Use of a Mobile Lifestyle Intervention App as an Early Intervention for Adolescents With Obesity: Single-Cohort Study

Abstract

Background Effective, resource-efficient treatment is urgently needed to address the high rates of pediatric and adolescent obesity. This need has been accelerated by the COVID-19 pandemic. The use of a mobile health tool as an early intervention before a clinic-based multidisciplinary weight management program could be an effective treatment strategy that is appropriate during a pandemic. Objective This study aims to assess the effectiveness of and adolescent engagement with a mobile app–based lifestyle intervention program as an early intervention before enrollment in a clinic-based multidisciplinary weight management program. Methods This prospective single-cohort study involved adolescents, aged 10-16 years, who were overweight and obese (defined as BMI percentile above the 85th percentile). Participants used the mobile Kurbo app as an early intervention before enrolling in a clinic-based multidisciplinary weight management program. Kurbo’s health coaches provided weekly individual coaching informed by a model of supportive accountability via video chat, and participants self-monitored their health behavior. The implementation of Kurbo as an early intervention was evaluated using the reach, effectiveness, adoption, implementation, and maintenance framework by reach (number who consented to participate out of all patients approached), implementation (Kurbo engagement and evaluation), and effectiveness as measured by the primary outcome of the BMI z-score at 3 months. Secondary outcome measures included changes in body fat percentage, nutrition and physical activity levels, and quality of life at 3 months. Maintenance was defined as the outcome measures at 6-month follow-up. Results Of the 73 adolescents who were approached for enrollment, 40 (55%) of adolescents were recruited. The mean age was 13.8 (SD 1.7) years, and the mean BMI z-score was 2.07 (SD 0.30). In the multiethnic Asian sample, 83% (33/40) of the participants had household incomes below the national median. Kurbo engagement was high, with 83% (33/40) of participants completing at least 7 coaching sessions. In total, 78% (18/23) of participants rated the app as good to excellent and 70% (16/23) stated that they would recommend it to others. There were no statistically significant changes in BMI z-scores at 3 months (P=.19) or 6 months (P=.27). Participants showed statistically significant improvements in measured body fat percentage, self-reported quality of life, and self-reported caloric intake from the 3-day food diaries at 3 and 6 months. Conclusions The use of Kurbo before enrollment in an outpatient multidisciplinary clinical care intervention is a feasible strategy to expand the reach of adolescent obesity management services to a low-income and racially diverse population. Although there was no significant change in BMI z-scores, the use of Kurbo as an early intervention could help to improve quality of life and reduce body fat percentage and total caloric intake.

Behavior Change Effectiveness Using Nutrition Apps in People With Chronic Diseases: Scoping Review

“…The studies focused on obesity prevention and treatment in many diverse populations that ranged in age, socioeconomic background, and physical status (ie, pregnancy and post partum). App features included physical activity tracking [ 69 - 78 ], food tracking [ 70 , 72 - 83 ], knowledge, education, or recommendations [ 70 , 72 - 76 , 78 , 79 , 82 - 86 ], push notifications or scheduled reminders [ 74 - 76 , 78 , 79 , 81 - 84 , 86 ], weight monitoring [ 75 , 76 , 78 , 81 , 85 , 86 ], behavior demonstration [ 69 , 75 , 83 ], motivational challenges [ 69 , 75 - 78 , 83 ], goal setting [ 69 , 73 - 75 , 78 , 81 , 84 , 85 ], feedback [ 69 , 70 , 73 , 75 , 76 , 81 - 83 , 86 ], community support [ 70 , 75 , 78 , 85 ], connectivity to digital health devices [ 70 , 72 , 81 , 86 ], clinician portals [ 72 , 73 , 82 ], and access to a health coach [ 76 - 78 ...…”

The effectiveness of exercise programs accessible from home on children's and adolescents' emotional well‐being: Systematic review & meta‐analysis

“…One study reported significant increase in the average weekly steps over the course of the intervention, however, the average mood state (positive and negative) remained the same 22 . Another study reported no significant changes in the time spent engaging in moderate to vigorous exercise and their emotional functioning immediately post‐intervention, whereas they found these measures reached significance at the 6‐month follow‐up 21 …”

“…Huang and colleagues 19 set their physical activity goals to engage in at least 1 h of "moderate-to-vigorous" physical activity, as well as a daily 15,000-step goal, whilst Chew and colleagues 21 recommended their participants to work towards 60 min of moderate to vigorous physical activity each day.…”

“…22 Another study reported no significant changes in the time spent engaging in moderate to vigorous exercise and their emotional functioning immediately post-intervention, whereas they found these measures reached significance at the 6-month follow-up. 21 Meta-analyses (anxiety & low mood)…”

“…Schoenfelder and colleagues22 had their participants wear a Fitbit, which automatically uploaded the information to a linked app to provide the participants graphs of the data and personalized feedback.Patrick and colleagues18 used a pedometer and encouraged their participants to report their steps weekly. Other studies required the participants to self-monitor their physical levels of activity and check in with a coach once a week for 15 min21 or they received twice-daily texts, weekly online materials and telephone-based coaching for the first month T A B L E 1 (Continued) findings He, M., Morgan, I., Congdon, N., Liu, Y. 17 and reduce anxiety and eye strain: Cluster randomized controlled trial four times per day) received text messages prompting participation in exercise at home, eye relaxation, or to stretch for 10 min.…”