An Internet-Based Childhood Obesity Prevention Program (Time2bHealthy) for Parents of Preschool-Aged Children: Randomized Controlled Trial

Abstract

Background Electronic health (eHealth) obesity programs offer benefits to traditionally delivered programs and have shown promise in improving obesity-related behaviors in children. Objective This study aimed to assess the efficacy of a parent-focused, internet-based healthy lifestyle program for preschool-aged children, who are overweight or at or above the fiftieth percentile for body mass index (BMI) for their age and sex, on child BMI, obesity-related behaviors, parent modeling, and parent self-efficacy. Methods The Time2bHealthy randomized controlled trial was conducted in Australia, during 2016 to 2017. Participants were recruited both online and through more traditional means within the community. Parent or carer, and child (aged 2-5 years) dyads were randomized into an intervention or comparison group. Intervention participants received an 11-week internet-based healthy lifestyle program, underpinned by social cognitive theory, followed by fortnightly emails for 3 months thereafter. Intervention participants set goals and received individual feedback from a dietitian. They were also encouraged to access and contribute to a closed Facebook group to communicate with other participants and the dietitian. Comparison participants received email communication only. Objectively measured child BMI was the primary outcome. Secondary outcomes included objectively measured physical activity, parent-measured and objectively measured sleep habits, and parent-reported dietary intake, screen time, child feeding, parent modeling, and parent self-efficacy. All data were collected at face-to-face appointments at baseline, 3 months, and 6 months by blinded data collectors. Randomization was conducted using a computerized random number generator post baseline data collection. Results A total of 86 dyads were recruited, with 42 randomized to the intervention group and 44 to the comparison group. Moreover, 78 dyads attended the 3- and 6-month follow-ups, with 7 lost to follow-up and 1 withdrawing. Mean child age was 3.46 years and 91% (78/86) were in the healthy weight range. Overall, 69% (29/42) of participants completed at least 5 of the 6 modules. Intention-to-treat analyses found no significant outcomes for change in BMI between groups. Compared with children in the comparison group, those in the intervention group showed a reduced frequency of discretionary food intake (estimate −1.36, 95% CI −2.27 to −0.45; P =.004), and parents showed improvement in child feeding pressure to eat practices (−0.30, 95% CI 0.06 to −0.00; P =.048) and nutrition self-efficacy (0.43, 95% CI 0.10 to 0.76; P =.01). No significant time by group interaction was found for other outcomes. Conclusions The trial demonstrated that a parent-focused eHealth childhood obesity prevention program can provide support to ...

Family-based prevention of overweight and obesity in children aged 2–6 years: a systematic review and narrative analysis of randomized controlled trials

“…The results showed improved dietary-related practices but no differences between groups in child BMI, indicating that targeting only the parents is not sufficient. Contrasting to Hammersley et al (2019), two of the studies in the present review including interventions where the children were not directly involved showed lower BMI in the children (Slusser et al 2012;Smith et al 2015). The results of this review, in terms of dietary measures, indicate that the studied interventions can be effective in changing families' eating and feeding behaviours, especially by promoting increased intake of healthy foods.…”

“…This is promising since parental and family modelling of healthy eating behaviours and environments promoting healthy diets are suggested to be factors with great influence on children's eating patterns (Mazarello Paes et al 2015;DeCosta et al 2017). However, a recent parent-focused eHealth study targeting parents to overweight children (Hammersley et al 2019) provided parents in both groups with internet-based information on preventing obesity in preschoolers and added individual communication with a dietician and a facebookchat with the dietician and other parents to the intervention group. The results showed improved dietary-related practices but no differences between groups in child BMI, indicating that targeting only the parents is not sufficient.…”

Process Evaluation of an eHealth Intervention (Food4toddlers) to Improve Toddlers' Diet: Randomized Controlled Trial

“…This is supported by a study by Boswell and collaborators [ 17 ] in which parents reported Facebook as the preferred digital platform for participating in an intervention. However, in the parent-focused Time2bHealthy study closed Facebook groups were made available, but less than 40% agreed or strongly agreed that the Facebook component was useful [ 18 ]. Our goal with including such a discussion forum was that participants could motivate each other and share experiences; however, as also others have found [ 18 ], the inclusion of such a forum might not be worth the effort of setting up.…”

“…Although we sent email reminders to the participants who did not log in, the adherence might have been higher by adding, for example, a phone call as in the MINISTOP study. Other studies have also emphasized personal contact (eg, the Australian Time2bHealthy study) [ 18 ]. However, the costs rise with more intensive follow-up of participants and will limit distribution to a large population.…”

Telemedicine in Pediatric Sleep

“…Only 69% of parent-child dyads completed 5 or 6 modules and reported some improvements, but overall the Internet-based intervention did not help children reduce body mass index, despite receiving reading material, videos, activities, quizzes, and goal-setting exercises; receiving feedback by a dietician; and getting advice, weekly e-mails, a Facebook group to post on, and gift card incentives. 15 …”