow-up for children of parents with higher BMI. However, these effects were reversed at 12-months follow-up in both intention-to-treat and per-protocol analyses, where children of parents in the app condition in general increased the most in zBMI.

Conclusions

This study suggests that the Samen Happie! program might prevent zBMI increases after 6 months among children of parents with lower educational level, and children of parents with higher BMI who more frequently use the app. However, the app did not prevent increases in zBMI after 12 months. Future research should investigate strategies to increase sustained app use and engagement in mHealth parenting programs for childhood obesity as well as options to combine app-based programs with additional support strategies aimed at high-risk families.

Trial registration

Netherlands trial register (ID: NTR6938), https://trialsearch.who.int/Trial2.aspx?TrialID=NTR6938.