Approaches to the Prevention and Management of Childhood Obesity: The Role of Social Networks and the Use of Social Media and Related Electronic Technologies: A Scientific Statement From the American Heart Association

Gamification to Promote Physical Activity in Youth and Mothers With Obesity

PURPOSE

Physical inactivity and sugar-sweetened beverage (SSB) consumption are associated with obesity. Gamification and self-monitoring to promote physical activity in youth is unknown, but evidence of effectiveness is present in adults. This study examined the effects of a gamification intervention on increased steps per day among parent-adolescent dyads with obesity compared with digital self-monitoring and if self-monitored SSB intake differed between these arms.

METHODS

Youth ages 10-16 years and their mothers (N = 39 pairs), both with obesity, were randomized to a self-monitoring (N = 18) or a self-monitoring plus gamification arm (N = 21) for 9 weeks. The step goal was set and incrementally increased each week and was measured with Fitbit devices. Mixed effects linear regression examined changes in steps and SSB consumption per day, per week by study arm.

RESULTS

During run-in, mothers averaged 8317 and youth 7508 steps per day. Compared with self-monitoring alone, gamification did not increase daily steps in mothers or youth beyond baseline levels. On average, SSB intake decreased in mothers by approximately 0.5 servings per day; occurred in both arms and persisted throughout the intervention.

CONCLUSION

Gamification did not promote physical activity levels in mother-youth dyads with obesity. SSB intake declined in mothers with obesity in both study arms.

Disentangling associations between pubertal development, healthy activity behaviors, and sex in adolescent social networks

With the onset of puberty, youth begin to choose their social environments and develop health-promoting habits, making it a vital period to study social and biological factors contextually. An important question is how pubertal development and behaviors such as physical activity and sleep may be differentially linked with youths' friendships. Cross-sectional statistical network models that account for interpersonal dependence were used to estimate associations between three measures of pubertal development and youth friendships at two large US schools drawn from the National Longitudinal Study of Adolescent to Adult Health. Whole-network models suggest that friendships are more likely between youth with similar levels of pubertal development, physical activity, and sleep. Sex-stratified models suggest that girls' friendships are more likely given a similar age at menarche. Attention to similar pubertal timing within friendship groups may offer inclusive opportunities for tailored developmental puberty education in ways that reduce stigma and improve health behaviors.

Is obesity and body perception disturbance related to social media addiction among university students?

Objective The use of social networks has grown substantially over the past few years and especially during COVID-19. This study aims to investigate the possible relationship between social media addiction and obesity which may lead to disturbed body perception in university students.Participants: A total of 250 undergraduates participated.Results: Social media addiction depends on the number of years of social media use, meal skipping, and increased frequency of fast food consumption. There was a significant relationship between fast-food consumption frequency and body perception. No significant relationship was found between BMI and SMAS while there was a significant relationship between SMAS and body perception.Conclusion: The findings support, social media addiction may lead to increased risk factors for obesity and as a consequence impair body perception in young adults.

The social origins of obesity within and across generations

We propose a model for obesity development that traces a considerable part of its origins to the social domain (mainly different forms of prolonged social adversity), both within and across generations, working in tandem with a genetic predisposition. To facilitate overview of social pathways, we place particular focus on three areas that form a cascading sequence: (A) social adversity within the family (parents having a low education, a low social position, poverty and financial insecurity; offspring being exposed to gestational stress, unmet social and emotional needs, abuse, maltreatment and other negative life events, social deprivation and relationship discord); (B) increasing levels of insecurity, negative emotions, chronic stress, and a disruption of energy homeostasis; and (C) weight gain and obesity, eliciting further social stress and weight stigma in both generations. Social adversity, when combined with genetic predisposition, thereby substantially contributes to highly effective transmission of obesity from parents to offspring, as well as to obesity development within current generations. Prevention efforts may benefit from mitigating multiple types of social adversity in individuals, families, and communities, notably poverty and financial strain, and by improving education levels.

Factors Associated With Treatment Adherence to a Lifestyle Intervention Program for Children With Obesity: The Experience of a Large Tertiary Care Pediatric Hospital

Early dropout and treatment adherence are main challenges in the treatment of children with obesity. The aim of this study was to identify factors associated with attrition and adherence to weight loss intervention program. We retrospectively reviewed the medical records of all the children who entered the program for pediatric weight loss over 5 years and retrieved demographic and clinical characteristics. Attrition and adherence were documented. Ninety-two of the 248 enrolled children (52% women, mean age 11.1 ± 3.9 years, mean body mass index 31.1 ± 7 kg/m²) dropped out (37%). Dropping out correlated with male sex, low parental education, and self-referral to the clinic (P < .05 for all). Adherence correlated with older age and the mother's healthy lifestyle (P < .05 for all). Sex, parental education, and referral source may predict treatment attrition. Early recognition of children at risk of attrition may help to facilitate better care of those children.

How Do Interpersonal Relationships Affect Children's Weight Management? A Qualitative Analysis of Parents' Long-Term Perceptions after Obesity Treatment

Background: Childhood obesity interventions are particularly effective during the preschool age, but little is known about parents' long-term perceptions of weight management. This study explores how parents perceive the influence of interpersonal relationships on their children's eating and physical activity 4 years after participating in a randomized controlled trial. Bronfenbrenner's ecological systems theory frames this study, with the child's environment conceptualized as interlocking microsystems that affect weight management. Methods: Interviews were conducted with 33 parents (85% mothers, 48% with university degree) of 33 children [mean age 9.3 (standard deviation 0.7), 46% girls] from Stockholm, Sweden. Interviews were analyzed using thematic analysis, focusing on parents' perceptions of interpersonal relationships: family, relatives, other children, preschool/school staff, and health care practitioners. Results: Two main themes were developed: (1) Discouragement, with the subthemes Conflicting rules and Social comparison, and (2) Support and understanding, with the subthemes Teamwork and Shared responsibility and continuity of care. Parents perceived children's weight management as a continuous orchestration of different influences across social spheres. Years after obesity treatment, parents struggled to maintain the child's healthy routines outside the home. However, when siblings, grandparents, teachers, and friends' parents acted supportively, routines were easier to maintain. Conclusions: The findings suggest that each microsystem in a child's environment has important influence on weight management, such that, as children grow older, children's lifestyles cannot be managed by parents alone. To facilitate weight management, more people in the child's environment should be involved early in the treatment process, and continued professional support should be offered to parents.

Efficacy of Emerging Technologies to Manage Childhood Obesity

Childhood obesity is a widespread medical condition and presents a formidable challenge for public health. Long-term treatment strategies and early prevention strategies are required because obese children are more likely to carry this condition into adulthood, increasing their risk of developing other major health disorders. The present review analyses various technological interventions available for childhood obesity prevention and treatment. It also examines whether machine learning and technological interventions can play vital roles in its management. Twenty-six studies were shortlisted for the review using various technological strategies and analysed regarding their efficacy. While most of the selected studies showed positive outcomes, there was a lack of studies using robots and artificial intelligence to manage obesity in children. The use of machine learning was observed in various studies, and the integration of social robots and other efficacious strategies may be effective for treating childhood obesity in the future.

Weight Stigma and Social Media: Evidence and Public Health Solutions

Weight stigma is a pressing issue that affects individuals across the weight distribution. The role of social media in both alleviating and exacerbating weight bias has received growing attention. On one hand, biased algorithms on social media platforms may filter out posts from individuals in stigmatized groups and concentrate exposure to content that perpetuates problematic norms about weight. Individuals may also be more likely to engage in attacks due to increased anonymity and lack of substantive consequences online. The critical influence of social media in shaping beliefs may also lead to the internalization of weight stigma. However, social media could also be used as a positive agent of change. Movements such as Body Positivity, the Fatosphere, and Health at Every Size have helped counter negative stereotypes and provide more inclusive spaces. To support these efforts, governments should continue to explore legislative solutions to enact anti-weight discrimination policies, and platforms should invest in diverse content moderation teams with dedicated weight bias training while interrogating bias in existing algorithms. Public health practitioners and clinicians should leverage social media as a tool in weight management interventions and increase awareness of stigmatizing online content among their patients. Finally, researchers must explore how experiences of stigma differ across in-person and virtual settings and critically evaluate existing research methodologies and terminology. Addressing weight stigma on social media will take a concerted effort across an expansive set of stakeholders, but the benefits to population health are consequential and well-worth our collective attention.

Use and Effectiveness of Social-Media-Delivered Weight Loss Interventions among Teenagers and Young Adults: A Systematic Review

Obesity is a risk factor that exponentially increases morbidity and mortality in the world. Today, new health strategies are being implemented based on the use of social media but the use and effectiveness for these interventions needs to be assessed. The objective of this systematic review is to assess the impact of social-media-delivered weight loss interventions among teenagers and young adults. We searched PubMed, Scopus, Google Scholar, PsycINFO, and OVID to identify articles that focused on this topic. Fourteen studies were included in the final review. The commitment of the participants was found to be fundamental factor when assessing the impact of social-media-delivered weight loss interventions, but also the social context in which the interventions were carried out. Our study highlights the potential of social media platforms to address weight loss interventions among younger groups. The works evaluated showed the usefulness of social media for the adequate monitoring and control in these groups. Finally, the current variety of study designs in this field highlights the need for greater homogeneity in their methodology and applications, which is a fundamental step before these tools could be considered a suitable tool for overweight management in clinical practice.

Effect of Mobile Health Technology on Weight Control in Adolescents and Preteens: A Systematic Review and Meta-Analysis

Childhood obesity is a crucial public health concern. In recent years, numerous studies have employed mobile health technology applications for weight control in children but obtaining varying effects. We conducted a meta-analysis to discuss the effectiveness of mobile health technology in reducing the body mass index (BMI) of obese children. The standardized mean difference (SMD) in BMI between the intervention and control groups was employed to measure the effect of mobile health technology intervention on weight control. The Comprehensive Meta-Analysis Version 3 software was employed for meta-analysis, and the results are presented in a forest plot. This study included nine randomized control trials, which featured a total of 1,202 participants. The meta-analysis revealed that mobile health technology intervention did not have a significant weight loss effect on subjects with obesity. However, by using ethnicity as a moderating variable for subgroup analysis, we discovered that the BMI of ethnic Chinese groups who received mobile health technology intervention was significantly lower than that of the control group. This effect was not significant in the non-ethnic Chinese subgroup. Therefore, the use of mobile health technology intervention for weight control in ethnic Chinese children resulted in significantly lower BMI in these children; however, the use of mobile health technology intervention for weight control is unsuitable for non-ethnic Chinese children.

Rationale and design of ePPOP-ID: a multicenter randomized controlled trial using an electronic-personalized program for obesity in pregnancy to improve delivery

Background

Pre-pregnancy obesity and excessive gestational weight gain (GWG) are established risk factors for adverse pregnancy, delivery and birth outcomes. Pregnancy is an ideal moment for nutritional interventions in order to establish healthier lifestyle behaviors in women at high risk of obstetric and neonatal complications.

Methods

Electronic-Personalized Program for Obesity during Pregnancy to Improve Delivery (ePPOP-ID) is an open multicenter randomized controlled trial which will assess the efficacy of an e-health web-based platform offering a personalized lifestyle program to obese pregnant women in order to reduce the rate of labor procedures and delivery interventions in comparison to standard care. A total of 860 eligible pregnant women will be recruited in 18 centers in France between 12 and 22 weeks of gestation, randomized into the intervention or the control arm and followed until 10 weeks of postpartum.

The intervention is based on nutrition, eating behavior, physical activity, motivation and well-being advices in which personalization is central, as well as the use of a mobile/tablet application. Inputs includes data from the medical record of participants (medical history, anthropometric data), from the web platform (questionnaires on dietary habits, eating behavior, physical activity and motivation in both groups), and adherence to the program (time of connection for the intervention group only). Data are collected at inclusion, 32 weeks, delivery and 10 weeks postpartum. As primary outcome, we will use a composite endpoint score of obstetrical interventions during labor and delivery, defined as caesarean section and instrumental delivery (forceps and vacuum extractor). Secondary outcomes will consist of data routinely collected as part of usual antenatal and perinatal care, such as GWG, hypertension, preeclampsia, as well as fetal and neonatal outcomes including premature birth, gestational age at birth, birth weight, macrosomia, Apgar score, arterial umbilical cord pH, neonatal traumatism, hyperbilirubinemia, respiratory distress syndrome, transfer in neonatal intensive care unit, and neonatal adiposity. Post-natal outcomes will be duration of breastfeeding, maternal weight retention and child weight at postnatal visit.

Discussion

The findings of the ePPOP-ID trial will help design e-health intervention program for obese women in pregnancy.

Trial registration

ClinicalTrials.gov Identifier: NCT02924636 / October 5th 2016.

Efficacy of a WeChat based intervention to adherence to secondary prevention in patients undergoing coronary artery bypass graft in China: A randomized controlled trial

INTRODUCTION

We assessed whether the social media-based (WeChat) intervention integrated with follow-up care could improve adherence to drugs, lifestyle changes and clinical risk markers in patients undergoing coronary artery bypass graft (CABG) in China.

METHODS

We randomized patients at hospital discharge following CABG to intervention group or control care in China. The intervention is a structured programme of cardiac health education, medication reminders and cardiologist-based follow-up service using WeChat platform. The control group maintains a routine practice pattern. The primary outcome is adherence to cardioprotective medications measured for 12 months after discharge. We also evaluated the lifestyle modifications and clinical risk markers at 12 months.

RESULTS

A total of 164 participants completed the trial for analysis. The intervention group had significantly greater adherence to statins use 98.6% vs. 75.0% (p < 0.01), beta-blockers 93.4% vs. 69.3% (p < 0.01) and aspirin 98.8% vs. 87.8% (p < 0.001). The intervention group had significantly greater adherence to regular physical activity (64.2% vs. 48.2%; p < 0.039). Furthermore, intervention versus standard group at 12 months had significantly lower mean systolic blood pressure and low-density lipoprotein cholesterol (p < 0.05).

DISCUSSION

A WeChat-based intervention strategy in post-CABG patients improved adherence to medications, including statin, aspirin and beta-blockers, and regular physical activity and resulted in an improvement in systolic blood pressure and low-density lipoprotein cholesterol level.

Metformin Alleviates Obesity and Systemic Oxidative Stress in Obese Young Swine

The present study assessed the relationship between obesity induced by lifestyle and systemic oxidative stress and possible modulations by oral metformin treatments in young individuals, by using a translational swine model of obesity and associated cardiometabolic disorders (Iberian pig). The results indicate the existence of an age-related increase in both adiposity and systemic oxidative stress (using hydrogen peroxide as a marker), which is higher in individuals with obesogenic lifestyle and increased weight and obesity. Such effect was not found in individuals treated with metformin. The translation of these results suggests that childhood obesity increases production of reactive oxygen species (ROS), and therefore systemic oxidative stress. Treatment with metformin would improve such oxidative status.

Toward Achieving Sustainable Food Consumption: Insights from the Life Course Paradigm

Trends in world population growth have created an agri-food demand that is unsustainable under the present resource-intensive agricultural systems and expected growth in income levels in many developing countries. As such, research and policy making related to sustainable development have focused on consumption. One major approach to sustainable consumption lies in shaping food demand that would require changes in people’s present food consumption habits that are excessive and unhealthy, leading to overweight and obesity. In order to change food consumption habits, one must understand the factors that lead to their onset and change. This article offers the life course paradigm, which is increasingly used by social and behavioral scientists to study the development and change of various forms of behavior, as a research framework for studying the onset and change in food consumption habits. It shows how the life course approach could help guide future research not only on sustainable consumption, but also on environmental and social sustainability.

Social media: How hospital facebook activity may influence patient satisfaction

Some hospitals use social media to promote accurate health-related education, information, and engage consumers. We performed multiple linear regression analyses to determine the associations between hospital Facebook activity and patient satisfaction for 390 hospitals. Hospitals that had a Facebook page were active on Facebook in the past 30 days and had more "likes," had more patients willing to definitely recommend the hospital, and had a higher overall satisfaction score. Practitioners can use the results when considering whether a minimal financial investment in social media may be worth customer loyalty and Centers for Medicare and Medicaid Systems (CMS) reimbursement benefits.

Social media use as a predictor of higher body mass index in persons living with HIV

Social media tools have been touted as an approach to bring more democratic communication to health care. We conducted a multi-site cross-sectional study among persons living with HIV (PLWH) to desrcibe technology use among PLWH in the US and the association between social media use and body-mass index (BMI). Our primary predictor variable was social media use. Our primary outcome was BMI measured through height and weight. Descriptive statistics were used to describe the demographic profiles of the study participants and linear regression models were used to analyze associations between the outcome and predictor variables controlling for demographic characteristics. Study participants (N = 606) across 6 study sites in the United States were predominately 50-74 years old (67%). Thirty-three percent of study participants had a normal weight (BMI 18.5-25), 33% were overweight (BMI 25-30), and 32% were obese (BMI > 30). Participants used several social media sites with Facebook (45.6%) predominating. Social media use was associated with higher BMI in study participants (p < .001) and this effect persisted, although not as strongly, when limiting the analysis to those who only those who used Facebook (p = .03). Further consideration of social factors that can be ameliorated to improve health outcomes is timely and needed.

Telemonitoring and remote counseling in hypertensive patients. Looking for new ways to do old jobs

XXI century emphasized humanity to embrace the digital era after a reality of Third and Fourth Industrial Revolutions, nowadays dictating new terms of social networking. It is expected that information and communication technologies integrated with value-based medicine will significantly impact healthcare delivery to tremendous number of patients with socially important noncommunicable diseases. Cardiovascular illnesses comprise the greatest part of such pathologies. Hypertension (HTN) being the most prevalent cardiovascular disease is also the key modifiable cardiovascular risk factor yet seems to be an attractive target for both value-based concept and telehealth interventions. Present review addresses up-to-date science on telehealth, sets out the main well-known, but yet unsolved challenges in management of HTN along with the new approaches involving telemedicine programs, digital health outlooks. The main barriers of telehealth implementation are also considered along with the possible solutions.

Probiotics in Adolescent Prediabetes: A Pilot RCT on Glycemic Control and Intestinal Bacteriome

Dysbiosis of intestinal ecology could be implicated in prediabetes. The aim of this pilot randomized controlled trial (RCT) was to collect preliminary data on the effects of probiotic supplementation (Vivomixx©) on markers of glucose metabolism, intestinal microbiome composition, and intestinal health indices, of prediabetic adolescents. The intervention group was administered probiotic sachets twice daily for 4 months, while both intervention and control groups received weekly consultation sessions for a healthier lifestyle. Thirty-two participants were recruited (1.3 participants per month) and were randomized (16 in control and 16 in intervention group). Fifteen of them signed the inform consent and never entered the study (6 in control and 9 in intervention group). Thus, seventeen participants completed the study (10 in control and 7 in intervention group), with no serious adverse events. After the 4-month intervention, no difference was observed in the markers of glycemic control between the two groups, although a minor effect was observed for fasting glucose at 1-month, probably due to the initial higher adherence to the probiotic supplements. Modifications of the protocol procedures are warranted because of the high attrition rates and suboptimal compliance that were noted. Future studies and further RCTs with larger samples need to be conducted to fully elucidate the potential effects of probiotics in the glycemic control of prediabetic adolescents.

Content Analysis of Media Coverage of Childhood Obesity Topics in UAE Newspapers and Popular Social Media Platforms, 2014-2017

The 2017 prevalence of obesity among children (age 5–17 years) in the United Arab Emirates (UAE) is 13.68%. Childhood obesity is one of the 10 top health priorities in the UAE. This study examines the quality, frequency, sources, scope and framing of childhood obesity in popular social media and three leading UAE newspapers from 2014 to 2017. During the review period, 152 newspaper articles from three leading national newspapers – Gulf News, The National and Al Ittihad – met the eligibility criteria for this study. There were 57 Facebook posts, 50 Twitter posts, 14 posted YouTube videos, and 13 Media releases on related to childhood obesity between 2014 and 2017. Childhood obesity was consistently problematized, primarily in health terms, but was not strongly linked to socio-economic and geographical factors. Childhood obesity was framed as being predominantly influenced by individual and parental behaviours more frequently (n = 76) compared with structural or environmental factors such as the roles of the food and beverage industry (n = 22). Unlike findings from studies with adult obesity, articles advocating individual behavior changes to address childhood obesity were relatively few (n = 29). Social media may be an effective way to help children overcome obesity, in part through online interaction with health care providers and health conscious obese peers. Areas for improvement in social media use to reduce childhood obesity prevalence in UAE include enhancing public engagement with social media posts on childhood obesity, as reflected in the numbers of Likes and Retweets or Shares.

Network influences on the development and implementation of active transportation policies in six U.S. cities

Many communities have prioritized policy and built environment changes to promote active transportation (AT). However, limited information exists on the partnerships and processes necessary to develop and implement such policy and environmental changes, particularly among organizations in non-health sectors. Within the transportation sector, metropolitan planning organizations (MPOs) are increasingly recognized as organizations that can support AT policies. This study examined inter-organizational relationships among MPOs and their partners working to advance AT policies in six U.S. cities. In fall 2015, an average of 22 organizations in each city participated in an online survey about partnerships with MPOs and other organizations developing and implementing AT policies. Measures included organizational characteristics and relational attributes including: level of AT policy collaboration, information transmission, resource sharing, and perceived decisional power. Descriptive network analysis and exponential random graph modeling were used to examine organizational attributes and relational predictors associated with inter-organizational collaboration in each network. MPOs served as collaborative intermediaries, connecting other organizations around AT policies, in half of the cities examined. Organizations in each city were more likely to collaborate around AT policies when partners communicated at least quarterly. In half of the cities, the probability of AT policy collaboration was higher when two agencies exchanged resources and when organizations had perceived decisional authority. Network analysis helped identify factors likely to improve partnerships around AT policies. Results may contribute to best practices for collaboration among researchers, practitioners, policymakers, and advocates across diverse sectors seeking to promote population-level physical activity.

Barriers and enablers for adopting lifestyle behavior changes in adolescents with obesity: A multi-centre, qualitative study

BACKGROUND

Many adolescents with obesity do not meet recommendations for nutrition, physical and sedentary activities, and sleep habits, all of which can influence weight management.

OBJECTIVE

To explore barriers and enablers that influenced the adoption of lifestyle behavior changes among adolescents receiving multidisciplinary clinical care for pediatric weight management.

METHODS

In this multi-centre, qualitative description study, we used purposeful sampling to recruit 13-17 year olds (body mass index ≥85th percentile) enrolled in one of two pediatric weight management clinics in Edmonton and Ottawa, Canada. Adolescents participated in one-on-one, in-person, semi-structured interviews in English or French. Interviews lasted 30-60 minutes, were audio-recorded, transcribed verbatim, and managed using NVivo 11. Data were triangulated using transcripts, field notes, and memos and analyzed by two independent researchers using inductive, semantic thematic analysis.

RESULTS

In total, 19 adolescents (12 Anglophone and 7 Francophone; 15.1±1.7 years old; 3.5±0.6 BMI z-score; n = 11 female; n = 13 Caucasian) participated. Adolescents reported diverse barriers to and enablers of healthy nutrition, physical and sedentary activities, and sleep habits, which we organized into the following themes: physiological mechanisms and physical health status, self-regulation for behavior change, controllability and competence beliefs, social relationships and interactions, and accessibility to and availability of opportunities for lifestyle enhancement. Across these themes and lifestyle areas, we identified three shared barriers and/or enablers, including the degree of controllability, the impact of mental health, and social pressures related to weight management.

CONCLUSIONS

This research provides evidence that can be used to tailor interventions and health services delivery, including a focus on psychosocial well-being, to support adolescents with obesity in making and maintaining healthy lifestyle behavior changes.

Effect of a School-Based Activity Tracker, Companion Social Website, and Text Messaging Intervention on Exercise, Fitness, and Physical Activity Self-Efficacy of Middle School Students

This study examined the effect of a 10-week activity tracker, companion social website, and text messaging intervention on body mass index (BMI), body fat percentage, physical fitness, and physical activity (PA) self-efficacy of children. Children (n = 98) were assigned to one of three groups: activity tracker group, text messaging group, and activity tracker + text messaging group. Pre-/posttest fitness, BMI, PA self-efficacy, and body fat percentage were measured. The activity tracker group had a significant increase in fitness, no significant difference in PA self-efficacy, and an increase in body fat percentage and BMI (p < .05). The text messaging group had a significant increase in BMI (p < .05). The activity tracker + text messaging group had no significant differences in fitness, BMI, PA self-efficacy, or body fat percentage. This study gives no clear support to the hypothesis that use of activity trackers and a text messaging intervention have a positive effect on fitness, PA self-efficacy, or body fat percentage.

Effect of Social Media on Child Obesity: Application of Structural Equation Modeling with the Taguchi Method

Through public health studies, specifically on child obesity modeling, research scholars have been attempting to identify the factors affecting obesity using suitable statistical techniques. In recent years, regression, structural equation modeling (SEM) and partial least squares (PLS) regression have been the most widely employed statistical modeling techniques in public health studies. The main objective of this study to apply the Taguchi method to introduce a new pattern rather than a model for analyzing the body mass index (BMI) of children as a representative of childhood obesity levels mainly related to social media use. The data analysis includes two main parts. The first part entails selecting significant indicators for the proposed framework by applying SEM for primary and high school students separately. The second part introduces the Taguchi method as a realistic and reliable approach to exploring which combination of significant variables leads to high obesity levels in children. AMOS software (IBM, Armonk, NY, USA) was applied in the first part of data analysis and MINITAB software (Minitab Inc., State College, PA, USA) was utilized for the Taguchi experimental analysis (second data analysis part). This study will help research scholars view the data and a pattern rather than a model, as a combination of different factor levels for target factor optimization.

Digital Education to Limit Salt in the Home (DELISH) Program Improves Knowledge, Self-Efficacy, and Behaviors Among Children

OBJECTIVE

To determine the efficacy of a Web-based salt reduction program on children's salt-related knowledge, attitudes, and behaviors (KABs), self-efficacy, and intake of dietary salt.

DESIGN

Pretest and posttest. An online survey determined KABs and self-efficacy and a 24-hour urine collection revealed salt intake.

SETTING

Victoria, Australia.

PARTICIPANTS

Child-parent dyads (n = 102) recruited from 5 government schools.

INTERVENTION

A 5-week behavior-based education program delivered via weekly online interactive education sessions.

MAIN OUTCOME MEASURES

Change in KABs, self-efficacy, and daily salt intake.

ANALYSIS

Changes in outcomes were assessed using McNemar test, paired t test, and Cohen's δ (CD).

RESULTS

A total of 83 children participated (mean age, 9.2 years [SD, 0.8 years]; 59% girls); 35% to 76% of children viewed weekly education session. Children with complete survey data (n = 75) had improved scores for salt-related knowledge (+3.6 ± 0.4 points; P < .001; CD: 1.16), behaviors (+1.3 ± 0.1 points; P < .001; CD: 1.08), and self-efficacy (+0.9 ± 0.2 points; P < .001; CD: 0.64), but not attitude. Children with valid urine collections (n = 51) showed no change in salt intake.

CONCLUSIONS AND IMPLICATIONS

Participation resulted in improvement of salt related knowledge, self-efficacy and behavior. Further research is required to confirm these results using a more robust study design which includes a control group. In addition, the long term impact on children's salt intakes of comparable education programs needs to be assessed.

Social Media Based STEM Enrichment Curriculum Positively Impacts Rural Adolescent Health Measures

Some STEM outreach programs connect students to real-world problems and challenge them to work towards solutions. Research shows one-third of children between ages 5-17 in the U.S. are overweight. Socioeconomic status, race, and parental educational attainment all influence this issue as well as living in a rural or urban area. A rural high school STEM outreach program used a social media curriculum focused on healthy lifestyles and measured impact on the health of adolescents from these backgrounds. Health screenings and college mentors were provided to 134 adolescents from 26 counties in WV. The social media intervention lasted seven months with participants using near-peer and mentor support to achieve personal health goals set at the initial health screening. The results of pre- and post-intervention health screenings were compared for any changes in health measures by student goal and participation. BMI decreased significantly in the group of participants who selected a weight loss goal, while those choosing to improve their nutrition significantly increased healthy cholesterol levels. A positive impact was seen on adolescent health outcomes through linking a high school STEM outreach program with a higher education institution to deliver STEM enrichment curriculum through social media.

Engineering Online and In-Person Social Networks for Physical Activity: A Randomized Trial

BACKGROUND

Social networks can influence physical activity, but little is known about how best to engineer online and in-person social networks to increase activity.

PURPOSE

The purpose of this study was to conduct a randomized trial based on the Social Networks for Activity Promotion model to assess the incremental contributions of different procedures for building social networks on objectively measured outcomes.

METHODS

Physically inactive adults (n = 308, age, 50.3 (SD = 8.3) years, 38.3 % male, 83.4 % overweight/obese) were randomized to one of three groups. The Promotion group evaluated the effects of weekly emailed tips emphasizing social network interactions for walking (e.g., encouragement, informational support); the Activity group evaluated the incremental effect of adding an evidence-based online fitness walking intervention to the weekly tips; and the Social Networks group evaluated the additional incremental effect of providing access to an online networking site for walking as well as prompting walking/activity across diverse settings. The primary outcome was mean change in accelerometer-measured moderate-to-vigorous physical activity (MVPA), assessed at 3 and 9 months from baseline.

RESULTS

Participants increased their MVPA by 21.0 min/week, 95 % CI [5.9, 36.1], p = .005, at 3 months, and this change was sustained at 9 months, with no between-group differences.

CONCLUSIONS

Although the structure of procedures for targeting social networks varied across intervention groups, the functional effect of these procedures on physical activity was similar. Future research should evaluate if more powerful reinforcers improve the effects of social network interventions.

TRIAL REGISTRATION NUMBER

The trial was registered with the ClinicalTrials.gov (NCT01142804).

Family-Based Obesity Prevention: Perceptions of Canadian Parents of Preschool-Age Children

Our objectives were to explore the perspectives of a community-based sample of Canadian parents with 2-5-year-old children on: (i) strategies to support the development of healthful weight-related behaviours and (ii) assessment approaches to measure weight-related behaviours and outcomes among children and families. We conducted 4 focus groups with 28 parents (89% mothers and 68% identified as White). Transcripts were analyzed using conventional content analysis. Regarding parent's perceptions of strategies to support healthful behaviours, we found that parents largely valued: home-based interventions, expert opinion, practical health behaviour strategies delivered in a nonjudgmental manner, and opportunities for social support. Regarding perceptions of assessment procedures, parents had mixed views on children providing blood samples, but looked upon it more favourably if it would contribute to research on child health. Our results suggest that to increase parental engagement interventions focused on improving weight-related behaviours among families with young children should be delivered within the home and include easy-to-implement behaviour change strategies communicated by experts, such as dietitians working in the clinical or public health setting. Using social media to share information and provide a platform for social support may also be an effective way to engage parents of young children.

The Development of a Web-Based Program to Reduce Dietary Salt Intake in Schoolchildren: Study Protocol

BACKGROUND

Salt intake of schoolchildren in the Australian state of Victoria is high. To protect future cardiovascular health, interventions that seek to reduce the amount of salt in children's diets are required.

OBJECTIVE

We sought to develop and pilot test a Web-based program (Digital Education to Limit Salt Intake in the Home [DELISH]) that aims to reduce dietary salt intake among schoolchildren and to improve child and parent knowledge, attitudes, and behaviors related to salt intake. This paper presents the DELISH study protocol, along with pilot findings used to inform the development of the program.

METHODS

The DELISH program is a 5-week Web-based intervention that targets schoolchildren aged 7-10 years and their parents. This is a single-arm study with a pretest and posttest design. We will assess change in salt intake through analysis of 24-hour urinary sodium excretion. Children and parents will complete online surveys assessing knowledge, attitudes, and behaviors related to salt intake. We will assess feasibility of the program via process measures, which include metrics to describe intervention uptake (eg, number of children who complete Web-based sessions and of parents who view online newsletters) and evaluation surveys and interviews conducted with children, parents, and schoolteachers. The first 2 Web sessions developed for children were pilot tested in 19 children aged 8-12 years.

RESULTS

Findings from pilot testing indicated that most children (session 1: 18/19, 95%; and session 2: 19/19, 100%) enjoyed completing each session and liked the inclusion of comic strips and interactive games. Commonly reported areas of improvement related to sessions being text and content heavy. Based on these findings, we simplified sessions and developed 3 additional sessions for use in the DELISH program. The DELISH program was implemented during June-December 2016. We expect to have results from this study at the end of 2017.

CONCLUSIONS

To our knowledge, this is the first Australian study to examine the effectiveness of a Web-based program to reduce salt intake among children in primary school. If shown to be acceptable and effective in lowering salt intake, the DELISH program could be tested using a more rigorous randomized controlled trial design.

Pediatric Obesity-Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline

COSPONSORING ASSOCIATIONS

The European Society of Endocrinology and the Pediatric Endocrine Society. This guideline was funded by the Endocrine Society.

OBJECTIVE

To formulate clinical practice guidelines for the assessment, treatment, and prevention of pediatric obesity.

PARTICIPANTS

The participants include an Endocrine Society-appointed Task Force of 6 experts, a methodologist, and a medical writer.

EVIDENCE

This evidence-based guideline was developed using the Grading of Recommendations, Assessment, Development, and Evaluation approach to describe the strength of recommendations and the quality of evidence. The Task Force commissioned 2 systematic reviews and used the best available evidence from other published systematic reviews and individual studies.

CONSENSUS PROCESS

One group meeting, several conference calls, and e-mail communications enabled consensus. Endocrine Society committees and members and co-sponsoring organizations reviewed and commented on preliminary drafts of this guideline.

CONCLUSION

Pediatric obesity remains an ongoing serious international health concern affecting ∼17% of US children and adolescents, threatening their adult health and longevity. Pediatric obesity has its basis in genetic susceptibilities influenced by a permissive environment starting in utero and extending through childhood and adolescence. Endocrine etiologies for obesity are rare and usually are accompanied by attenuated growth patterns. Pediatric comorbidities are common and long-term health complications often result; screening for comorbidities of obesity should be applied in a hierarchal, logical manner for early identification before more serious complications result. Genetic screening for rare syndromes is indicated only in the presence of specific historical or physical features. The psychological toll of pediatric obesity on the individual and family necessitates screening for mental health issues and counseling as indicated. The prevention of pediatric obesity by promoting healthful diet, activity, and environment should be a primary goal, as achieving effective, long-lasting results with lifestyle modification once obesity occurs is difficult. Although some behavioral and pharmacotherapy studies report modest success, additional research into accessible and effective methods for preventing and treating pediatric obesity is needed. The use of weight loss medications during childhood and adolescence should be restricted to clinical trials. Increasing evidence demonstrates the effectiveness of bariatric surgery in the most seriously affected mature teenagers who have failed lifestyle modification, but the use of surgery requires experienced teams with resources for long-term follow-up. Adolescents undergoing lifestyle therapy, medication regimens, or bariatric surgery for obesity will need cohesive planning to help them effectively transition to adult care, with continued necessary monitoring, support, and intervention. Transition programs for obesity are an uncharted area requiring further research for efficacy. Despite a significant increase in research on pediatric obesity since the initial publication of these guidelines 8 years ago, further study is needed of the genetic and biological factors that increase the risk of weight gain and influence the response to therapeutic interventions. Also needed are more studies to better understand the genetic and biological factors that cause an obese individual to manifest one comorbidity vs another or to be free of comorbidities. Furthermore, continued investigation into the most effective methods of preventing and treating obesity and into methods for changing environmental and economic factors that will lead to worldwide cultural changes in diet and activity should be priorities. Particular attention to determining ways to effect systemic changes in food environments and total daily mobility, as well as methods for sustaining healthy body mass index changes, is of importance.

OPREVENT2: Design of a multi-institutional intervention for obesity control and prevention for American Indian adults

Background

Obesity and other nutrition-related chronic disease rates are high in American Indian (AI) populations, and an urgent need exists to identify evidence-based strategies for prevention and treatment. Multi-level, multi-component (MLMC) interventions are needed, but there are significant knowledge gaps on how to deliver these types of interventions in low-income rural AI communities.

Methods

OPREVENT2 is a MLMC intervention targeting AI adults living in six rural reservations in New Mexico and Wisconsin. Aiming to prevent and reduce obesity in adults by working at multiple levels of the food and physical activity (PA) environments, OPREVENT2 focuses on evidence-based strategies known to increase access to, demand for, and consumption of healthier foods and beverages, and increase worksite and home-based opportunities for PA. OPREVENT2 works to create systems-level change by partnering with tribal stakeholders, multiple levels of the food and PA environment (food stores, worksites, schools), and the social environment (children as change agents, families, social media). Extensive evaluation will be conducted at each level of the intervention to assess effectiveness via process and impact measures.

Discussion

Novel aspects of OPREVENT2 include: active engagement with stakeholders at many levels (policy, institutional, and at multiple levels of the food and PA system); use of community-based strategies to engage policymakers and other key stakeholders (community workshops, action committees); emphasis on both the built environment (intervening with retail food sources) and the social environment. This paper describes the design of the intervention and the evaluation plan of the OPREVENT2.

Trial registration

Clinical Trial Registration: NCT02803853 (June 10, 2016)

A Social Media Peer Group Intervention for Mothers to Prevent Obesity and Promote Healthy Growth from Infancy: Development and Pilot Trial

BACKGROUND

Evidence increasingly indicates that childhood obesity prevention efforts should begin as early as infancy. However, few interventions meet the needs of families whose infants are at increased obesity risk due to factors including income and maternal body mass index (BMI). Social media peer groups may offer a promising new way to provide these families with the knowledge, strategies, and support they need to adopt obesity prevention behaviors.

OBJECTIVE

The aim of this study is to develop and pilot test a Facebook-based peer group intervention for mothers, designed to prevent pediatric obesity and promote health beginning in infancy.

METHODS

We conducted in-depth semi-structured interviews with 29 mothers of infants and focus groups with 30 pediatric clinicians, to inform the development of a theory-based intervention. We then conducted a single-group pilot trial with 8 mothers to assess its feasibility and acceptability. All participants were recruited offline at pediatric primary care practices. Participants in the pilot trial joined a private Facebook group, moderated by a psychologist, with a weekly video-based curriculum, and also had the option to meet at a face-to-face event. Within the Facebook group, mothers were encouraged to chat, ask questions, and share photos and videos of themselves and babies practicing healthy behaviors. Consistent with the literature on obesity prevention, the curriculum addressed infant feeding, sleep, activity, and maternal well-being. Feasibility was assessed using the frequency and content of group participation by mothers, and acceptability was measured using online surveys and phone interviews.

RESULTS

Based on preferences of mothers interviewed (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 27, all Black), we designed the intervention to include frequent posts with new information, videos showing parents of infants demonstrating healthy behaviors, and an optional face-to-face meeting. We developed a privacy and safety plan that met the needs of participants as well as the requirements of the local institutional review board (IRB), which included use of a "secret" group and frequent screening of participant posts. Clinicians, 97% (29/30) women and 87% (26/30) pediatricians, preferred no direct involvement in the intervention, but were supportive of their patients' participation. In our 8-week, single group pilot trial, all participants (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 28, all Black) viewed every weekly video post, and interacted frequently, with a weekly average of 4.4 posts/comments from each participant. All participant posts were related to parenting topics. Participants initiated conversations about behaviors related to healthy infant growth including solid food introduction, feeding volume, and managing stress. All 8 pilot group participants reported that they found the group helpful and would recommend it to others.

CONCLUSIONS

Our methodology was feasible and acceptable to low-income mothers of infants at high risk of obesity, and could be adapted to implement peer groups through social media for underserved populations in varied settings.

CLINICALTRIAL

ClinicalTrials.gov NCT01977105; https://clinicaltrials.gov/ct2/show/NCT01977105 (Archived by WebCite at http://www.webcitation.org/6iMFfOBat).

Testing the Efficacy of OurSpace, a Brief, Group Dynamics-Based Physical Activity Intervention: A Randomized Controlled Trial

BACKGROUND

Emerging technologies (ie, mobile phones, Internet) may be effective tools for promoting physical activity (PA). However, few interventions have provided effective means to enhance social support through these platforms. Face-to-face programs that use group dynamics-based principles of behavior change have been shown to be highly effective in enhancing social support through promoting group cohesion and PA, but to date, no studies have examined their effects in Web-based programs.

OBJECTIVE

The aim was to explore proof of concept and test the efficacy of a brief, online group dynamics-based intervention on PA in a controlled experiment. We expected that the impact of the intervention on PA would be moderated by perceptions of cohesion and the partner's degree of presence in the online media.

METHODS

Participants (n=135) were randomized into same-sex dyads and randomly assigned to one of four experimental conditions: standard social support (standard), group dynamics-based-high presence, group dynamics-based-low presence, or individual control. Participants performed two sets of planking exercises (pre-post). Between sets, participants in partnered conditions interacted with a virtual partner using either a standard social support app or a group dynamics-based app (group dynamics-based-low presence and group dynamics-based-high presence), the latter of which they participated in a series of online team-building exercises. Individual participants were given an equivalent rest period between sets. To increase presence during the second set, participants in the group dynamics-based-high presence group saw a live video stream of their partner exercising. Perceptions of cohesion were measured using a modified PA Group Environment Questionnaire. Physical activity was calculated as the time persisted during set 2 after controlling for persistence in set 1.

RESULTS

Perceptions of cohesion were higher in the group dynamics-based-low presence (overall mean 5.81, SD 1.04) condition compared to the standard (overall mean 5.04, SD 0.81) conditions ( P=.006), but did not differ between group dynamics-based-low presence and group dynamics-based-high presence (overall mean 5.42, SD 1.07) conditions ( P=.25). Physical activity was higher in the high presence condition (mean 64.48, SD 20.19, P=.01) than all other conditions (mean 53.3, SD 17.35).

CONCLUSIONS

A brief, online group dynamics-based intervention may be an effective method of improving group cohesion in virtual PA groups. However, it may be insufficient on its own to improve PA.

A call for research exploring social media influences on mothers' child feeding practices and childhood obesity risk

There is increasing interest in leveraging social media to prevent childhood obesity, however, the evidence base for how social media currently influences related behaviors and how interventions could be developed for these platforms is lacking. This commentary calls for research on the extent to which mothers use social media to learn about child feeding practices and the mechanisms through which social media influences their child feeding practices. Such formative research could be applied to the development and dissemination of evidence-based childhood obesity prevention programs that utilize social media. Mothers are identified as a uniquely important target audience for social media-based interventions because of their proximal influence on children's eating behavior and their high engagement with social media platforms. Understanding mothers' current behaviors, interests, and needs as they relate to their social media use and child feeding practices is an integral first step in the development of interventions that aim to engage mothers for obesity prevention. This commentary highlights the importance of mothers for childhood obesity prevention; discusses theoretical and analytic frameworks that can inform research on social media and mothers' child feeding practices; provides evidence that social media is an emerging context for social influences on mothers' attitudes and behaviors in which food is a salient topic; and suggests directions for future research.

Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers

OBJECTIVE

To explore outcomes and measures of success that matter most to 'positive outlier' children who improved their body mass index (BMI) despite living in obesogenic neighborhoods.

METHODS

We collected residential address and longitudinal height/weight data from electronic health records of 22,657 children ages 6-12 years in Massachusetts. We defined obesity "hotspots" as zip codes where >15% of children had a BMI ≥95th percentile. Using linear mixed effects models, we generated a BMI z-score slope for each child with a history of obesity. We recruited 10-12 year-olds with negative slopes living in hotspots for focus groups. We analyzed group transcripts and discussed emerging themes in iterative meetings using an immersion/crystallization approach.

RESULTS

We reached thematic saturation after 4 focus groups with 21 children. Children identified bullying and negative peer comparisons related to physical appearance, clothing size, and athletic ability as motivating them to achieve a healthier weight, and they measured success as improvement in these domains. Positive relationships with friends and family facilitated both behavior change initiation and maintenance.

CONCLUSIONS

The perspectives of positive outlier children can provide insight into children's motivations leading to successful obesity management.

PRACTICE IMPLICATIONS

Child/family engagement should guide the development of patient-centered obesity interventions.

Effects of Social Network Exposure on Nutritional Learning: Development of an Online Educational Platform

Background

Social networking sites (SNSs) such as Facebook have the potential to enhance online public health interventions, in part, as they provide social exposure and reinforcement.

Objective

The objective of the study was to evaluate whether social exposure provided by SNSs enhances the effects of online public health interventions.

Methods

As a sample intervention, we developed Food Hero, an online platform for nutritional education in which players feed a virtual character according to their own nutritional needs and complete a set of virtual sport challenges. The platform was developed in 2 versions: a "private version" in which a user can see only his or her own score, and a "social version" in which a user can see other players’ scores, including preexisting Facebook friends. We assessed changes in participants’ nutritional knowledge using 4 quiz scores and 3 menu-assembly scores. Monitoring feeding and exercising attempts assessed engagement with the platform.

Results

The 2 versions of the platform were randomly assigned between a study group (30 members receiving the social version) and a control group (33 members, private version). The study group's performance on the quizzes gradually increased over time, relative to that of the control group, becoming significantly higher by the fourth quiz (P=.02). Furthermore, the study group's menu-assembly scores improved over time compared to the first score, whereas the control group's performance deteriorated. Study group members spent an average of 3:40 minutes assembling each menu compared to 2:50 minutes in the control group, and performed an average of 1.58 daily sport challenges, compared to 1.21 in the control group (P=.03).

Conclusions

This work focused on isolating the SNSs' social effects in order to help guide future online interventions. Our results indicate that the social exposure provided by SNSs is associated with increased engagement and learning in an online nutritional educational platform.

Sensors and systems for obesity care and research

Obesity and overweight decrease the quality and length of life and increases healthcare costs. Dramatic increase of obesity, particularly childhood obesity, in developed countries requires efficient methods and systems for obesity research and monitoring of users. New generation of smart sensors and ubiquitous monitoring systems provide unprecedented opportunities to assess real-life environments, mobility, physical activity, and physiological responses. In this paper we present current trends in sensing, social networks, and systems integration. New monitoring and intervention technologies create new opportunities for remote patient monitoring and intervention.

Efficacy and causal mechanism of an online social media intervention to increase physical activity: Results of a randomized controlled trial

Objective: To identify what features of social media – promotional messaging or peer networks – can increase physical activity. Method: A 13-week social media-based exercise program was conducted at a large Northeastern university in Philadelphia, PA. In a randomized controlled trial, 217 graduate students from the University were randomized to three conditions: a control condition with a basic online program for enrolling in weekly exercise classes led by instructors of the University for 13 weeks, a media condition that supplemented the basic program with weekly online promotional media messages that encourage physical activity, and a social condition that replaced the media content with an online network of four to six anonymous peers composed of other participants of the program, in which each participant was able to see their peers' progress in enrolling in classes. The primary outcome was the number of enrollments in exercise classes, and the secondary outcomes were self-reported physical activities. Data were collected in 2014. Results: Participants enrolled in 5.5 classes on average. Compared with enrollment in the control condition (mean = 4.5), promotional messages moderately increased enrollment (mean = 5.7, p = 0.08), while anonymous social networks significantly increased enrollment (mean = 6.3, p = 0.02). By the end of the program, participants in the social condition reported exercising moderately for an additional 1.6 days each week compared with the baseline, which was significantly more than an additional 0.8 days in the control condition. Conclusion: Social influence from anonymous online peers was more successful than promotional messages for improving physical activity. Clinical Trial Registration: ClinicalTrials.gov: NCT02267369.

•

We conduct a 13-week social media-based exercise program.

•

We examine the causal effects of promotional messaging and social influence.

•

Promotional messages moderately increase enrollment in exercise classes.

•

Anonymous social networks significantly increase enrollment in exercise classes.

•

Social influence is more successful for improving physical activity.

Social Relationships and Obesity: Benefits of Incorporating a Lifecourse Perspective

Social networks reflect the structure of our interpersonal relationships. The effect of social networks on health is a topic of growing interest, particularly in an increasingly connected world. This review provides an overview of how social relations shape obesity risk and the effectiveness of network-based obesity interventions across the life course. The review highlights that, while the literature suggests obesity and related health behaviors are similar between socially-connected individuals, why this is the case and how to effectively intervene remains unclear. In addition, the review outlines methodological gaps limiting our understanding of how social networks shape obesity risk throughout the lifecourse. Several implications for obesity prevention and research are offered, including the need to examine the relationship of social networks and obesity across rather than within life-course stages, continued development of statistical social network analysis methods and the need for new cohort studies, particularly among children and the elderly.

Treatment of child/adolescent obesity using the addiction model: a smartphone app pilot study

BACKGROUND

The aim of this study was to test a weight loss program for young people based on an addiction treatment approach.

METHODS

A pilot study (n=43) was conducted of a 20-week child/adolescent obesity intervention based on an addiction treatment model (staged, incremental withdrawal from problem foods, snacking/grazing, and excessive amounts at meals) and implemented by a server-integrated smartphone app with health professional support. The primary outcome was standardized %overBMI measured at four time points. Secondary outcomes were participants' self-ratings of self-esteem, control over food, and the degree they turned to food when stressed. User satisfaction data were collected with an online questionnaire. Latent growth modeling techniques were used to identify independent variables and possible mediating treatment process variables associated with weight change.

RESULTS

Mean age of participants was 16 years (range, 10-21), 65% girls, and 84% Caucasian. Twenty-seven (63%) completed the program. There was a significant decrease in %overBMI over time of 7.1. There were significant improvements in participant ratings of self-esteem, control over food, and a reduction in turning to food when stressed. Males, younger participants, and participants with higher levels of program compliance achieved better weight loss. Participants who reported that calling obesity an addiction made their guilt worse experienced poorer weight loss. Females were more likely than males to report "addiction guilt," and this partly mediated the overall gender effect.

CONCLUSIONS

The staged, incremental food withdrawal approach was feasible to implement and was useful in helping reduce excessive weight, particularly among boys.

Factors influencing the frequency of children's consumption of soft drinks

Among other focus areas, interventions designed to improve children's diets need to address key factors contributing to children's consumption of sugar-sweetened beverages. The present study employed structural equation modelling to investigate the relationship between a broad range of predictor variables and the frequency with which Australian children consume soft drinks. In total, 1302 parents of children aged 8 to 14 years responded to an online survey about their children's food consumption behaviours. Soft drink consumption frequency was primarily influenced by parents' attitudes to soft drinks, children's pestering behaviours, and perceived social norms relating to children's consumption of these products. Importantly, pestering and social norms had significant direct effects on consumption frequency in addition to indirect effects via their impact on parents' attitudes to soft drink.

Internet-based implementation of non-pharmacological interventions of the "people getting a grip on arthritis" educational program: an international online knowledge translation randomized controlled trial design protocol

BACKGROUND

Rheumatoid arthritis (RA) affects 2.1% of the Australian population (1.5% males; 2.6% females), with the highest prevalence from ages 55 to over 75 years (4.4-6.1%). In Canada, RA affects approximately 0.9% of adults, and within 30 years that is expected to increase to 1.3%. With an aging population and a greater number of individuals with modifiable risk factors for chronic diseases, such as arthritis, there is an urgent need for co-care management of arthritic conditions. The increasing trend and present shifts in the health services and policy sectors suggest that digital information delivery is becoming more prominent. Therefore, it is necessary to further investigate the use of online resources for RA information delivery.

OBJECTIVE

The objective is to examine the effect of implementing an online program provided to patients with RA, the People Getting a Grip on Arthritis for RA (PGrip-RA) program, using information communication technologies (ie, Facebook and emails) in combination with arthritis health care professional support and electronic educational pamphlets. We believe this can serve as a useful and economical method of knowledge translation (KT).

METHODS

This KT randomized controlled trial will use a prospective randomized open-label blinded-endpoint design to compare four different intervention approaches of the PGrip-RA program to a control group receiving general electronic educational pamphlets self-management in RA via email. Depending on group allocation, links to the Arthritis Society PGrip-RA material will be provided either through Facebook or by email. One group will receive feedback online from trained health care professionals. The intervention period is 6 weeks. Participants will have access to the Internet-based material after the completion of the baseline questionnaires until the final follow-up questionnaire at 6 months. We will invite 396 patients from Canadian and Australian Arthritis Consumers' Associations to participate using online recruitment.

RESULTS

This study will build on a pilot study using Facebook, which revealed promising effects of knowledge acquisition/integration of the evidence-based self-management PGrip educational program.

CONCLUSIONS

The use of online techniques to disseminate knowledge provides an opportunity to reduce health care costs by facilitating self-management of people with arthritis. Study design strengths include the incorporation of randomization and allocation concealment to ensure internal validity. To avoid intergroup contamination, the Facebook group page security settings will be set to "closed", thus allowing only invited participants to access it. Study limitations include the lack of participant blinding due to the characteristics of this KT randomized controlled trial and a potential bias of recruiting patients only online, though this was proven effective in the previous pilot study.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000397617; http://www.anzctr.org.au/TrialSearch.aspx (Archived by WebCite at http://www.webcitation.org/6PrP0kQf8).