# Telehealth Secure Solution to Provide Childhood Obesity Monitoring
## 3 Family-Based Weight Management for Children
For the second indicator, body fat, the cutoffs for the percentage of body fat were chosen so that within each sex-age group, the number of children in the fatness categories (normal, moderate, and elevated) would be equal to that in the corresponding body mass index for age categories (normal weight, overweight, and obese, respectively) [29]. For the last indicator, BMI, which is a simple index of weight-for-height that is commonly used to classify overweight and obesity, we are using the WHO growth reference data. In addition to the growth patterns, the children will wear an activity bracelet which will be linked to the parents' mobile phone. The bracelet will collect information on physical activity and sleep hours (sum of light and deep sleep time) of the children and will synchronize that information with the parent's smart phone and a mobile application will access and select the data to be sent securely to health professionals by using the Internet. These data and their categorizations are shown in Figure 2. Light sleep time is considered when breathing slows down, the muscles relax, and the brain waves are less active, whereas deep sleep time light is considered as the short time when breathing, heartbeat, body temperature, and brain waves reach their lowest levels and the body repairs tissue and cellular energy is restored. Detection of insufficient levels of physical activity and insufficient sleep hours is essential for the identification of children and adolescents more prone to develop obesity [30], although it is difficult to accurately measure these habits. Subjective measures, such as self-reported questionnaires, are compromised by the inability of children and parents to accurately remember all relevant details about their daily patterns of physical activity, the level of intensity of physical activity, and their daily sleep hours. For that reason, we are proposing to collect both physical activity and sleep by using basic activity bracelets. Physical inactivity is undoubtedly one of the factors that has a significant impact on childhood obesity. According to international recommendations, children from 5 to 17 years of age should perform at least an average of 60 minutes of moderate to vigorous physical activity (MVPA) daily [31]. We propose the use of bracelets to objectively measure the child's physical activity and express it as absolute counts and minutes dedicated to an activity of a particular intensity. [PERSON] et al. has suggested that the most optimal step count for children and adolescents (5-19 years) is 12,000 steps per day, which indicates that the physical activity recommendations are being met [32]. For the number of sleep hours, after conducting a systematic review, [PERSON] et al. [33] found that there is an association between short sleep duration and less favorable diet quality in childhood. Short sleepers tend to select foods with higher energy density, more added sugar, and drinks sweetened with sugar than long sleepers [34; 35]. In their systematic review, [PERSON] et al. found that the short duration of sleep is a risk factor for the development of obesity in infants, children, and adolescents [36]. For the classification of sleep duration and the recommended duration of sleep hours, we used those reported by [PERSON] et al., where the standardized sleep duration reference was defined as shown in Table 1[35].