Mobile Health Intervention to Identify Early Responders to Treatment in Adolescent Obesity
Condition: Adolescent Obesity
MeSH terms: Obesity; Pediatric Obesity
Study type: Interventional

Summary: 
      Background: The Expert Committee on the Assessment, Prevention and Treatment of Child and
      Adolescent Overweight and Obesity recommends a staged based approach to the management of
      adolescents with overweight and obesity from Stage 1-4 with increasing intensity of
      management in higher stages. Mobile health application is an attractive community based
      treatment for adolescent obesity due to its wide penetration and convenience. Early weight
      loss has been found to be the strongest predictor of good long term outcome in obesity.
      However there is currently no known study that use early weight loss as a predictor factor
      for a stepped up approach using a mobile health application.

      Clinical significance: The current study use a mobile health intervention to identify
      participants with early weight loss in a stepped up approach.

      Primary objective will be to examine the proportion of patients triaged to the low risk
      Weight Management Clinics (WMC) after brief intervention by a nurse coordination and
      completion of 4 sessions of Kurbo Program over a 12 month recruitment period.

      Secondary objectives will be to examine changes in BMI z-score, metabolic profile, examine
      program feasibility and fidelity and explore other predictors of poor response to program.

      Methodology:

      Children aged 13-17 years old with BMI percentile of above 90th percentile, who are referred
      to the WMC, will receive a brief intervention by the WMC nurse coordinator followed by
      introduction to Kurbo program, a multifunctional mobile application, for more detailed
      dietary and physical activity recommendations and implementation of behavioural changes.
      Patients that are able to engage with Kurbo intervention and showed a decrease in BMI
      percentile over 4 sessions of Kurbo will be offered the low risk weight management clinic.

      At baseline, month 3 and month 6, the patient's weight and height, body fat composition,
      waist circumference and blood pressure will be measured as per usual standard protocol.
      Questionnaires to assess eating, quality of life and dietary recall will be administered as
      part of the research. Accelerometers will also be fitted to assess physical activity.

      At baseline and month 6, metabolic blood tests (HbA1C, fasting lipid panel, oral glucose
      tolerance test, fasting insulin level and liver function test) were collected after a minimum
      8 hour fasting period together with bloods for aromatic amino acid, branch chain amino acid
      and long chain acylcarnitines .

      Current low risk WMC patients will be offered 2 monthly follow up with optional dietician and
      exercise physiologists counselling and exercise sessions. The high risk WMC patients will be
      routinely offered the standard high risk follow up protocol consisting of weekly follow up
      with the multidisciplinary team for 4 weeks followed by 2 weekly appointments for 2 months
      and monthly appointment thereafter based on clinical response.
    


Intervention name(s): Mobile health intervention
Intervention type(s): Behavioral
Intervention description(s): The Kurbo program is a multifunctional mobile application that aid adolescents and their families to learn healthy eating habits and weight management through the use of a mobile application with dietary self-monitoring and weekly interactive coaching sessions. Using the Kurbo app, adolescents track their food and exercise, as well as learn about healthy behaviours through games and videos. The Kurbo coaches check in with adolescents for 15 minutes once a week via video, phone or text over a 12 weeks period.
Intervention model: Single Group Assignment
Intervention model description: prospective single arm study
Masking: None (Open Label)
Primary purpose: Health Services Research
Keywords: stepped care; mobile application