A Digital Health Behavior Intervention to Prevent Childhood Obesity
Creators: name: Schildcrout, Jonathan S.
name: Smith, Michelle Cruz Jimenez
name: Sommer, Evan C.
name: Ramirez, Kimberly S.
name: de la Barrera, Belen
name: Cruzatte, Evelyn F.
name: Yin, H. Shonna
name: Perrin, Eliana M.
name: Flower, Kori B.
name: Orr, Colin J.
name: Adams, Laura E.
name: Delamater, Alan M.
name: Bian, Aihua
name: Howard, Janna B.
name: Heerman, William J.
name: Soto, Altagracia
name: Bility, Malakha
name: Shepard, W. Elizabeth
name: Lampkin, Jacarra
name: Schilling, Samantha
name: Guevara, Gabriela
name: Wallace, Shelby
name: Rodriguez, Javier
name: Rothman, Russell L.
name: Velazquez, Jessica J.
name: Gross, Rachel S.
name: Forster, Lourdes Quintana
name: McBride, Jennifer Pilotos
name: Kay, Melissa C.
name: Wood, Charles T.
name: Sanders, Lee M.
Publisher: name: The University of North Carolina at Chapel Hill University Libraries
Year: 2024

description: <p>Infant growth predicts long-term obesity and cardiovascular disease. Previous interventions designed to prevent obesity in the first 2 years of life have been largely unsuccessful. Obesity prevalence is high among traditional racial and ethnic minority groups. To compare the effectiveness of adding a digital childhood obesity prevention intervention to health behavior counseling delivered by pediatric primary care clinicians. Individually randomized, parallel-group trial conducted at 6 US medical centers and enrolling patients shortly after birth. To be eligible, parents spoke English or Spanish, and children were born after 34 weeks&rsquo; gestational age. Study enrollment occurred between October 2019 and January 2022, with follow-up through January 2024. In the clinic-based health behavior counseling (clinic-only) group, pediatric clinicians used health literacy&ndash;informed booklets at well-child visits to promote healthy behaviors (n = 451). In the clinic + digital intervention group, families also received health literacy&ndash;informed, individually tailored, responsive text messages to support health behavior goals and a web-based dashboard (n = 449). The primary outcome was child weight-for-length trajectory over 24 months. Secondary outcomes included weight-for-length z score, body mass index (BMI) z score, and the percentage of children with overweight or obesity. Of 900 randomized children, 86.3% had primary outcome data at the 24-month follow-up time point; 143 (15.9%) were Black, non-Hispanic; 405 (45.0%) were Hispanic; 185 (20.6%) were White, non-Hispanic; and 165 (18.3%) identified as other or multiple races and ethnicities. Children in the clinic + digital intervention group had a lower mean weight-for-length trajectory, with an estimated reduction of 0.33 kg/m (95% CI, 0.09 to 0.57) at 24 months. There was also an adjusted mean difference of &minus;0.19 (95% CI, &minus;0.37 to &minus;0.02) for weight-for-length z score and &minus;0.19 (95% CI, &minus;0.36 to &minus;0.01) for BMI z score. At age 24 months, 23.2% of the clinic + digital intervention group compared with 24.5% of the clinic-only group had overweight or obesity (adjusted risk ratio, 0.91 [95% CI, 0.70 to 1.17]) based on the Centers for Disease Control and Prevention criteria of BMI 85th percentile or greater. At that age, 7.4% of the clinic + digital intervention group compared with 12.7% of the clinic-only group had obesity (adjusted risk ratio, 0.56 [95% CI, 0.36 to 0.88]). A health literacy&ndash;informed digital intervention improved child weight-for-length trajectory across the first 24 months of life and reduced childhood obesity at 24 months. The intervention was effective in a racially and ethnically diverse population that included groups at elevated risk for childhood obesity. ClinicalTrials.gov Identifier: NCT04042467</p>