Aim2Be mHealth intervention for children with overweight and obesity: study protocol for a randomized controlled trial

Background

The prevalence of overweight and obesity remains high in Canada, and the current standard for the treatment of childhood obesity is in-person, family-based, multidisciplinary interventions that target lifestyle behaviors (e.g., diet, physical activity, and sedentary behaviors). These programs are costly to operate, have limited success, and report recruitment and retention challenges. With recent advances in technology, mobile health or mHealth has been presented as a viable alternative to in-person interventions for behavior change, especially with teens.

Purpose

The primary aim of this study is to test the efficacy of Aim2Be, a gamified app based on behavior change theory with health coaching to improve weight outcomes (i.e., decrease in standardized body mass index (zBMI)) and lifestyle behaviors (i.e., improve dietary quality, increase fruit and vegetable intake, reduce sugar-sweetened beverage intake, increase physical activity, and reduce screen time) among children 10- to 17-years old with overweight or obesity versus their peers randomized into a waitlist control condition. The secondary aims of this study are to 1) test whether supplementing the Aim2Be program with health coaching increases adherence and 2) examine the mediators and moderators of adherence to the Aim2Be intervention.

Methods

We will employ a randomized controlled trial design and recruit 200 child and parent dyads to participate in the study (2019–2020). Participants will be recruited from Canadian pediatric weight management clinics and through online advertisements. Child participants must be between the ages of 10 and 17 years, have overweight or obesity, be able to read English at least at a grade 5 level, and have a mobile phone or home computer with internet access. Following baseline data collection, participants will be randomized into intervention and waitlist control groups. Intervention participants will receive access to Aim2Be, with access to health coaching. After having their data collected for 3 months, the control group will gain access to Aim2Be, with no access to health coaching. Participants will control their frequency and duration of app usage to promote autonomy.

Discussion

Findings from this study will determine the efficacy of using Aim2Be in improving child weight outcomes and lifestyle behaviors and guide future mHealth interventions for pediatric weight management.

Trial registration

ClinicalTrials.gov, NCT03651284. Registered 29 August 2018.

What Is the Relationship between the Neighbourhood Built Environment and Time Spent in Outdoor Play? A Systematic Review

Outdoor play has been associated with children’s and adolescents’ healthy development and physical activity. Attributes of the neighbourhood built environment can influence play behaviours. This systematic review examined the relationship between attributes of the neighbourhood built environment and the time children and adolescents (0–18 years) spend in self-directed outdoor play. We identified and evaluated 18 relevant papers using the Mixed Methods Appraisal Tool and developed a narrative synthesis of study results. We found moderate evidence that lower traffic volumes (ages 6–11), yard access (ages 3–10), and increased neighbourhood greenness (ages 2–15) were positively associated with time spent in outdoor play, as well as limited evidence that specific traffic-calming street features such as fewer intersections, low traffic speeds, neighbourhood disorder, and low residential density were positively associated with time spent in outdoor play. To our knowledge, this is the first systematic review on this topic. The limited number of “good quality” studies identified highlights the need for additional research on the topic.

Roaming the Neighbourhood: Influences of Independent Mobility Parenting Practices and Parental Perceived Environment on Children's Territorial Range

Children’s independent mobility (IM), their freedom to move about their neighbourhood without supervision by adults, has been in steady decline in recent decades. Previous research has linked perceptions of the environment with various measures of IM, but recently concerns have been raised regarding inconsistency in measuring IM. This study used various measures of IM and aimed to address how parental perceptions of the neighbourhood environment are associated with children’s territorial range (actual IM), as well as how this relationship is mediated by IM parenting practices (allowed IM). A sample of 105 child/parent dyads from Vancouver, Canada participated in this study. Children (age 10–13) wore a global positioning system (GPS) watch and an accelerometer and completed an activity diary for seven days to assess their territorial range. Parents completed a questionnaire that assessed perceptions of their neighbourhood environment and IM parenting practices—license for IM and roaming allowance. Path analyses were used to address the research aims. License for IM and roaming allowance mediated the relationship between perceived walking facilities, crime safety, and neighbourhood relations and children’s territorial range. Findings suggest that future interventions to increase children’s territorial range should focus primarily on attitude and behaviour change among parents to grant children more freedom.